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Uveitis (cont.)

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How do health-care professionals diagnose uveitis?

An ophthalmologist will ask several questions about the symptoms, both in the eyes and the rest of the body. For example, the presence of painful joints, weight changes, skin rashes, fatigue, and other symptoms may help the doctor diagnose an underlying illness that may be associated with uveitis. The doctor will also need a detailed history of any existing medical conditions and family history of medical disorders.

The vision and eye pressures will be measured and the eyes carefully examined with the slit lamp. The dilated red blood vessels on the eyes' surface can have a characteristic appearance called a ciliary flush of deep red that is typical of uveitis (as opposed to the lighter reddish eyes of conjunctivitis). Though there are several types of uveitis, they all have one thing in common; white blood cells (immune cells of inflammation found in the bloodstream) leak from inside the blood vessels of the uvea to outside the blood vessels. These white cells permeate the uveal tissue and leak out of the uvea into the aqueous (liquid in the front part of the eye) and/or the vitreous (gelatinous material in the back part of the eye). This presence of white blood cells is what an ophthalmologist looks for when making the diagnosis of uveitis. Iritis can appear initially as subclinical with no white blood cells visible. Other times, uveitis is not so subtle, with large numbers of cells visible in the aqueous and/or vitreous. In some cases, clusters of white blood cells accumulate on the back side of the cornea (the clear dome-shaped front cover of the eye). These clusters of cells are referred to as mutton fat deposits. In extreme cases, the cells can also form a large pool in the space between the iris and the cornea. This is referred to as a hypopyon.

Cyclitis (intermediate uveitis) appears as white blood cells floating in the vitreous and collections of cells on the surface of uveal tissues behind the iris. Choroiditis appears as cells in the vitreous and uveal tissue but further posterior (toward the back of the eye). An ophthalmologist will need to dilate the patient's eyes and use special examination techniques to visualize this. Pictures of the back part of the eye using OCT, fluorescein angiography, or other technologies can also be helpful in assessing the extent of a posterior uveitis.

Additional tests might include laboratory evaluation of a small sample of aqueous or vitreous liquid from the eye, blood tests, and/or X-rays. These tests take time. Therefore, a treatment plan is usually initiated based on a clinical judgment before the cause can be definitively identified.

Medically Reviewed by a Doctor on 12/20/2016


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