Diagnosis of Anterior Uveitis
The guideline describes clinical procedures for examining and managing
patients with signs and symptoms suggestive of anterior uveitis or patients with
diagnosed anterior uveitis. The evaluation includes the elements of a
comprehensive eye and vision examination with particular emphasis on the
following areas:
Patient history
Ocular examination
- Visual acuity
- External examination
- Slit lamp examination
- Tonometry
- Gonioscopy
- Fundus examination
Supplemental testing, including laboratory testing, imaging studies, and
fluorescein angiography.
Assessment and Diagnosis
Narrowing the diagnosis of anterior uveitis involves at least three stages:
- Collecting and integrating clinical data
- Identifying the type of anterior uveitis as
specifically as possible
- Ordering additional laboratory tests, x-rays, or consultations to rule
out systemic etiologies
Ruling out conjunctivitis, episcleritis, or keratitis is a fairly
straightforward procedure. However, a dilemma may exist concerning whether to
order additional tests once the diagnosis of anterior uveitis has been
established. The clinician should determine whether to pursue a systemic
diagnosis or treat the anterior uveitis without further testing. Communication
and co-management with the patient's primary care physician may be
appropriate.
Specific recommendations regarding laboratory tests, x-ray studies,
consults/referrals or other test to isolate systemic causes of anterior uveitis
are provided in the guideline document.
Management of Anterior Uveitis
The extent to which an optometrist can provide treatment for anterior uveitis
may vary depending on the state's scope of practice laws and regulations and the
individual optometrist's certification. Treatment of the patient with anterior
uveitis may require consultation with or referral to the patient's primary care
physician or an ophthalmologist for those services outside the optometrist's
scope of practice.
Basis for treatment:
The general goals for therapy in anterior uveitis are:
- To preserve visual acuity
- To relieve ocular pain
- To eliminate the ocular inflammation or
identify the source of inflammation
- To prevent formation of synechiae
- To manage intraocular pressure
The treatment of anterior uveitis is nonspecific, usually involving topical
therapy with corticosteroids and cycloplegics. Occasionally oral steroids or
nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed. Available
treatment options include corticosteroids, cycloplegics and mydriatics
(atropine, 0.5%, 1%, 2%; homatropine 2%, 5%; scopolamine, 0.25%; cyclopentolate,
0.5%, 1%, 2%), oral steroids (prednisone) and nonsteroidal anti-inflammatory
drugs (aspirin, ibuprofen); and other therapies. Therapeutic regimens are
described in detail in the guideline document.
Follow-up
After the initial workup, the number and frequency of follow-up visits vary,
depending on the severity of disease. At a minimum, a patient may expect two to
five follow-up visits after the initial diagnosis. The frequency and composition
of evaluation and management visits for anterior uveitis are summarized in the
following table:
Frequency and Composition of Evaluation and Management Visits for Anterior Uveitis
|
| Severity of Anterior Uveitis |
Frequency of Follow-Up Visits |
Visual Acuity |
Slit Lamp For Cells and Flare |
Tonometry |
Ophthalmoscopy |
Management Plan |
|
| Mild |
Every 4 to 7 days |
Yes |
Yes |
Yes |
If not done on initial visit |
Refer to guideline document for specific regimens |
| Moderate |
Every 2 to 4 days |
Yes |
Yes |
Yes |
If not done on initial visit |
Refer to guideline document for specific regimens |
| Severe |
Every 1 to 2 days |
Yes |
Yes |
Yes |
If not done on initial visit |
Refer to guideline document for specific regimens |
|
