Chapter 37
Uveitis: Diagnostic Approach and Ancillary Analysis
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There is a strong tendency for most ophthalmologists to rely heavily on ancillary testing to establish a diagnosis in patients with uveitis. Although such testing is often useful, most authorities agree that the vast majority of information required to make a diagnosis in patients with uveitis is obtained from the history, review of systems, and physical examination.1–7 This information helps direct the physician toward choosing the appropriate laboratory tests and special studies to confirm or exclude those few uveitic syndromes suspected on clinical grounds. We take the following steps when evaluating and treating patients with uveitis2:
  1. History, including demographic and geographic history, chief complaint, history of present illness, past ocular history, past medical and surgical history, personal history, and family history
  2. Review of systems
  3. Physical examination, both systemic and ocular
  4. “Naming”
  5. “Meshing”
  6. Clinical laboratory investigations, special tests and procedures, and subspecialist consultation, as determined by steps 1 through 5
  7. Uveitic diagnosis, as determined by steps 1 through 6
  8. Patient management, based on the known course and prognosis of the identified uveitic entity as weighed against the potential risks of various treatments
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The most pertinent patient demographics are age, sex, and race.7–14 Of these, age is by far the most important. The majority of uveitic syndromes tend to occur during the broad, middle-age group of 20 to 60,7–14 and virtually all diagnoses should be considered for patients in this category. Childhood uveitis encompasses a disproportionate number of cases of juvenile rheumatoid arthritis (JRA),15,16 pars planitis,17,18 toxocariasis,19,20 and toxoplasmosis.21–23 HLA-B27-related uveitis,24,25 pars planitis,17,18 and Fuchs' heterochromic iridocyclitis26,27 are seen primarily in older adolescents and young adults. Serpiginous28,29 and birdshot chorioretinopathy,30,31 in contrast, are more prevalent in those over 50. Masquerade syndromes should be suspected at both ends of the spectrum,32,33 with retinoblastoma, leukemia, and juvenile xanthogranuloma occurring in the very young, and intraocular lymphoma, uveal melanoma, metastatic carcinoma, ocular ischemia, and paraneoplastic syndromes presenting more often in the elderly.

With the exception of JRA,15,16 which tends to affect young girls, and HLA-B27-related uveitis,24,25 which tends to affect young men, the most common uveitic syndromes are more or less evenly distributed between the sexes.

A few uveitic syndromes do have a racial predilection. For example, there is an increased prevalence of (1) HLA-B27-related uveitis24,25 and the so-called white-dot syndromes or inflammatory chorioretinopathies34,35 in whites; (2) ocular sarcoidosis36–38 and systemic lupus erythematosus39,40 in blacks; (3) Behçet's syndrome41,42 in those of Mediterranean, Middle Eastern, and Asian descent; and (4) Vogt-Koyanagi-Harada (VKH) syndrome43–45 in Asians, Asian Indians, and Native Americans.


A patient's birthplace and history of travel and residence are important factors when considering uveitic diagnoses. Uveitic syndromes are segregated along geographic boundaries for at least three reasons. First, as mentioned earlier, a few uveitic entities occur more commonly among certain races, presumably reflecting genetic susceptibility. Second, the intermediate hosts and environmental factors preferred by some infectious agents limit their spread to certain parts of the world. In the United States, this is seen with coccidioidomycosis,46,47 which occurs in the semiarid desert regions of the Southwest; with histoplasmosis,48,49 which is indigenous to the Mississippi river valley; and with Lyme disease,50,51 which is prevalent in the Northeast from Massachusetts to Maryland, in the Midwest (especially Wisconsin and Minnesota), and on the West coast (particularly California and Oregon). Similarly, coccidioidomycosis46,47 and cysticercosis52,53 are found in Central and South America, whereas onchocerciasis54,55 occurs in Central America and West Africa. Third, socioeconomic factors that promote the spread of infection vary from region to region. Infectious causes of uveitis, for example, are more common in the developing world, where population densities are high and sanitation is relatively poor.56–58 Toxoplasmosis is more frequent in parts of France59,60 and Brazil,61,62 where eating raw or undercooked meat is commonplace.


Recognition of a specific chief complaint allows the physician to identify that aspect of the patient's disorder that he or she finds most bothersome or problematic. In the case of uveitis, the chief complaint is usually voiced as unilateral or bilateral pain, photophobia, redness, floaters, or blurred or decreased vision, either alone or in combination. Although blurred or decreased vision is the most common and, unfortunately, least localizing symptom reported by patients with uveitis, other symptoms can suggest a primary site of intraocular inflammation. Pain, photophobia, and redness, for example, most often reflect iritis, iridocyclitis, elevated intraocular pressure, or corneoscleral disease. One notable exception in this regard is JRA,15,16 or so-called white iritis,63 in which pain, photophobia, and redness are frequently absent in the setting of significant, ongoing iridocyclitis. Symptomatic floaters can occur in virtually all forms of uveitis, but in the absence of pain, redness, and photophobia, floaters suggest primary vitreous inflammation. Other localizing complaints include fixed scotomata, which suggest focal retinal damage, metamorphopsia, or micropsia, which can occur with subretinal or intraretinal fluid; and altitudinal or patchy visual field loss, which is frequently seen with optic neuritis.

The history of present illness should address the severity, time of onset, and course of the patient's ocular complaints, including specific mention of whether the presentation was acute, chronic, or recurrent. In characterizing the course of the complaints, we consider a 3-month duration of symptoms to constitute a transition from acute uveitis to chronic uveitis.

Special note should be made of past treatment successes and failures. Most forms of endogenous uveitis respond to local or systemic immunosuppressants, such as corticosteroids. Masquerade syndromes, in contrast, show little response to such treatments, whereas intraocular infections paradoxically worsen with immunosuppressive therapy.


Pertinent past ocular history should be noted in all patients with uveitis, including refractive error, past or present ocular diseases, and any history of ocular trauma or surgery. High myopia, for example, is associated with retinitis pigmentosa64 and retinal detachment,65 both of which may cause symptoms of floaters and show evidence of vitritis. Similarly, a history of herpes simplex keratitis66 or herpes zoster ophthalmicus67 might suggest the diagnosis in a patient with anterior uveitis and elevated intraocular pressure, whereas a history of amblyopia or strabismus might represent monocular vision loss during early childhood, as can occur with toxoplasmosis21–23 or toxocariasis19,20 involving the macula. Past ocular trauma and surgery both increase the risk of endophthalmitis,68,69 lens-induced uveitis,70,71 and sympathetic ophthalmia.72,73 Lastly, a history of nonuveitic glaucoma is important for at least three reasons. First, β-blockers can infrequently cause drug-related uveitis.74,75 Second, cholinomimetics, such as pilocarpine, promote intraocular inflammation and should be avoided in patients with uveitis.76 Third, patients with glaucoma are at increased risk for having elevated intraocular pressure in response to local and systemic corticosteroids77,78 and so should be followed closely during treatment.


A detailed past medical and surgical history will often disclose systemic illnesses associated with intraocular inflammation, most commonly collagen vascular diseases, autoimmune or hypersensitivity syndromes, or infections. We find that a thorough uveitis questionnaire, to be filled out by the patient before his or her visit, is quite helpful in obtaining this information.4,5 In addition, some systemic conditions complicate the use of immunosuppressants in patients with uveitis. A history of tuberculosis, diabetes mellitus, peptic ulcer disease, or systemic hypertension, for example, must be weighed carefully against the treatment benefits when considering the use of systemic corticosteroids. Likewise, a history of renal insufficiency might weigh against the use of systemic cyclosporine (Cyclosporin A) or antiviral agents, such as foscarnet or ganciclovir. Lastly, some commonly used systemic medications have been associated with uveitis, including antibiotic sulfonamides,79 pamidronate disodium (an inhibitor of bone resorption),80 and rifabutin,81–83 used in patients with acquired immunodeficiency syndrome (AIDS) as prophylaxis against, and treatment for, Mycobacterium avium complex infection.


A thorough dietary, sexual, drug-use, pet, and contagion-exposure history should be elicited from every patient with uveitis.


Pica, a practice common among children, increases the risk for both toxocariasis19,20 and toxoplasmosis.21–23 Similarly, eating raw or incompletely cooked meat can lead to toxoplasmosis21–23 or cysticercosis,52,53 and drinking unpasteurized milk can transmit tuberculosis84,85 or brucellosis.86,87 Curiously, and for unknown reasons, eating English walnuts has been associated with the formation of oral aphthae in patients with Behçet's syndrome.2


Unprotected sexual relations put patients at risk for a host of sexually transmitted diseases, many of which have been associated with uveitis. These diseases and pathogens include herpes simplex virus,66 herpes zoster virus,67 cytomegalovirus (CMV),88,89 syphilis,90,91 chlamydia,92 human T-cell leukemia virus,93,94 and human immunodeficiency virus (HIV).95–100 Interestingly, HIV-infected patients experience a dramatically altered spectrum of uveitic disorders,95–100 such that CMV retinitis,88,89 Pneumocystis carinii choroiditis,101,102 and cryptococcal uveitis103,104—diseases that were once rare and seen only in patients with profound immunosuppression from systemic medications or malignancy—are now encountered frequently in these patients. Other important risk factors for contracting HIV include intravenous drug use or a history of blood-product transfusion.


In addition to HIV, intravenous drug use increases a patient's risk for endogenous endophthalmitis,105,106 most typically with Candida or other fungal species.


Diseases passed from animals to humans, termed zoonoses, have become increasingly recognized in ophthalmology. For example, cats can transmit both Toxoplasma gondii,21–23 which causes toxoplasmosis, and Bartonella henselae,107,108 the causative organism for cat-scratch disease. Dogs, especially puppies, can shed Toxocara canis.19,20


The most important non-sexually transmitted contagious causes of uveitis in immunocompetent patients are tuberculosis84,85 and toxoplasmosis,21–23 which are of particular importance in developing countries. TORCH infections (toxoplasmosis,109 other [including syphilis110], rubella,111 CMV,112 and herpes simplex virus)113 can be transmitted from mother to fetus.

Once an infectious cause of uveitis is documented, a detailed history regarding the type, dosage, and duration of medical therapy should be obtained. In addition, state and local laws require that many contagious diseases be reported to the public health department.


With rare exceptions,114–120 uveitic syndromes are not believed to have a classic mendelian inheritance (i.e., recessive, dominant, or X-linked). Genetics, however, does appear to play a role in some forms of uveitis, as evidenced by their increased association with race or human leukocyte antigen (HLA). The two most notable associations in this regard are (1) HLA-B27 with anterior uveitis (particularly in whites), often occurring together with ankylosing spondylitis, Reiter's syndrome, psoriasis, or inflammatory bowel disease24,25; and (2) HLA-A29 with birdshot chorioretinopathy.30,31 Other HLA associations of note include HLA-B51 and HLA-B12 with Behçet's syndrome41,42; and HLA-B53, HLA-DR4, and HLA-DRw53 with VKH syndrome.43–45

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A thorough, systematic review of systems serves at least two purposes in patients with uveitis:
  1. It identifies specific signs and symptoms that might indicate the presence of a systemic disease previously unrecognized by the patient. Examples include the arthritis that occurs with JRA,15,16 the diarrhea of inflammatory bowel disease,121,122 and the fevers and night sweats that occur with tuberculosis.84,85
  2. It provides the uveitis specialist with an opportunity to identify novel uveitic syndromes and associations. As with the past medical and surgical history, a well-designed uveitis questionnaire can be quite helpful with the review of systems.4,5
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A directed systemic examination should be part of the uveitis workup. Special attention should be paid to examination of the mucocutaneous, musculoskeletal, cardiopulmonary, gastrointestinal, and neurologic systems, because many systemic disorders associated with uveitis can affect these organs. For example, syphilitic uveitis can be accompanied by psoriasis of the palms and soles90,91; VKH syndrome can produce meningismus, vitiligo, poliosis, alopecia, and hearing loss43–45; and toxocariasis19,20 is occasionally associated with a restrictive airway disease that can mimic asthma.


Patients with uveitis require a complete eye examination, with special attention to the following.


A careful refraction is required to provide an accurate assessment of the patient's best-corrected visual acuity. Both intraocular inflammation and corticosteroids accelerate cataract formation, frequently producing a significant myopic shift. Recognition of such refractive changes can substantially improve a patient's vision and is especially important when trying to weigh the relative risks and benefits of therapeutic interventions, such as cataract removal or posterior sub-Tenon's corticosteroid injection for cystoid macular edema.

Intraocular Pressure

Any form of uveitis can be complicated by glaucoma if its course is chronic or recurrent.76 In contrast, acute uveitis is typically associated with a lowered intraocular pressure. Notable exceptions to this rule of acute uveitic hypotony include sarcoidosis36–38 herpes simplex keratouveitis,66 herpes zoster keratouveitis,67 toxoplasmosis,21–23 and Posner-Schlossman syndrome (also termed glaucomatocyclitic crisis),123 all of which may be accompanied by acutely elevated intraocular pressure.

Lids, Conjunctiva, Sclera, and Cornea

The lids, palpebral and bulbar conjunctiva, and sclera should be examined carefully for nodules suggesting granulomatous disease, as can occur with sarcoidosis36–38 or tuberculosis.84,85 Ciliary injection often accompanies iritis, whereas injection of deep episcleral vessels with edema usually represents scleritis. Scleral thinning, as manifested by increased visualization of uveal pigment, suggests prior episodes of severe, necrotizing scleritis,124,125 seen with rheumatoid arthritis or less common systemic vasculitides (e.g., Wegener's granulomatosis, polyarteritis nodosa, relapsing polychondritis). Evidence of past or present keratitis may be related to a number of infectious organisms, but herpes simplex66 and herpes zoster67 should be considered when corneal sensation is decreased or intraocular pressure elevated.76 Band keratopathy results from longstanding uveitis and is seen frequently in JRA15,16 and sarcoidosis.36–38 Inferior corneal thickening and nummular stromal infiltrates have been described in patients with sarcoidosis,126 as well as idiopathic intermediate uveitis.127

Keratic precipitates should be described with regard to number, distribution, appearance, and size.2,4 Most are found on the inferior corneal endothelium between 4 and 8 o'clock, an area termed Arlt's triangle. Keratic precipitates are characterized as follows:

  Pigmented: Often old and inactive
  White or yellow: Recently or currently active
  Granulomatous: Larger and frequently “greasy” in appearance
  Nongranulomatous: Smaller
  Stellate: Often distributed over the entire endothelial surface; occur most commonly with herpes simplex and zoster uveitis, Fuchs' heterochromic iridocyclitis, toxoplasmosis, and sarcoidosis2

Active stromal keratitis with uveitis is seen with both herpes simplex66 and herpes zoster infections,67 and keratic precipitates are often seen directly under the site of corneal inflammation.


The angle should be examined for granulomas, termed Berlin's nodules, as well as anterior synechiae and neovascularization, both of which may occur with recurrent or chronic intraocular inflammation.

Anterior Chamber

Anterior chamber shallowing in the patient with uveitis may result from extensive anterior synechiae formation with contraction, extensive posterior synechiae formation with iris seclusion, or inflammatory infiltration of the anterior choroid producing anterior displacement of the lens-iris diaphragm. The presence of cells and flare in the anterior chamber should be graded carefully. We use the system of 0 to 4+ proposed by Hogan and associates,128 although other grading systems are available (Table 1).1,4,5 Hypopyon formation signifies severe anterior inflammation and may be seen in HLA-B27-related uveitis,24,25 Behçet's syndrome,41,42 and endophthalmitis,105 or in association with keratitis, particularly herpetic.66,67 A pseudohypopyon may represent tumor cells, either from a primary intraocular malignancy, such as retinoblastoma, or from a metastatic carcinoma.32,33 The occurrence of a hemorrhagic hypopyon with chronic uveitis suggests the possibility of iris or angle neovascularization,129 whereas anterior chamber bleeding in the setting of acute uveitis is seen most often with herpetic uveitis or with masquerade syndromes such as retinoblastoma or juvenile xanthogranuloma.32,33


TABLE 1. Uveitis Grading Schemes

Anterior Chamber Cell*
GradeSchlaegel1Hogan et al128Nussenblatt et al5Opremcak4
1+Occasional cells5–10 cells6–15 cells5–15 cells
2+8–15 cells10–20 cells16–20 cells16–25 cells
3+Too many to count20–50 cells26–50 cells26–60 cells
4+Most ever seen>50 cells>50 cells>60 cells
Anterior Chamber Flare
GradeSchlaegel1Hogan et al128Opremcak4 
1+Very slightFaintFaint 
2+Mild to moderate (iris/lens clear)Moderate (iris/lens clear)Moderate (iris/lens clear) 
3+Moderate (iris/lens hazy)Marked (iris/lens hazy)Marked (iris/lens hazy) 
4+Severe (fibrin, plastic aqueous)Severe (fibrin, fixed/ coagulated aqueous)Severe (fibrin, no motion of cells) 
Anterior Vitreous Inflammation
We recommend the same slit-lamp setting used to grade anterior chamber cell, but using double the cell counts recommended by Hogan et al128 for grading anterior chamber cell. 
Posterior Vitreous Inflammation
We recommend using a Hruby or fundus contact lens to determine location. Posterior vitreous cells are best seen in relief over the optic nerve head or an area of active retinal or choroidal inflammation. 
Diffuse Vitreous Inflammation
GradeHogan et al 128 (Direct Ophthalmoscope/Hruby Lens)Nussenblatt et al 133 (Indirect Ophthalmoscope)  
0No opacitiesNo opacities  
1+Few scattered fine and course opacities; clear fundus detailOpacities present; mildly obscured fundus detail  
2+Scattered fine and course opacities;obscured fundus detailOpacities present; moderately obscured fundus detail  
3+Many opacities; marked blurring of fundus detailMarked blurring of fundus detail; barely visible disc and vessels  
4+Dense opacities; no view of fundusSevere blurring; no view of disc or vessels  

* Schlaegel recommended using a “wide beam and narrow slit.” We and others4,5 recommend a 1 × 1 mm maximal intensity beam, set at an incident angle of approximately 45°. Some authors have provided intermediate grades, and have described fewer than 5 cells per high-power field as rare, trace, or occasional. We record the actual number of cells per high-power field when inflammation is less than 1+ .



The iris is typically miotic in the inflamed eye, but may be irregular if synechiae are present, or there is a history of trauma or herpes virus infection with damage to the sphincter muscle. Iris precipitates are seen in granulomatous uveitis2,4,5 and are located either at the pupillary margin (Koeppe nodules) or between the pupillary margin and angle (Busacca nodules). Posterior synechiae tend to occur in recurrent or chronic uveitis and, when extensive, may result in seclusion with secondary angle closure glaucoma. Iris atrophy, commonly seen with Fuchs' heterochromic iridocyclitis26,27 and herpes zoster uveitis,67 is best visualized with retroillumination. Herpes zoster uveitis, in particular, can cause sector iris atrophy. Rubeosis can occur in chronic anterior uveitis, although its presence in the setting of diffuse uveitis should prompt a search for retinal nonperfusion or ocular ischemia.


Anterior lens capsule pigment clumps may represent broken posterior synechiae from old bouts of uveitis. Cataract formation, particularly posterior subcapsular opacification, is a common complication of both uveitis and its therapy, corticosteroids. When a pseudophakus is present, the capsular bag should be examined carefully for the presence of residual lens material, suggesting lens-induced uveitis, and for white plaques representing possible infection with a slowly growing organism, such as Propionibacterium acnes or Staphylococcus epidermidis.130,131


Vitreous inflammation may be anterior, posterior, or diffuse. Anterior vitreous cells are often seen in the setting of iridocyclitis, where they represent “spillover” from the anterior segment. Best seen with a slit beam, anterior vitreous cells should be graded on a 0 to 4+ scale, similar to that used for anterior chamber cells (see Table 1). Posterior vitritis occurs with retinal, choroidal, or optic nerve head inflammation. Posterior vitritis is best seen with a Hruby or contact fundus lens by focusing just in front of the area of inflammation, which serves as a pale relief against which the small, dark, cellular silhouettes are readily visualized. Diffuse vitreous cells obscure the view of the posterior pole and should be graded on a 0 to 4+ scale using either a direct ophthalmoscope or Hruby lens, as suggested by Kimura and associates,132 or an indirect ophthalmoscope, as described by Nussenblatt and colleagues133 (see Table 1). Vitreous cells may aggregate to form “snowballs,” “strings of pearls,” or “snowmen,” or they may organize to form an opaque band at the inferior periphery, termed “snowbank,” which is seen most typically in intermediate uveitis.


Retinitis can be manifested as retinal whitening, hemorrhage, or vasculitis. When examining areas of retinitis, the depth of the inflammation is particularly important. CMV88,89 and toxoplasmosis,21–23 for example, typically produce full-thickness inflammation, whereas the focal inflammation that occurs with neuroretinitis108 or acute multifocal retinitis134 tends to be superficial. Conditions such as acute multifocal placoid pigment epitheliopathy,34,35 acute retinal pigment epitheliitis,34,35 multiple evanescent white-dot syndrome,34,35 and progressive outer retinal necrosis syndrome,135 described in patients with AIDS, affect primarily the outer retina, including the retinal pigment epithelium (RPE).28,29 The location and extent of the retinitis should also be noted carefully, particularly with regard to major retinal landmarks, such as the arcade vessels, optic disc, and fovea.

Retinal vasculitis may affect predominantly the arterioles, causing arteriolitis, or the venules, producing venulitis or phlebitis. Certain forms of uveitis, such as the acute retinal necrosis136 and Behçet's41,42 syndromes, tend to produce arteriolitis, whereas other forms, such as sarcoidosis,36–38 syphilis,90,91 and toxoplasmosis,21–23 primarily produce retinal phlebitis. In addition, the vasculitis may be either exudative, seen as sheathing, or occlusive. In general, arteriolitis tends more often to be occlusive than does phlebitis, whereas phlebitis is more commonly associated with sheathing and, on occasion, hemorrhage. The classic example of exudative phlebitis is seen with sarcoidosis and is termed tache de bougie, or candle wax drippings. Inflammation of the small retinal capillaries, termed microvasculitis, produces cotton-wool spots and intraretinal hemorrhages. Microvasculitis is most characteristic of collagen-vascular diseases137 and Behçet's syndrome.41,42

Retinal neovascularization occurs in response to both intraocular inflammation and retinal ischemia. New blood vessels typically arise from the optic nerve head or arcade vessels, although neovascularization may occur in the midperiphery as well. It is important to recognize that the development of neovascular fronds requires an adherent posterior hyaloid surface to act as a scaffolding, and so the presence of a posterior vitreous detachment can allow rubeosis to develop in the absence of visible retinal neovascularization.

Cystoid macular edema is the most common cause of visual loss in patients with uveitis138 and is believed to reflect the degree of vitritis and/or the proximity of associated retinal or optic nerve head inflammation. Foveal cysts are best assessed with a Hruby or fundus contact lens, but when the edema is mild or the view limited, fluorescein angiography may be required to make the diagnosis.

Exudative retinal detachments occur infrequently in patients with uveitis. When present, however, subretinal fluid is usually secondary to choroidal inflammation, as can occur with VKH syndrome,43–45 posterior scleritis,139 or sympathetic ophthalmia.72,73 As exudative retinal detachments resolve, widespread RPE mottling and atrophy may remain, a common occurrence in patients with VKH syndrome termed “sunset-glow fundus.”


Active choroidal inflammation is usually white or yellow, dependent largely on the amount of overlying choroidal and RPE pigmentation. Typical causes of choroiditis in immunocompetent patients include sarcoidosis,36–38 tuberculosis,84,85 syphilis,90,91 and sympathetic ophthalmia.72,73 Immunosuppressed patients, in contrast, are more likely to have an opportunistic infection of the choroid, such as pneumocysticosis,101,102 histoplasmosis,140 or cryptococcosis.103,104

Choroidal neovascularization is an uncommon finding in patients with uveitis131 but does occur, particularly when the inflammation is chronic and involves the outer retina and choroid.

Optic Nerve

Optic disc edema is a common finding in patients with uveitis. Most often, optic nerve swelling is secondary to adjacent vitritis, as in intermediate uveitis17,18 or surrounding choroiditis, which are seen with VKH syndrome43–45 or posterior scleritis.132 We term such secondary optic disc edema “uveitic papillopathy.” This is distinct from primary inflammation of the optic disc, which is termed “optic neuritis” or “papillitis,” and is distinguished by objective evidence of optic nerve dysfunction, such as an afferent pupillary defect or color vision loss.

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To categorize or subdivide uveitic syndromes, a number of schemes have been used based on demographics, severity, chronology, laterality, pathology, location and pattern of intraocular inflammation, associated ocular and systemic findings, and when applicable, predisposing factors or events (Table 2). In isolation, none of these classification schemes is wholly adequate, because by focusing on information intrinsic to any one categorizing system, important information may be inappropriately de-emphasized or overlooked. We therefore recommend what we refer to as “naming”—the process by which all information for each of the above-mentioned categories is combined to form a synoptic description of the patient with uveitis. In most cases the naming step alone narrows considerably the range of diagnostic possibilities, usually to three or four. The template is as follows:


TABLE 2. Uveitis Classification Schemes

DemographicsAnatomy (continued)
SexPars planitis
AnteriorPredisposing Factors
AnatomyDrug use


A [age]-year-old [race] [sex] with [severity], [chronicity], [laterality], [pathology], [location and pattern] uveitis associated with [ocular and systemic findings], who [predisposing factors and events].

The following are examples of patient descriptions using the naming approach:

  1. A 9-year-old white girl with moderately severe, acute, bilateral, nongranulomatous iridocyclitis associated with mild, bilateral band keratopathy and occasional right knee pain: juvenile rheumatoid arthritis
  2. A 35-year-old Asian man with severe, chronic, bilateral, granulomatous, diffuse uveitis associated with neurosensory retinal detachments and tinnitus: Vogt-Koyanagi-Harada syndrome
  3. A 40-year-old black woman with severe, chronic, bilateral, granulomatous, diffuse uveitis associated with painless, bilateral lacrimal gland enlargement and retinal phlebitis: Sarcoidosis
  4. A 30-year-old white woman with mild, chronic, unilateral, nongranulomatous iridocyclitis associated with mildly elevated intraocular pressure, cataract, and iris heterochromia: Fuchs' heterochromic iridocyclitis
  5. A 70-year-old Hispanic man with mild, chronic, unilateral, nongranulomatous, diffuse uveitis associated with discrete, small, white opacities on the posterior lens capsule, who underwent uncomplicated extracapsular cataract extraction in the same eye 6 months earlier: Delayed endophthalmitis; Propionibacterium acnes, S. epidermidis, etc
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The naming step generates a succinct description, or profile, of the patient with uveitis, constructed entirely from the patient history, review of systems, and physical examination. This clinical picture is then compared with the known profiles of the 40 to 50 common uveitic syndromes (Table 3) in a process we term “meshing,” whereby a short differential diagnosis is generated. Unfortunately, meshing is based almost entirely on clinical experience, and clinical experience varies from clinic to clinic and country to country. Hence, infectious causes of uveitis are seen much more commonly in patients with AIDS95–100 and in third-world countries.56–58 Similarly, VKH syndrome43–45 and Behçet's syndrome41,42 are much more common in Asia and the Middle East, respectively. However, these caveats notwithstanding, Table 3 can be used to generate a differential diagnosis in most settings. Our meshing for the five naming examples given above is as follows:


TABLE 3. Most Commonly Encountered Uveitic Disease Entities

NameAgeSexRaceSeverity/ChronologyLateralityLocation/Anatomy/PatternPathologyAssociated Clinical FindingsDirected Laboratory Evaluation/ConsultationTherapyPrognosis and Complications*
1. TraumaticAny ageM > FAny raceMild to severe/acuteUnilateralIritis, iridocyclitis, endophthalmitisNongranulomatousTraumaOrbital x-rays if perforation suspectedCycloplegia; steroid if severeDepends on severity of trauma and presence of infection
2. PostsurgicalElderlyEqualAny raceSevere/acuteUnilateralIritis, iridocyclitis, endophthalmitisNongramulomatousSurgeryGram's stain/aqueous and vitreous culturesAntibiotics, steroid, cycloplegiaUsually poor with infection
3. Anterior idiopathicYoung adultEqualW > B/AMild to severe/acute recurrent, of chronicBilateral > unilateralIritis, iridocyclitisNongranulomatousNoneBaseline workup† if severe, bilateral, recurrent, granulomatous, or unresponsive to standard therapySteroid, cycloplegiaGood; worse if recurrent or chronic
4. HLA-B27-related uveitisYoung adultM > FW > B/AMild to severe/ acute, recurrent, or chronicBilateral > unilateral (usually alternating)Iritis, iridocyclitisNongranulomatousArthritis' psoriasis, mucosal ulcers, inflammatory bowel disease; bypopyonNone for first attack if systemically asymptomatic; if chronic recurrent, severe, bilateral, granulomatous, or systemic symptomatic, consider baseline workup † plus HLA-B27 ESR, ANA, RF, AND joint imaging; rheumatology, dermatology, urology, or GI consult, as indicatedSteroid and cycloplegia; if recurrent, consider nighttime cycloplegia, even when in activeUsually good; worse when recurrent or chronic
5. Juvenile rheumatoid arthritis/uveitis in young girlsChildF > MW > B/AMild to severe/chronic recurrent › acuteBilateral > unilateralIritis, iridocyclitisNongranulomatousArthritis (pauciarticular > polyarticular), fevers, hepatosplenomegaly; band keratopathy, cataract, glaucomaBaseline workup†plus ESR, ANA, RF, HLA-B27; rheumatology consultSteroid, cycloplegicGuarded
6. Fuchs' heterochromic iridocyclitisYoung adultEqualW > B/AMild to moderate/chronic > recurrent > acuteUnilateral › bilateralIritis, iridocyclitisNongranulomatous; occasional Keoppe noduleIris heterochromia(atrophy), cataract,Baseline workupSteroid, cycloplegia glaucoma medicineGood
7. Glaucomatocyclitic crisis (Posner-Schlossman syndrome)Young adultM > FW > B/AModerate to severe/recurrent > acuteUnilateral > bilateralIritis, iridocyclitisNongranulomatousGlaucomaBaseline workupSteroid, cycloplegia, glaucoma medicine during attacks onlyGood
8. Herpetic anterior uveitis: simplex or zosterChild to adult; VZV in elderly or HIV+EqualAny raceMild to severe/acute recurrent, or chronic; may be bilateral in atopy or HIV+Unilateral > bilateralIritis, iridocyclitisNongranulomatous or granulomatousDermatitis; keratitis, decreased corneal sensation, glaucoma, iris atrophyUsually none; baseline workup† if atypical; HIV test for VZV in patients <60Acyclovir, cycloplegia; steroid if severe or unresponsiveGood; typically requires slow steroid taper, may develop neurotrophic keratopathy, iris atrophy
9. Lens-inducedElderlyEqualAny raceMild to severe/acute or chronicUnilateralIritis, iridocyclitis or diffuseGranulomatous > nongranulomatousTrauma or surgeryGram's stain and culturesSteroid, cycloplegia, removal of lens, intravitreal antibioticsGood if no endophthalmitis
10. Drug-inducedAny ageEqualAny raceMild to severe/acute, recurrent, or chronicBilateral;unilateral if topicalIritis, iridocyclitis or diffuseNongranulomatousß-Blocker, sulfonamide, pamidronate disodium, rifabutinBaseline workup† trial of drug withdrawalDrug withdrawalGood
11. Primary Sjogrens syndromeYoung adultF > MW > B/AMild to moderate/chronic > recurrent › acuteBilateral > unilateralIritis, iridocyclitis or diffuseNongranulomatousDry eye/mouth; arthritisBaseline workup,† Schirmer test, minor salivary gland biopsy, ESR, ANA, RF, HLA-B27; anti-SSA/Ro and anti-SSB/La if ANA+; FA if CME or neovascularization suspectedSteroid, cycloplegia, dry eye therapy as indicatedGood; CME primary cause of vision loss;may develop neovascularization
12. Pars planitis/idiopathic intermediate uveitisChild to young adultEqualW > B/AMild to severe/chronic > recurrent › acuteBilateral > unilateralIntermediate; may have anterior spillover (diffuse)NongranulomatousNoneBaseline workup; FA if CME or neovascularization suspectedSteroid, cycloplegiaGood; CME primary cause of vision loss; may develop neovascularization
13. Multiple sclerosisYoung adultF > MW > B/AMild to severe/chronic > recurrent › acuteBilateral > unilateralIntermediate; may have anterior spillover (diffuse)Nongranulomatous > granulomatousNeurologic symptomsBaseline workup; CT or MRI; neurology referral to consider LPSteroid, cycloplegia IV steroids for optic neuritisGood if no optic atrophy or chronic CME; may develop neovascularization
14. TuberculosisAny ageEqualAny raceMild to severe (?)/acute, recurrent, or chronicBilateral > unilateralAnterior, intermediate, or diffuseGranulomatous > nongranulomatousPulmonary or constitutional symptoms; may affect any organ system; multifocal choroiditisBaseline workup† other tests if extrapulmonary tuberculosis suspected; consider 2- to 4-month trial of antituberculous medicinesAntituberculous medicines; steroid, cycloplegiaVariable, depending on location and severity of inflammation
15. SyphilisAny ageEqualAny raceMild to severe (?)/acute, recurrent, or chronicBilateral > unilateralAnterior, intemediate, or diffuseGranulomatous > nongranulomatousPsoriasis of soles and palms or skin rash in acquired; frontal bossing, short maxillage, high palatal arch rhagades, saber shins, notched incisors, saddle nose deformity, and deafness in congenital; may affect any organ system; interstitial keratitis, chorioretinitisBaseline workup† LP if syphilis serology positive; HIV testingIntravenous penicillin for 7 to 10 days; doxycycline for concurrent bacterial urethritisVariable, depending on location and severity of inflammation
16. SarcoidosisAny ageF > MB > W/AMild to severe/acute, recurrent or chronicBilateral > unilateralAnterior, intermediate, or diffuseGranulomatous > nongranulomatousPulmonary or constitutional symptoms; may affect any organ system; retinal phlebitisBaseline workup, gallium scan, pulmonary function testsSteroid, cycloplegia: may need steroid sparing immunosuppression fro chronic or severe diseaseVariable, depending on location and severity of inflammation
17. ToxoplasmosisAny ageEqualAny raceMild to severe/acute or recurrentUnilateral; congenital scars may be bilateral; if bilaterally active, suspect AIDSModerate diffuse with full-thickness retinochoroiditis; mild diffuse with outerretinochoroiditis or endophthalmitisGranulomatous > nongranulomatousNeurologic symptoms with severe congenital disease or AIDSToxoplasmosis severology(lgG and lgM); skull film for calcification if congenital; HIV testing if bilateral; CT or MRI if HIV-positive and symptomaticPyrimethamine, sulffonamide, clindamycin, and systemic steroid if severe or threatening the optic disc or macula; topical steroid; cycloplegiaVariable, depending on locaiton and severity of retinochoroiditis
18. ToxocariasisChild to young adultEqualAny raceMild to severe/acute, rucrrent, or chronicUnilateralMild diffuse with posterior retinochoroiditis; intermediate with pars planamass snowbank, or endophthalmitisGranulomatous > nongranulomatousAsthmaToxocara ELISA; CBC for eosinophilia with systemic disease(uncommon)Steroid, cyclopegiaVariable, depending on location and severity of retinochoroiditis
19. Acute retinal necrosis (herpetic posterior uveitis)Child to elderlyEqualAny raceSevere/acuteUnilateral > bilateralSevere diffuse, retinitis, vasculitisGranulomatous > nongranulomatousHerpetic dermatitis or encephalitisVitreous aspiration for viral culture and PCRIntravenous acyclovir, intravitreal foscarnet or ganciclovir, cycloplegiaPoor, especially wiht retinal detachment
20. Behçet's syndrome.Child to adultM > FA > B/WModerate to severe/acute, recurrent, or chronicBilateral > unilateralIridocyclitis or diffuseNongranulomatous > granulomatousMajor criteria: apthous ulcers, skin lesions (erythemanodosum, acne, thrombophlbitis), genital ulcers Minor criteria: arthritis, Gl ulcers, epididymitis, vascular occlusion or aneurysm, neuro-psychiatric symptoms; bypopyon, retinitis, vasculitis, optic neuritisClinical diagnosis based on typical eye disease in the presence of additional major and minor diagnostic criteria; HLA-B5 testing supportiveSteroid, cycloplegia, steroidsparing immunosuppression if chronic or severePoor
21. Vogt-Koyanagi Harada syndromeChild to adultEqualA > B > WMild to severe/acute, recurrent, or chronicBilateral > unilateralDiffuse uveitis, often with exudative retinal detachment, optic nerve edemaNongranulomatous = granulomatousMeningismus, tinnitus, dysacousis, alopecia, vitiligo, poliosis; exudative retinal detachment, optic nerve edema, choroidal granulomataClinical diagnosis based on three of the following in the absence of prior ocular surgery or trauma:(1) anterior uveitis; (2) posterior uveitis; (3) skin findings; (4) neurologic findings; FA shows characteristic RPE leaks; ultrasound shows choroidal thickening: audiometrySystemic and topic steroid, cycloplegiaGuarded: limited by RPE atrophy, choroidal neovascularization, glaucom, cataract, CME
22. Endogenous endophthalmitisChild and elderlyEqualAny raceModerate to severe/acuteUnilateralDiffuse › iridocyclitisGranulomatous > nongranulomatousConstitutional symptoms, urinary sumptoms, diabetes, indwelling catheter or IV use; retinal, choroidal, or anterior chamber infiltrateAqueous and/or vitreous tap for Gram's stain and cultures; blood, urine, and catheter culture, as indicatedIntravenous and intravitreal antibiotics, steroid, cycloplegiaPoor
23. LymphomaElderlyEqualAny raceMild to severe/chronic > recurrentUnilateral > bilateralDiffuse, intermediate, retinal or optic nerve infiltrateNongranulomatous > granulomatousNeurologic symptomsBaseline workup,- CT or MRI, LP; neurology consultRadiation, chemotherapyGuarded, depending on degree of CNS involvement
24. Birdshot chorioretinopathyAdult to elderlyM > FW > B/AModerate to severe/chronic › recurrentBilateral > unilateralDiffuse, radial choroidal infiltratesNongranulomatousColor vision loss, dysacousis, dysphoria, CME, choroidal neovascularization, RPE atrophyBaseline workup,† HLA-A29, FA, ERG/EOG; audiometrySteroid, cyclogia laser photocoagulationGood; may be limited by choroidal neovascularization, CME, or RPE atrophy
25. Eales' diseaseYoung adultEqualA > W/BModerate to severe/chronic recurrentBilateral > unilateralMild diffuse with vasculitisNongranulomatousRetinal ischemia, vitreous hemorrhageBaseline workup,, ESR, ANA, RF ANCA, FASteroid, cycloplegia, retinal photocogulation, vitrectomyPoor
26. Acute multifocal pigment placoid epitheliopathy (AMPPE)Young adultEqualW > B/AModerate to severe/acute > recurrentBilateral > unilateralMild diffuse; multifocal placoid outer retinitisNongranulomatousFlulike prodrome, erythema, nodosum, dysacousis, cerebral vasculitisBaseline workup, FANoneGood; mild to moderate visual loss with extensive involvement of macular RPE
27. Serpiginous choroiditisYoung adult to elderlyM > FW > B/AModerate to sever/chronic, recurrentBilateral > unilateralMild diffuse; geographic-helicoid chorioretinitisNongranulomatousChoroidal neovascularization, exudative retinal detachmentBaseline workup, FASteroid, steroidsparing immunosuppression, laser photocoagulationPoor; limited by proximity to fovea and occurrence of choroidal neovascularization or exudative retinal detachment
28. HistoplasmosisYoung adultEqualW > B/AModerate to severe/acute, recurrentBilateral > unilateralMild posterior; multifocal chorioretinitisNongranulomatousChoroidal neovascularizationBaseline workup, FALaser photocoagulation with posterior sub-Tenon's steriodGood; limited by location and occurence of choroidal neovascularization
29. SympatheticChild to elderlyEqualAny raceMild to severe/chronic > recurrentBilateralDiffuse, multifocal choroiditisNongranulomatousPrior trauma or surgery; choroidal granulomata (Dalen-Funchs' nodules), exudative retinal detachmentsBaseline workup,† ultrasound, FASteroid, cycloplegia, steroidsparing immunosuppressionGuarded
30. Whipple's diseaseYoung adultM > FW/B/AMild to severe/chronic > recurrentBilateralDiffuseNongranulomatous or granulomatousMalabsorption diarrhea, abdominal tenderness, lymphadenopathy, dementia, arthritis, skin hyperpigmentation; chorioretinitis, vasculitisBaseline workup, FA, jejunal biopsy, GI consultTrimethoprim-sulfameth-oxazoleGuarded
31. Lyme diseaseYoung to adultEqualAny raceMild to severe/acute, or chronicBilateral > unilateralIritis, iridocyclitis intermediate, or diffuseNongranulomatous or granulomatousErythema migrans, lymphadenopathy, conjunctivitis, cranial nerve palsy, keratitis myocarditis arthritisBaseline workup,† Lyme serology (lgG and lgM)Steroid, cycloplegia, antibiotics (amoxicillin or doxycycline for early disease; ceftriaxone for late disease)Variable; good with early treatment
32. Multiple evanescent white-dot syndrome (MEWDS)Young adultF > MW > B/AMild to moderate/acuteUnilateral > bilateralMild diffuse, multifocal outer retinitisNongranulomatousNoneBaseline workup; blood cultures for constitutional symptoms; ESR, ANA, RIF, and ANCA if symptomatic; HIV test if at risk; bartonella henselae serology if cat at home; FA visual fieldNoneGood
33. Acute retinal pigment epithelitisYoung adultEqualW > B/AMild to moderate/acuteUnilateral or bilateralMild diffuse, multifocal, outer retinitisNongranulomatousNoneBaseline workup,† Toxoplasma serology if single forcus, FA, ERG/EOGNoneGood
34. Diffuse unilateral subacute neuroretinitis (DUSN)Child to adultEqualAny raceMild to moderate/chronicUnilateralModerate diffuseNongranulomatousMultifocal outer retinitis, occlusive vasculitis, retinal tracks, optic neuritisBaseline workup, FA, ERG/EOG, visual fieldLaser photocoagulation or vitrectomy to remove parasitePoor
35. NeuroretinitisChild to adultEqualAny raceMild to severe/acuteUnilateralMild diffuse, optic neuritisNongranulomatousFlulike prodrome, lumphadenopathy; macular star, multifocal retinitisBaseline workup, Toxoplasma serology; B. henselae serology if cat at home; ESR, ANA, RF, Lyme serology if symptomatic, FAAntibiotics as indicated, steroid for severe casesGood
36. Acute multifocal retinitisYoung adultF > MW > B/AAcuteUnilateral or bilateralMild diffuse, multifocal retinitisNongranulomatousFlulike prodromeBaseline workup,† Toxoplasma serology, B. henselae serology if cat at home; blood cultures if constitutional symptoms, HIV if at risk, FAAntibiotics as indicated, steroid for severe casesGood
37. Multifocal choroiditis panuveitisYoung to adultF > MW > B/AMild to severe/chronic > recurrentBilateral > unilateralModerate diffuse, multifocal choroiditisNongranulomatous or granulomatousRetinal tracks, CME, exudative retinal detachment, subretinal fibrosisBaseline workup, FA, visual fieldSteroid, cycloplegia, laser photocoagulation, for choroidal neovascularizationGuarded; limited by occurence of CME or choroidal neovascularization
38. LeptospirosisChild to adultM > FAny raceModerate to severe/acute, recurrent, or chronicBilateral > unilateralIritis, iridocyclitis intermediate, or diffuseGranulomatous or nongranulomatousRash, constitutional symptoms, headache, hepatosplenomegaly; hypopyonBaseline workup, Leptospira serologyPenicillin if severe, doxycycline otherewise; steroid, cycloplegiaVariable, depending on the location and severity of the inflammation
39. BrucellosisYoung to adultEqualAny raceMild to severe/acute, recurrent, or chronicBilateral > unilateralIritis, iridocyclitis intermediate, or diffuseGranulomatous or nongranulomatousConstitutional symptomsBaseline workup† Brucella serologyDoxycycline and rifampin or strptomycin, steroid, cycloplegiaVariable, depending on the location and severity of the inflammation
40. Collagen vascular syndromes(SLE, Wegener's granulomato PAN, etc)Young to adultF > MB > W > AMild to severe/acute, recurrent, or chronicBilateral > unilateralIritis, iridocyclitis intermediate, or diffuseNongranulomatousConstitutional symptoms, rash, erythema nodosum, mucosalucers or bleeding, sinus disease; retinal vasculitis, optic neuritisBaseline workup, ESR, ANA, RF, ANCASteroid, cycloplegia, steriodsparing immunosuppressionVariable; reflects activity of systemic disease
41. Acute interstitial nephritis/uveitis syndromeYoung to adultF > MAny raceMild to moderate/acute, recurrent, or chronicBilateral > unilateralIridocyclitis or diffuseNongranulomatousInterstitial nephritisBaseline workup, renal function studies, nephrology consultSteroid, cycloplegiaGood
42. CysterciscosisChild to adultEqualAny raceModerate to severe/or acute, recurrentUnilateralDiffuse, subretinal vitreous massNongranulomatousConstitutional symptoms, headache, seizures, cranial nerve palseisBaseline workup,† FA, ultrasoundVitrectomy to remove parasiteGuarded, depending on location of cyst
43. CoccidioidomycosisChild to adultEqualAny raceModerate to severe/chronic or recurrentUnilateralIridocyclitis or diffuseGranulomatous > nongranulomatousConstitutional symptoms, pulmonary, skin nodules, meningitis, arthritis, multifocal choroiditis, anterior chamber massBaseline workup, Coccidioides immitis serology, coccidioidin skin test; CT or MRI, and galluim scan,as indicated; pulmonary,neurology, rheumatology consults, as indicatedIntravitreal and systemic amphotericin B, oral azolesPoor
44. Cytomegalovirus retinitisInfant to adultEqualAny raceModerate to severe/chronic or recurrentBilateral > unilateralMild to moderate diffuse, retinitisNongranulomatousHIV-positive, immunosuppressed, congenital infection; may have encephalitis or gastroenteritis; neurology, GI, or pediatric consult, as indicatedNone; CMV serology of limited utility; Toxoplasma serology for equivocal casesIV or intravitreal ganciclovir, foscarnet or cidofovirPoor
45. Pneumocystis cannii choroiditisYoung to adultEqualAny raceMild to moderate/chronic or recurrentBilateral > unilateralMild to diffuse, multifocal choroiditisNongranulomatousHIV-positive, immunosuppressed; pneumonitis, disseminated infectionSputum cultureTrimethoprim suffamethoxazaole, IV pentamidineGood
46. Progressive outer retinal necrosis (PORN) syndromeYoung to adultEqualAny raceSevere/acuteBilateral > unilateralMild diffuse, multifocal outer retinitisNongranulomatousHIV-positive, zoster drmatitisVitreous tap for viral cultures and PCRIntravitreal ganciclovir or foscarnetPoor
47. Cryptococcal uveitisChild to adultEqualAny raceMild to moderate/acute or recurrentBilateral > unilateralIridocyclitis or mild diffuse with multifocal choroiditis, or optic neuritisNongranulomatousHIV-positive, headache, meningeal signs, neurologic signs or sumptomsCT or MRI, LP, cryptococcal antigen titer, visual field; neurology consult, as indicatedIV amphotericin B, oral azolesGuarded; optic neuritis may cause progressive visual field loss

*Any chronic uveitis may be complicated by cataract formation or glaucoma.
† Baseline workup includes (1) syphilis serologies (RPR or VDRL. and treponernal antibody titers); (2) chest x-ray to rule-out Granulomatous disease, such as sarcoidosis and tuberculosis; (3) skin testing with PPD, as well as mumps and Candida to rule out anergy; and (4) serum angiotensin-converting enzyme (ACE) and/or lysozyme levels for sarcoidosis.
A, Asian; ANA, antinuclear antibody; ANCA, antineutrophil cycloplasmic antibodies; B, Black; CBC, complete blood count; CME, cystoid macular edema; CMV, cytomegalovirus; CNS, central nervous system; CT, computed tomography; ELISA, enzyme-linked immunosorbent assay; EOG, electro-oculogram; ERG, electroretinogram; ESR, erythrocyte sedimentation rate; FA, Fluorescein angiogram; GI, gastrointestinal; LP, lumbar puncture; PAN, polyarteritis nodosa; PCR, polymerase chain reaction; PPD, purified protein derivative; RF, rheumatoid factor; RPE, retinal pigment epithelium; RPR, rapid plasma reagin; SLE, systemic lupus erethematosus; VDRL, Venereal Disease Research Laboratory; VZV, varicella zoster virus; W, White.


  1. A 9-year-old white girl with moderately severe, acute, bilateral, nongranulomatous iridocyclitis associated with mild, bilateral band keratopathy and occasional right knee pain: (a) juvenile rheumatoid arthritis; (b) sarcoidosis; (c) syphilis; (d) tuberculosis
  2. A 35-year-old Asian man with severe, chronic, bilateral, granulomatous, diffuse uveitis associated with neurosensory retinal detachments, and tinnitus: (a) Vogt-Koyanagi-Harada syndrome; (b) sympathetic ophthalmia; (c) sarcoidosis; (d) syphilis; (e) tuberculosis.
  3. A 40-year-old black woman with severe, chronic, bilateral, granulomatous, diffuse uveitis associated with painless, bilateral lacrimal gland enlargement and retinal phlebitis: (a) sarcoidosis; (b) syphilis; (c) tuberculosis; (d) Behçet's syndrome; (e) collagen-vascular disease
  4. A 30-year-old white woman with mild, chronic, unilateral, nongranulomatous iridocyclitis associated with mildly elevated intraocular pressure, cataract, and iris heterochromia: (a) Fuchs' heterochromic iridocyclitis; (b) herpes simplex or herpes zoster uveitis; (c) sarcoidosis; (d) syphilis; (e) tuberculosis; (f) HLA-B27-associated iridocyclitis
  5. A 70-year-old Hispanic man with mild, chronic, unilateral, nongranulomatous, diffuse uveitis associated with discrete, small, white opacities on the posterior lens capsule, and who underwent uncomplicated extracapsular cataract extraction in the same eye 6 months prior: (a) Delayed postoperative endophthalmitis (Propionibacterium acnes, S. epidermidis, etc); (b) lens-induced uveitis; (c) intraocular lymphoma; (d) syphilis; (e) tuberculosis; (f) sarcoidosis

One important point is that tuberculosis, syphilis, and sarcoidosis are found on virtually all lists of differential diagnoses, because these diseases, known to be “great imitators,” may present as virtually any form of uveitis. In addition, syphilis, tuberculosis, and sarcoidosis are largely treatable, further emphasizing the need for accurate diagnosis. We therefore test specifically for these entities in virtually every patient with uveitis. Our baseline workup includes the following: (1) syphilis serologies, including both a rapid plasma reagin (RPR) or Venereal Diseases Research Laboratory (VDRL) test and a specific treponemal antibody test (FTA-ABS or MHATP); (2) a routine chest x-ray to look for evidence of granulomatous or infiltrative disease; and (3) skin testing for tuberculosis (purified protein derivative; PPD), as well as for mumps antigen and Candida to test for anergy.

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The selection of laboratory tests in patients with uveitis should be tailored to confirm or eliminate those few diagnostic possibilities generated by the naming and meshing steps discussed earlier.141,142 In general, we treat empirically without further testing for first episodes of acute, unilateral, mild to moderately severe, nongranulomatous iritis or iridocyclitis in otherwise healthy, young to middle-aged adults; we call this presentation “simple anterior uveitis.” If, however, patients with simple anterior uveitis (have a change in their presentation, such that the ocular inflammation becomes recurrent, bilateral, severe, or granulomatous, or if the patient fails to respond promptly to standard treatment with intensive topical corticosteroids and cycloplegia, we proceed to a baseline workup, as described earlier. Moreover, if signs or symptoms suggest an underlying systemic disease, additional testing is requested (see Table 3). The following is a discussion of some of the more commonly ordered laboratory tests.


Angiotensin-converting enzyme (ACE) cleaves two amino acids from the C-terminus of the decapeptide angiotensin I to produce the much more potently vasoactive angiotensin II, an octapeptide. ACE is produced primarily by capillary endothelial cells, abundant in both lung and liver, and by secretory monocytes, especially macrophages. For this reason, a number of pulmonary, hepatic, and lymphoproliferative disorders are associated with an elevated ACE level. Clinically, ACE levels are ordered almost exclusively to aid in the diagnosis of sarcoidosis, because circulating levels are elevated in more than two thirds of patients with active disease.143,144 Moreover, although ACE levels may be elevated in a number of conditions, very few of these disorders are associated with uveitis and a negative skin test for tuberculosis. Therefore, in the setting of uveitis and a negative PPD, we interpret an elevated ACE as fairly specific for sarcoidosis. This stated, it is important to realize that ACE levels are elevated in childhood and may be lowered by prolonged use of systemic corticosteroids or by systemic ACE inhibitors used to lower blood pressure.


Antinuclear antibodies (ANAs) are directed against proteins, nucleic acids, and/or nucleoprotein complexes normally confined to cellular nuclei. The ANA test is typically performed by applying serial dilutions of the patient's serum to cultured tumor cells and then titrating for the presence and pattern of nuclear autoantibody staining. The ANA test is generally used to confirm what is already a strong clinical suspicion, based on the history, review of systems, and physical examination, that the patient has a collagen-vascular disease, particularly systemic lupus erythematosus or juvenile rheumatoid arthritis.141,142 Other rheumatic diseases that are also associated with elevated ANA titers include Sjögren's syndrome, rheumatoid arthritis, scleroderma, Raynaud's disease, periarteritis nodosa, and dermatomyositis. More than 15% of normal patients, particularly elderly women, also have a mildly elevated ANA, making markedly elevated titers most useful in determining the diagnosis. When the suspicion of collagen-vascular disease is high and the ANA is elevated to greater than 1:80, antibodies to more specific antinuclear antigens should be considered: for example, anti-Ro/SSA and anti-La/SSB/Ha antibodies for Sjögren's syndrome and systemic lupus erythematosus; anti-dsDNA, anti-ssDNA, anti-nRNP, and anti-Sm antibodies for systemic lupus erythematosus; or antihistone antibodies for rheumatoid arthritis or mixed connective tissue disease.145,146


Antineutrophil cytoplasmic antibodies (ANCAs) are IgG autoantibodies directed against cytoplasmic antigens of human polymorphonuclear cells. ANCAs are sensitive for the presence of severe small-vessel vasculitis, such as Wegener's granulomatosis, microscopic polyarteritis nodosa, and segmental necrotizing glomerulonephritis. ANCAs can also be positive in arthritides, inflammatory bowel disease, and HIV infection. Two types of ANCAs have been described based on the cytoplasmic distribution of autoantibodies. A cytoplasmic pattern of staining, termed cANCA, is most often directed against proteinase 3, a neutral serine protease present in polymorphonuclear cells. cANCA is approximately 90% sensitive and specific for Wegener's granulomatosis. A perinuclear staining pattern, termed pANCA, is less specific for disease type and represents autoantibodies to a number of polymorphonuclear antigens. In general, we reserve ANCA testing for patients with uveitis accompanied by severe scleritis, retinal vasculitis, or optic neuritis, particularly when systemic signs or symptoms suggest concurrent renal or respiratory tract disease.147–150 It should be noted, however, that elevated ANCA titers have been demonstrated in 10% to 20% of patients with chronic, idiopathic uveitis in the absence of either ocular or systemic vasculitis.147,151 Some authors have suggested using ANCA titers to monitor disease activity and response to treatment.150,151


A complete blood cell count with differential can determine whether an elevated white blood cell count is due to systemic infection or leukemia. In addition, systemic eosinophilia can be found in systemic toxocara infections, atopy, and allergic granulomatous angiitis (or Churg-Strauss syndrome).152,153 Lastly, it is good general practice to obtain a complete blood cell count before initiating systemic therapy with either corticosteroids or other immunosuppressive agents, particularly alkylating agents such as cyclophosphamide and chlorambucil, the effects of which are titrated to total white blood cell count.


The erythrocyte sedimentation rate (ESR) is a nonspecific indicator of plasma fibrinogen and globulin levels and may be elevated in systemic infection or inflammation or in the presence of malignancy or paraproteinemias. Using the Westergren method, a normal ESR should be less than 10 mm/h for children, 15 mm/h for men, and 20 mm/h for women. These values may increase to 20 mm/h and 30 mm/h, respectively, for men and women older than 50. Miller and associates154 studied more than 28,000 healthy men and 1000 healthy women aged 20 to 65 and found that for men, 98% of the ESRs would be less than age/2, whereas for women the 98% cutoff could be estimated by (age + 10)/2. These formulas were less reliable for subjects older than 70.

For ophthalmologists, an ESR is most often used to diagnose and monitor giant cell arteritis and polymyalgia rheumatica.155 Although less studied, the ESR may be helpful when systemic signs or symptoms suggest a vasculitis other than giant cell, especially in the setting of severe scleritis, retinal vasculitis, or optic neuritis. Although an elevated ESR does not provide a diagnosis, it strongly supports the presence of a systemic disorder and, as with giant cell arteritis, may be used to gauge the efficacy of systemic immunosuppressants.156,157 C-reactive protein, another circulating acute-phase reactant, provides comparable information.158


The prevalence of herpesvirus antibodies is so high in the general population that a positive antibody titer is virtually meaningless.159,160 A negative test, however, all but eliminates herpesvirus infection from the list of diagnostic possibilities, and therefore can be useful in selected instances. An example of the use of herpesvirus serology to rule out herpetic uveitis might be the young patient with anterior uveitis, elevated intraocular pressure, and iris atrophy who has no associated herpetiform dermatitis or keratitis. For this patient, negative serologic testing for herpes simplex and zoster would essentially confirm the diagnosis of Fuchs' heterochromic iridocyclitis. Serologic testing is available for antibodies against herpes simplex virus, herpes zoster virus, CMV, and Epstein-Barr virus. Herpesvirus serology should remain positive for life.


Human immunodeficiency virus antibodies are most commonly detected using an enzyme-linked immunoassay. Positive results are confirmed by a Western blot test.161,162 The predictive value of a positive result on both tests exceeds 99%. We order HIV testing in uveitis patients with (1) known HIV risk factors, (2) severe or bilateral retinitis or choroiditis, and (3) suspected herpes zoster uveitis when they are younger than 50 years of age. HIV testing requires patient consent.


Human leukocyte antigens (HLAs) are gene products derived from the major histocompatibility complex.163,164 HLA antigens are divided into class I, II, and III: Class I antigens include HLA-A, -B, and -C subtypes, are present on virtually every cell, and mediate the presentation of antigens to cytotoxic T-cells (CD8+ ), a phenomenon termed HLA restriction. Class I antigens are important for lysis of virally infected cells and mediate graft-versus-host disease. Class II antigens, including HLA-DR, HLA-DP, and HLA-DQ subtypes, are found preferentially on B-cells and macrophages, and mediate antigen presentation to helper T-cells (CD4+ ). Aberrant expression of class II antigens has been postulated as an autoimmune mechanism. Class III antigens circulate in the bloodstream, and include the second and fourth components of the classic complement pathway (C2 and C4), as well as properdin factor B of the alternative pathway.

HLA antigens are used for organ and bone marrow transplantation, choosing platelet donors for immunized recipients, and paternity testing, as well as to support the diagnosis of certain diseases known to have increased associations with certain HLA antigens. In the acute, anterior, nongranulomatous uveitis seen with ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or Reiter's syndrome, more than 75% of cases are HLA-B27 positive, whereas only 5% to 10% of the general population carry this serotype.24,25 Similarly, more than 90% of patients with birdshot choroiditis are HLA-A29 positive.30,31 Other HLA associations of note include HLA-B51 and HLA-B12 with Behçet's syndrome41,42; and HLA-B53, HLA-DR4, and HLA-DRw53 with VKH syndrome.43–45


Lyme disease is a multisystem, tick-borne disorder caused by infection with the spirochete Borrelia burgdorferi.50,51 As with HIV, an enzyme-linked immunoassay in combination with a Western blot test offers the most sensitive and specific testing for serum antibodies against Borrelia burgdorferi.165,166 False-negative results may be obtained in the first few weeks after infection, especially if the patient has been treated with antibiotics, whereas false-positive results occur from cross-reactivity with other spirochetes, including Treponema pallidum,167 and in patients with collagen-vascular disorders.168 Positive testing is therefore most helpful in the setting of known risk factors, such as camping or hiking in wooded areas, or systemic findings suggesting Lyme disease, including migratory arthritis, erythema migrans, or isolated cranial neuropathies.


Like ACE, lysozyme is an enzyme produced by epithelioid cells, giant cells, and macrophages found in granulomas. Although lysozyme levels tend to parallel ACE levels, some authors have suggested that an elevated serum lysozyme level is a more sensitive indicator of active pulmonary sarcoidosis.169 As with ACE, however, studies have yet to address the sensitivity and specificity of an elevated lysozyme for sarcoidosis in a population of uveitis patients with a negative PPD. We generally obtain both ACE and lysozyme levels, because in the absence of a characteristic biopsy, the diagnosis of sarcoidosis is based on the cumulative weight of clinical and laboratory findings, and because studies to date has failed to provide evidence for a clear superiority of circulating ACE versus lysozyme levels in the setting of uveitis.


Rheumatoid factor (RF) refers to a class of autoantibodies directed against the Fc fragment of human IgG.142,170 Most often, rheumatoid factor consists of IgM-anti-IgG, although IgG-anti-IgG does occur. About 80% of patients with rheumatoid arthritis are RF seropositive,170 defined as a titer of greater than 1:80. RF seropositivity is nonspecific, however, and may occur in a number of collagen-vascular disorders. RF is therefore best used to support a clinical diagnosis of rheumatoid arthritis, based primarily on age, sex, and the presence of arthritis and extra-articular manifestations, such as subcutaneous nodules or scleritis.141,142 Mildly elevated RF may be seen in acute infections and in the elderly.


Antitreponemal antibody tests, such as the FTA-ABS and MHATP, approach 100% sensitivity and specificity for syphilis, regardless of stage, and are therefore the preferred tests for prior exposure. Unfortunately, these tests remain positive for life and therefore do not reflect ongoing disease activity or the adequacy of prior treatment. The RPR and VDRL titers, in contrast, do reflect disease activity and are therefore used primarily to gauge disease activity and response to therapy. Both types of tests may be run on either serum or cerebrospinal fluid. RPR and VDRL may be falsely elevated in autoimmune disease and related spirochete infections, such as Lyme disease, yaws, and leprosy.171 Both indirect and direct tests for syphilis may be falsenegative in patients with AIDS.172


CD4+ and CD8+ T-lymphocyte counts and ratios have assumed considerable importance with the advent of AIDS, and the recognition that the number of CD4+ T-lymphocytes declines more rapidly than does the number of CD8+ T-lymphocytes during the course of HIV infection.173 As a general rule, children start with about 3000 CD4+ cells/mm3 and reach their normal circulating levels of 1500 cells/mm3 by adulthood. This number continues to decline with age, but should always be greater than 500 cells/mm3; counts less than 500 cells/mm3 are suggestive of immunosuppression. CD4+ cell counts vary considerably from day to day and may be elevated by stress. Splenectomy also elevates peripheral CD4+ counts but tends not to alter the CD4+ ÄCD8+ ratio.174

Once patients are found to be HIV positive, absolute CD4+ T-lymphocyte counts can provide considerable information about ocular disease susceptibility.173 For example, Kaposi's sarcoma, lymphoma, and tuberculosis tend to occur at CD4+ cell counts of between 200 and 500 cells/mm3, whereas pneumocystosis and toxoplasmosis are often seen at counts of 100 to 200 cells/mm3, and CMV retinitis, herpes zoster retinitis, and cryptococcal choroiditis are most prevalent at counts less than 100 cells/mm3.173


Several different tests are available to detect and quantify anti-Toxoplasma gondii antibodies, including the Sabin-Feldman dye test, the indirect fluorescent antibody (IFA) test, and the enzyme-linked immunosorbent assay (ELISA).21–23,175,176 Of these, the Sabin-Feldman dye test remains the most sensitive and specific and the standard against which all other tests are judged. However, the Sabin-Feldman dye test is technically difficult and of limited availability, whereas IFA and ELISA are relatively easy and economical and can be used to distinguish IgG from IgM anti-Toxoplasma gondii antibodies. Moreover, ELISA is available in convenient kits and appears to offer greater specificity at low antibody titers. When interpreting positive titers, it is important to remember that IgM anti-Toxoplasma gondii antibodies may be elevated for up to 1 year after infection, limiting the accuracy with which they can date acute infection, and that antibody titers are generally less reliable in patients with AIDS.

Some investigators have suggested that anterior chamber paracentesis be used to compare the ratio of the circulating anti-Toxoplasma gondii antibody titer with that inside the eye, the so-called Witmer or Witmer-Goldmann coefficient. Here, a ratio of greater than 1 would support the diagnosis of active intraocular toxoplasmosis.21–23 In practice, collection of intraocular fluid for anti-Toxoplasma gondii antibody testing is rarely necessary and, for those few diagnostic dilemmas requiring paracentesis, has been largely supplanted by newer polymerase chain reaction-based assays.177–179


A number of immunodiagnostic approaches for the detection of anti-Toxocara canis antibodies have been developed, including hemagglutination, complement fixation, and IFA testing.19,20 None of these, however, has the sensitivity and specificity of ELISA, which exceeds 90% in most laboratories.180,181 Although a titer of greater than 1:8 is considered diagnostic for ocular toxocariasis, it is important to remember that ocular toxocariasis is primarily a clinical diagnosis and that a negative titer does not rule out the disease.

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Formal audiometry may be useful for symptomatic patients with syphilis,90,91 VKH syndrome,43–45 birdshot chorioretinopathy30,31 and occasionally autoimmune vasculitis.137


Chorioretinal biopsy is most helpful in patients with undiagnosed chorioretinal inflammatory disorders that are unresponsive to standard therapy. We usually consider intraocular biopsy only in poorly seeing eyes, particularly when the second eye shows similar and worsening inflammation.182


Color vision testing serves as an objective measure of optic nerve dysfunction. In addition, patients with birdshot chorioretinopathy30,31 can develop color vision loss disproportionate to their visual acuity or fundus findings, presumably reflecting the widespread outer retinal dysfunction believed to occur in this disease.


Conjunctival and lacrimal gland biopsy should be reserved for those patients with visible conjunctival masses or lacrimal gland enlargement, as can occur with sarcoidosis,36–38 tuberculosis,84,85 or coccidioidomycosis.46,47 Blind conjunctival biopsies, although once popular in patients with suspected sarcoidosis, have a very low yield and should be avoided.183 Occasionally, a gallium scan will demonstrate lacrimal gland uptake and support the use of lacrimal gland biopsy.


Fluorescein angiography is most often used to diagnose uveitic cystoid macular edema, retinal or choroidal neovascularization, or retinal nonperfusion. Angiography is also useful in patients with neurosensory retinal detachments and outer retinal inflammations, particularly those involving the RPE.34,184


Lumbar puncture is most often used in patients with suspected intraocular lymphoma; atypical cells can be detected cytologically.32,33 Lumbar puncture should be done after a complete neurologic evaluation and imaging procedure (e.g., computed tomography [CT], magnetic resonance imaging [MRI]) to avoid unexpected shifting of intracranial contents. Lumbar puncture also is used to test for suspected meningitis, most often due to syphilis,90,91 tuberculosis,84,85 toxoplasmosis,21–23 cryptococcosis,103,104 or coccidioidomycosis.46,47


The greatest use of oral mucosal biopsy is for the diagnosis of Behçet's syndrome41,42; evidence of an occlusive vasculitis can greatly support the diagnosis. Similarly, characteristic inflammation of one of the minor salivary glands can confirm a clinical suspicion of Sjögren's disease,185 whereas inflammation of the intestinal mucosa can support the diagnosis of ulcerative colitis, Crohn's disease, or Whipple's disease.121,122


Although anterior chamber and vitreous paracenteses have limited utility with regard to determination of intraocular antibody titers (see earlier discussion), aqueous and vitreous samples are useful for polymerase chain reaction testing for toxoplasmosis177–179 and the herpesviruses,186–190 particularly in AIDS patients, in whom diagnosis can be difficult. Biopsy of the anterior and posterior chamber is also used in the following settings: (1) endophthalmitis, to obtain specimens for Gram's stain and culture or to give intraocular antibiotics191; and (2) suspected intraocular lymphoma, to obtain cells for cytologic examination.32,33,191


Intravenously injected gallium-67 citrate localizes to normal liver, spleen, and bone, as well as to areas of active inflammation, such as inflamed lymph nodes, parotid and lacrimal glands, and joints. Although any cause of inflammation can produce a positive test, the gallium scan is used most frequently to identify pulmonary hilar, or lacrimal, parotid, or submandibular gland inflammation—findings suggestive of sarcoidosis.36–38,192 It is interesting to note that although lacrimal, parotid, and salivary gland uptake is said to be less specific than hilar or paratracheal enhancement for sarcoidosis, there are fewer previous studies directly comparing regional uptake in patients with uveitis, and so the predictive value of lacrimal, parotid, and salivary gland uptake in patients with intraocular inflammation and a negative PPD remains unknown.


The sacroiliac joint is inflamed in 60% to 90% of patients with HLA-B27-related uveitis.24,25 Plain radiographs are quite useful for demonstrating inflammatory narrowing of the sacroiliac joints,193 and we order this study in any symptomatic patient with anterior, intermediate, or diffuse uveitis. CT194 and MRI195 offer increased sensitivity for documented sacroiliitis, but are considerably more expensive.


The Schlaegel test was originally proposed by Schlaegel and Weber196 as a 3-week therapeutic trial of oral isoniazid to treat presumed tuberculous uveitis. Improvement during or after treatment was viewed as a positive outcome. Early studies produced equivocal results, however, suggesting poor sensitivity.84,85 These studies notwithstanding, when skin testing supports the diagnosis of tuberculous uveitis and the remaining uveitis workup is negative, we still advocate a therapeutic trial with antituberculous medicines. We tend, however, to use two to four drugs and to treat for 2 to 6 months, depending on the patient's age and early response to the treatment.


Skin testing involves intradermal injection of 0.1 mL of antigen to elicit a delayed-type hypersensitivity reaction indicative of prior exposure. We test virtually all patients with uveitis for tuberculosis with 0.1 mL of 5 units of PPD. This includes patients with a prior bacille Calmette-Guérin (BCG) vaccination or a distant history of tuberculosis, because PPD positivity quickly reverts after BCG or adequate antituberculous therapy, and because a markedly positive test is much more supportive than 5 to 10 mm of induration.197,198 In addition, we place at least two control injections, typically Candida and mumps antigen, to rule out anergy, which can occur with sarcoidosis, AIDS, severe illness, advanced age, or pharmacologic immunosuppression.199,200

Patients with active Behçet's syndrome occasionally show increased dermal sensitivity, termed pathergy, which is manifested by formation of a local pustule in response to intradermal injection of 0.1 mL of sterile normal saline solution. This test should be performed with a 25-gauge needle and read 12 to 36 hours after injection. Although often discussed, the Behçet's skin test has limited sensitivity, even in the active phase of Behçet's syndrome.41,42

The Kveim-Siltzbach test involves intradermal injection of a suspension of spleen tissue obtained from a patient with biopsy-“proven” sarcoidosis.36–38 A biopsy specimen is obtained from the injection site at 6 weeks and examined for sarcoid granulomas, which indicates a positive test. This test is reported to be positive in up to 90% of patients with active pulmonary sarcoidosis and 25% to 50% of patients with extrapulmonary disease. Although of historical interest, the difficulty of obtaining suitable tissue, the inability to use systemic corticosteroids after placement, and concerns about transmitting infectious agents, particularly HIV, have made the test obsolete.


B-scan ultrasonography is used most commonly in patients with uveitis to investigate inflammatory choroidal and scleral thickening, as can occur with VKH syndrome,43–45 posterior scleritis,139 and sympathetic ophthalmia,72,73 and to evaluate the posterior segment in patients with dense cataracts or other media opacities.

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Our approach, consisting of a thorough history, review of systems, physical examination, thoughtful use of the naming and meshing techniques, and judicious choice of laboratory tests and special studies, should permit the practicing ophthalmologist to arrive at a diagnosis for the vast majority of patients with uveitis. Treatment options and prognoses, although outlined in Table 3, are covered more thoroughly in other sources.1–7
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1. Schlaegel TF Jr: Essentials of Uveitis. Boston, Little, Brown & Co, 1969

2. Smith RE, Nozik RA: Uveitis: A Clinical Approach to Diagnosis and Management, 2nd ed. Baltimore, Williams & Wilkins, 1989

3. Brockhurst RJ, Jakobiec FA (sect eds): Uveal tract. In Alberts DM, Jakobiec FA (vol eds): Principles and Practice of Ophthalmology. Vol 1, Clinical Practice, Sect 2, Chaps 21–37. Philadelphia, WB Saunders, 1994

4. Opremcak ME: Uveitis: A Clinical Manual for Ocular Inflammation. New York, Springer-Verlag, 1995

5. Nussenblatt RB, Whitcup SM, Palestine AG: Uveitis: Fundamentals and Clinical Practice, 2nd ed. St. Louis, Mosby, 1996

6. Pepose JS, Holland GN, Wilhelmus KR: Ocular Infection & Immunity. St. Louis, Mosby, 1996

7. Perkins ES, Folk J: Uveitis in London and Iowa. Ophthalmologica 189:36, 1984

8. Kanski JJ, Sun-Shin GA: Systemic uveitis syndromes in childhood: an analysis of 340 cases. Ophthalmology 91: 1247, 1984

9. Palvonsalo-Hietanen T, Vaahtoranta-Lehtonen H, Tuominen J, Saari KM: Uveitis survey at the university eye clinic in Turku. Acta Ophthalmologica 73:505, 1994

10. Henderly DE, Genstler AJ, Smith RE, Narsing RA: Changing patterns of uveitis. Am J Ophthalmol 103:131, 1987

11. Weiner A, BenEzra D: Clinical patterns and associated conditions in chronic uveitis. Am J Ophthalmol 112:151, 1991

12. Rothova A, Buitenhuis HJ, Meeken C et al: Uveitis and systemic disease. Br J Ophthalmol 70:137, 1992

13. Tugal-Tutkun I, Havrlikova K, Power WJ, Foster CS: Changing patterns in uveitis of childhood. Ophthalmology 103:375, 1996

14. Rodriguez A, Calonge M, Pedroza-Seres M et al: Referral patterns of uveitis in a tertiary eye care center. Arch Ophthalmol 114:593, 1996

15. Rosenberg AM: Uveitis associated with juvenile rheumatoid arthritis. Semin Arthritis Rheum 16:158, 1987

16. O'Brien JM, Albert DM: Therapeutic approaches for ophthalmic problems in juvenile rheumatoid arthritis. Rheum Dis Clin North Am 15:413, 1989

17. Henderly DE, Gentsler AJ, Rao NA, Smith RE: Pars planitis. Trans Ophthalmol Soc UK 105:227, 1985

18. Capone A Jr, Aaberg TM: Intermediate uveitis. In Albert DM, Jacobiec FA (eds): Principles and Practice of Ophthalmology, Chap 26, pp 423–442. Philadelphia, WB Saunders, 1994

19. Shields JA: Ocular toxocariasis: a review. Surv Ophthalmol 28:361, 1984

20. Molk R: Ocular toxocariasis: a review of the literature. Ann Ophthalmol 15;216, 1983

21. Nussenblatt RB, Belfort R Jr: Ocular toxoplasmosis: an old disease revisited. JAMA 271:304, 1994

22. Rothova A: Ocular involvement in toxoplasmosis. Br J Ophthalmol 77:371, 1993

23. Ronday MJ, Luyendijk L, Baarsma GS et al: Presumed acquired ocular toxoplasmosis. Arch Ophthalmol 113: 1524, 1995

24. Tay-Kearney ML, Schwam BL, Lowder C et al: Clinical features and associated systemic diseases of HLA-B27 uveitis. Am J Ophthalmol 121:47, 1996

25. Linssen A, Meenken C: Outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis. Am J Ophthalmol 120:351, 1995

26. Jones NP: Fuchs' heterochromic uveitis: an update. Surv Ophthalmol 37:253, 1993

27. La Hey E, de Jong PT, Kijlstra A: Fuchs' heterochromic cyclitis: review of the literature on the pathogenetic mechanisms. Br J Ophthalmol 78:307, 1994

28. Ciulla TA, Gragoudas ES: Serpiginous choroiditis. Int Ophthalmol Clin 36:135, 1996

29. Hardy RA, Schatz H: Macular geographic helicoid choroidopathy. Arch Ophthalmol 105:1237, 1987

30. Ryan SJ, Maumenee AE: Birdshot retinochoroidopathy. Am J Ophthalmol 89:31, 1980

31. Priem HA, Oosterhuis JA: Birdshot chorioretinopathy: clinical characteristics and evolution. Br J Ophthalmol 72:646, 1988

32. Nussenblatt RB, Whitcup SM, Palestine AG (eds): Masquerade syndromes. In: Uveitis: Fundamentals and Clinical Practice, 2nd ed, Chap 29, pp 385–395. St. Louis, Mosby, 1996

33. Weissman SS: Masquerade syndromes. Ophthalmol Clin North Am 6:127, 1993

34. Gass JDM (ed): Inflammatory diseases of the retina and choroid. In Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment, 4th ed, Vol 2, Chap 7, pp 601–736. St. Louis, Mosby, 1997

35. Nussenblatt RB, Whitcup SM, Palestine AG (eds): White-dot syndromes. In Uveitis: Fundamentals and Clinical Practice, 2nd ed, Chap 28, pp 371–384. St. Louis, Mosby, 1996

36. Weinreb RN, Tessler H: Laboratory diagnosis of ophthalmic sarcoidosis. Surv Ophthalmol 28:653, 1984

37. Jabs DA: Sarcoidosis. In Ryan SJ (ed): Retina, 2nd ed, Vol 2, Medical Retina, Chap 107, pp 1705–1712. St. Louis, Mosby-Year Book, 1994

38. Dana M-R, Merayo-Lloves J, Schaumberg DA, Foster CS: Prognosticators for visual outcome in sarcoid uveitis. Ophthalmology 103:1846, 1996

39. Jabs DA, Fine SL, Hochberg MC et al: Severe retinal vaso-occlusive disease in systemic lupus erythematosus. Arch Ophthalmol 104:558, 1986

40. Reddy DV, Foster CS: Systemic lupus erythematosus. In Albert DM, Jacobiec FA (eds): Principles and Practice of Ophthalmology, Chap 235, pp 2894–2901. Philadelphia, WB Saunders, 1994

41. Michelson JB, Chisari VF: Behçet's disease. Surv Ophthalmol 26:190, 1982

42. Jacobs DS, Foster CS: Behçet's disease. In Albert DM, Jacobiec FA (eds): Principles and Practice of Ophthalmology, Chap 253, pp 3126–3132. Philadelphia, WB Saunders, 1994

43. Rubsamen PE, Gass JDM: Vogt-Koyanagi-Harada syndrome: clinical course, therapy, and long-term visual outcome. Arch Ophthalmol 109:682, 1991

44. Benz J, Forster DJ, Lean JS et al: Variations in clinical features of the Vogt-Koyanagi-Harada syndrome. Retina 11:275, 1991

45. Moorthy RS, Inomata H, Rao NA: Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol 39:265, 1995

46. Galgiani JN: Coccidioidomycosis. West J Med 159:153, 1993

47. Foos RY, Zakka KA: Coccidioidomycosis. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 103, pp 1430–1436. St. Louis, Mosby, 1996

48. Ellis FD, Schlaegel TF: The geographic localization of presumed histoplasmic choroiditis. Am J Ophthalmol 75: 953, 1973

49. Hawkins BS, Alexander J, Schachat AP: Ocular histoplasmosis. In Ryan SJ (ed): Retina, 2nd ed, Vol 2, Medical Retina, Chap 103, pp 1661–1676. 1994

50. Kauffmann DJH, Wornser GP: Ocular Lyme disease: case report and review of the literature. Br J Ophthalmol 74:325, 1990

51. Wittpenn JR, Sibony PA, Datwyler RJ: Lyme borreliosis. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 106, pp 1469–1479. St. Louis, Mosby, 1996

52. Cano MR: Ocular cysticercosis. In Ryan SJ (ed): Retina, 2nd ed, Vol 2, Medical Retina, Chap 194, pp 1553–1557. 1994

53. Friedman AH: Cysticercosis. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 87, pp 1236–1243. St. Louis, Mosby, 1996

54. Taylor HR, Nutman TB: Onchocerciasis. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 107, pp 1481–1504. St. Louis, Mosby, 1996

55. World Health Organization Expert Committee: Epidemiology of onchocerciasis: technical report series 597, WHO, Geneva, 1976

56. Consul BN, Sharma DP, Chhabra HN, Sahai R: Uveitis: etiological pattern in India. Eye, Ear, Nose Throat Monthly 51:122, 1972

57. Ayanru JO: The problem of uveitis in the Bendel State of Nigeria: experience in Benin City. Br J Ophthalmol 61: 655, 1977

58. Ronday MJ, Stilma JS, Barbe RF et al: Blindness from uveitis in a hospital population in Sierra Leone. Br J Ophthalmol 78:690, 1994

59. Kean BH: Clinical toxoplasmosis: 50 years. Trans R Soc Trop Med Hyg 66:549, 1972

60. Feldman HA, Miller LT: Serological study of ocular toxoplasmosis. Am J Hyg 64:320, 1956

61. Glasner PD, Silveira CM, Kruszon-Moran D et al: An unusually high prevalence of ocular toxoplasmosis in southern Brazil. Am J Ophthalmol 114:136, 1992

62. Melamed J, Sebben JC, Maestri M et al: Epidemiology of ocular toxoplasmosis in Rio Grande do Sul, Brazil. In Dernouchamps JP, Verougstraete C, Caspers-Velu L (eds): Recent Advances in Uveitis: Proceedings of the Third International Symposium on Uveitis, Brussels, Belgium. Amsterdam, Kugler, 1993

63. Kanski JJ, Petty RE: Chronic childhood arthritis and uveitis. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 40, pp 485–493. St. Louis, Mosby, 1996

64. Sieving PA, Fishman GA: Refractive errors of retinitis pigmentosa patients. Br J Ophthalmol 62:163, 1978

65. Schepens CL, Marden D: Data on the natural history of retinal detachment: further characterization of certain unilateral non-traumatic cases. Am J Ophthalmol 61:213, 1966

66. O'Connor GR: Recurrent herpes simplex uveitis in humans. Surv Ophthalmol 21:165, 1976

67. Womack LW, Liesegang TJ: Complications of herpes zoster ophthalmicus. Arch Ophthalmol 101:42, 1983

68. Boldt HC, Pulido JS, Blodi CF et al: Rural endophthalmitis. Ophthalmology 96:1722, 1989

69. Brinton GS, Topping TM, Hyndiuk RA et al: Posttraumatic endophthalmitis. Arch Ophthalmol 102:547, 1984

70. Marak GE: Phacoanaphylactic endophthalmitis. Surv Ophthalmol 36:325, 1992

71. Meltzer DW: Sterile hypopyon following intraocular lens surgery. Arch Ophthalmol 98:100, 1980

72. Chan CC, Roberge FG, Whitcup SM, Nussenblatt RB: 32 cases of sympathetic ophthalmia: a retrospective study at the National Eye Institute, Bethesda, MD, from 1982-1992. Arch Ophthalmol 113:597, 1995

73. Rao NA, Xu S, Font RL: Sympathetic ophthalmia: an immunohistochemical study of epithelioid and giant cells. Ophthalmology 92:1660, 1985

74. Melles RB, Wong IG: Metipranolol-associated granulomatous iritis. Am J Ophthalmol 118:712, 1994

75. Jain S: Betaxolol-associated anterior uveitis. Eye 8:708, 1994

76. Yaldo MK, Lieberman MF: The management of secondary glaucoma in the uveitis patient. Ophthalmol Clin North Am 6:147, 1993

77. Becker B: IOP response to topical corticosteroids. Invest Ophthalmol 4:198, 1965

78. Weinreb R, Polansky J, Kramer S, Baxter JD: Acute effects of dexamethasone on intraocular pressure in glaucoma. Invest Ophthalmol Vis Sci 26:170, 1985

79. Tilden ME, Rosenbaum JT, Fraunfelder FT: Systemic sulfonamides as a cause of bilateral, anterior uveitis. Arch Ophthalmol 109:67, 1991

80. Macarol V, Fraunfelder FT: Pamidronate disodium and possible ocular adverse drug reactions. Am J Ophthalmol 118:220, 1994

81. Shafran SD, Deschenes J, Miller M et al: Uveitis and pseudojaundice during a regimen of clarithromycin, rifabutin, and ethambutol. N Engl J Med 330:438, 1994

82. Saran BR, Maguire AM, Nichols C et al: Hypopyon uveitis in patients with acquired immunodeficiency syndrome treated for systemic Mycobacterium avium complex infection with rifabutin. Arch Ophthalmol 112:1159, 1994

83. Tseng AL, Walmsley SL: Rifabutin-associated uveitis. Ann Pharmacother 29:1149, 1995

84. Helm CJ, Holland GN: Ocular tuberculosis. Surv Ophthalmol 38:229, 1993

85. Rosen PH, Spalton DJ, Graham EM: Intraocular tuberculosis. Eye 4:486, 1990

86. Tabbara KF, al Kassimi H: Ocular brucellosis. Br J Ophthalmol 74:249, 1990

87. Walker J, Sharma OP, Rao NA: Brucellosis and uveitis. Am J Ophthalmol 114:374, 1992

88. Egbert PR, Pollard RB, Gallagher JG, Merigan TC: Cytomegalovirus retinitis in immunosuppressed hosts: II. Ocular manifestations. Ann Intern Med 93:664, 1980

89. Kuppermann BD, Pety JG, Richman DD et al: Correlation between CD4+ counts and the prevalence of cytomegalovirus retinitis and human immunodeficiency virus-related noninfectious retinal vasculopathy in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 115:575, 1993

90. Margo CE, Hamed LM: Ocular syphilis. Surv Ophthalmol 37:203, 1992

91. Tamesis RR, Foster CS: Ocular syphilis. Ophthalmology 97:1281, 1990

92. Wakefield D, Penny R: Cell-mediated immune response to Chlamydia in anterior uveitis: role of HLA-B27. Clin Exp Immunol 51:191, 1983

93. Manabu M, Watanabe T, Yamaguchi K, Tajima K: Human T-lymphotrophic virus, type I associated disease. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 98, pp 1366–1387. St. Louis, Mosby, 1996

94. Mochizuki M, Tajima K, Yamaguchi K: Human T lymphotrophic virus type I uveitis. Br J Ophthalmol 78:149, 1994

95. Holland GN, Pepose JS, Petit TH et al: Acquired immune deficiency syndrome: ocular manifestations. Ophthalmology 90:859, 1983

96. Palestine AG, Rodrigues MM, Macher AM et al: Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology 91:1092, 1984

97. Kestelyn P, Van de Perre P, Rouvroy D et al: A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome in Africa. Am J Ophthalmol 100:230, 1985

98. Jabs DA, Green WR, Fox R et al: Ocular manifestations of acquired immune deficiency syndrome. Ophthalmology 96:1092, 1989

99. Dennehy PJ, Warman R, Flynn JT et al: Ocular manifestations in pediatric patients with acquired immunodeficiency syndrome. Arch Ophthalmol 107:978, 1989

100. Lewallen S, Kumwend J, Maher D, Harries AD: Retinal findings in Malawian patients with AIDS. Br J Ophthalmol 78:757, 1994

101. Rao NA, Zimmerman PL, Boyer D et al: A clinical, histopathologic, and electron microscopic study of Pneumocystis carinii choroiditis. Am J Ophthalmol 107:218, 1989

102. Holland GN, McArthur LJ, Foos RY: Choroidal pneumocystosis. Arch Ophthalmol 109:1454, 1991

103. Muccioli C, Belfort R Jr, Neves R, Rao N: Limbal and choroidal Cryptococcus infection in the acquired immunodeficiency syndrome. Am J Ophthalmol 120:539, 1995

104. Kestelyn P, Taelman H, Bogaerts J et al: Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 116:721, 1993

105. Whitcher JP, Irvine AR: Endogenous bacterial endophthalmitis. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 92, pp 1287–1297. St. Louis, Mosby, 1996

106. Pettit TH, Edwards JE Jr, Purdy EP, Bullock JD: Endogenous fungal endophthalmitis. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 91, pp 1262–1286. St. Louis, Mosby, 1996

107. Jones DB: Cat-scratch disease. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 99, pp 1389–1397. St. Louis, Mosby, 1996

108. Golnik KC, Marotto ME, Fanous MM et al: Ophthalmic manifestations of Rochalimaea species. Am J Ophthalmol 118:145, 1994

109. Mets MB, Holfels E, Boyer KM et al: Eye manifestations of congenital toxoplasmosis. Am J Ophthalmol 122:309, 1996

110. Nicol WG, Rios-Montenegro EN, Smith JL: Congenital ocular syphilis. Am J Ophthalmol 68:467, 1969

111. Arnold J: Ocular manifestations of congenital rubella. Curr Opin Ophthalmol 6:45, 1995

112. Pass RF, Stagno S, Myers GJ, Alford CA: Outcome of symptomatic congenital cytomegalovirus infection: results of long-term longitudinal follow-up. Pediatrics 66:758, 1980

113. Nahmias AJ, Visintine AM, Caldwell DR, Wilson LA: Eye infections with herpes simplex viruses in neonates. Surv Ophthalmol 21:100, 1976

114. Hogan MJ, Kimura SJ: Chronic cyclitis. Trans Am Ophthalmol Soc 61:373, 1963

115. Witmer R, Korner G: Uveitis in kindesalter. Ophthalmologica 152:277, 1966

116. Giles CL, Tanton JH: Peripheral uveitis in three children of one family. J Pediatr Ophthalmol Strabismus 17:297, 1980

117. Augsburger JJ, Annesley WH, Sergott RC et al: Familial pars planitis. Ann Ophthalmol 13:553, 1981

118. Culbertson WW, Giles GL, West C, Stafford T: Familial pars planitis. Retina 3:179, 1983

119. Blau EB: Familial granulomatous arthritis, iritis, and rash. J Pediatr 107:689, 1985

120. Eridsson A, Fagerholm P, Olsson K: Keratouveitis: two families with a dominantly inherited disorder. Acta Ophthalmol Scand 74:473, 1996

121. Ernst BB, Lowder CY, Meisler DM, Gutman FA: Posterior segment manifestations of inflammatory bowel disease. Ophthalmology 98:1272, 1991

122. Richman LS, Freeman WR, Green WR et al: Brief report: uveitis caused by Tropheryma whippelli (Whipple's bacillus). N Engl J Med 332363, 1995

123. Posner A, Schlossman A: Syndrome of unilateral recurrent attacks of glaucoma with cyclitic symptoms. Arch Ophthalmol 39:517, 1948

124. Legmann A, Foster CS: Noninfectious necrotizing scleritis. Int Ophthalmol Clin 36:73, 1996

125. Sainz de la Maza M, Foster CS, Jabbur NS: Scleritis associated with rheumatoid arthritis and with other systemic immune-mediated diseases. Ophthalmology 101:1281, 1994

126. Lucchese N, Tessler H: Keratitis associated with chronic iridocyclitis. Am J Ophthalmol 92:717, 1981

127. Khodadoust AN, Karama Y, Stoessel KM, Puklin JE: Pars planitis and autoimmune endotheliopathy. Am J Ophthalmol 102:633, 1986

128. Hogan MJ, Kimura SJ, Thygeson P: Signs and symptoms of uveitis: I. Anterior uveitis. Am J Ophthalmol 47:155, 1959

129. Fong DS, Raizman MB: Spontaneous hyphema associated with anterior uveitis. Br J Ophthalmol 77:635, 1993

130. Meisler DM, Palestine AG, Vastine DW et al: Chronic Propionibacterium endophthalmitis after extracapsular cataract extraction and intraocular lens implantation. Am J Ophthalmol 102:733, 1986

131. Flicker L, Meredith TA, Wilson LA et al: Chronic bacterial endophthalmitis. Am J Ophthalmol 103:745, 1987

132. Kimura SJ, Thygeson P, Hogan MJ: Signs and symptoms of uveitis: II. Classification of the posterior manifestations of uveitis. Am J Ophthalmol 47:171, 1959

133. Nussenblatt RB, Palestine AG, Chan CC, Roberge F: Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology 92:467, 1985

134. Cunningham ET Jr, Schatz H, McDonald HR, Johnson RN: Acute multifocal retinitis. Am J Ophthalmol 123:347, 1997

135. Engstrom RE Jr, Holland GN, Margolis TP et al: The progressive outer retinal necrosis syndrome: a variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology 101:1488, 1994

136. Pepose JS: Acute retinal necrosis syndrome. In Ryan SJ (ed): Retina, 2nd ed, Vol 2, Medical Retina, Chap 97, pp 1597–1605. 1994

137. Nussenblatt RB, Whitcup SM, Palestine AG (eds): Retinal Vasculitis. In Uveitis: Fundamentals and Clinical Practice, 2nd ed, Chap 26, pp 354–363. St. Louis, Mosby, 1996

138. Rothova A, Suttorp-van Schulten MSA, Treffers WF, Kijlstra A: Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol 80: 332, 1996

139. Calthorpe CM, Watson PG, McCartney ACE: Posterior scleritis: a clinical and histopathological survey. Eye 2: 267, 1988

140. Macher A, Rodriguex MM, Kaplan W et al: Disseminated bilateral chorioretinitis due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome. Ophthalmology 92:1159, 1985

141. Rosenbaum JT, Wernick R: Selection and interpretation of laboratory tests for patients with uveitis. Int Ophthalmol Clin 30:238, 1990

142. Rosenbaum JT, Wernick R: The utility of routine screening of patients with uveitis for systemic lupus erythematosus or tuberculosis. Arch Ophthalmol 108:1291, 1990

143. Ainsley GM, Benatar SR: Serum angiotensin converting enzyme in sarcoidosis: sensitivity and specificity in diagnosis: correlations with disease activity, duration, extrathoracic involvement, radiographic type and therapy. Q J Med 55:253, 1985

144. Lieberman J: Enzymes in sarcoidosis: angiotensin converting enzyme (ACE). Clin Lab Med 9:745, 1989

145. Nakamura RM, Tan EM: Update on autoantibodies to intracellular antigens in systemic rheumatic diseases. Clin Lab Med 12:1, 1992

146. Thomas C, Robinson JA: The antinuclear antibody test: when is a positive result clinically relevant? Postgrad Med 2:55, 1993

147. Young DW: The antineutrophil antibody in uveitis. Br J Ophthalmol 75:208, 1991

148. Soukiasian SH, Foster CS, Niles JL, Razman MB: Diagnostic value of anti-neutrophil cytoplasmic antibodies in scleritis associated with Wegener's granulomatosis. Ophthalmology 99:125, 1992

149. Nolle B, Coners H, Guncker G: ANCA in ocular inflammatory disorders. Adv Exp Med Biol 336:305, 1993

150. Savige JA, Davies DJ, Gatenby PA: Anti-neutrophil cytoplasmic antibodies (ANCA): their detection and significance: report from workshops. Pathology 26:186, 1994

151. Chan TKJ, Dick AD, Forrester JV, Herriot R: Antineutrophil cytoplasmic antibodies in chronic idiopathic intraocular inflammatory disease. Ocular Immunol Inflamm 4:83, 1996

152. Churg J, Strauss L: Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol 27:277, 1951

153. Lanham JG, Elkon KB, Pusey CD, Hughes GR: Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine 63:65, 1984

154. Miller A, Green M, Robinson D: Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J Clin Res Ed 286:266, 1983

155. Weinberg DA, Savino PJ, Sergott RC, Bosley TM: Giant cell arteritis: corticosteroids, temporal artery biopsy, and blindness. Arch Fam Med 3:623, 1994

156. Zlonis M: The mystique of the erythrocyte sedimentation rate: a reappraisal of one of the oldest laboratory tests still in use. Clin Lab Med 13:787, 1993

157. Wolfe F, Michaud K: The clinical and research significance of the erythrocyte sedimentation rate. J Rheumatol 21: 1227, 1994

158. Dinant GJ, De Kock CA, van Wersch JWJ: Diagnostic value of C-reactive protein measurement does not justify replacement of the erythrocyte sedimentation rate in daily general practice. Eur J Clin Invest 25:353, 1995

159. Siegel D, Golden E, Washington AE et al: Prevalence and correlation of herpes simplex infections: the population-based AIDS in multiethnic neighborhoods study. JAMA 268:1702, 1992

160. Lucht E, Sundqvist V-A, Linde A et al: Presence of autologous neutralizing antibodies against cytomegalovirus (CMV) in serum of human immunodeficiency virus type 1-infected patients shedding CMV in saliva. J Infect Dis 169:1096, 1994

161. Ness PM, Nass CC: Blood donor testing for HIV-I/II and HTLV-I/II. Arch Pathol Lab Med 118:337, 1994

162. Hansen KN: HIV testing. Emerg Med Clin North Am 13:43, 1995

163. Tomlinson IP, Bodmer WF: The HLA system and the analysis of multifactorial genetic disease. Trends Genet 11:493, 1995

164. Thomson G: HLA disease associations: Models for the study of complex human genetic disorders. Crit Rev Clin Lab Sci 32:183, 1995

165. Luger SW, Krauss E: Serologic tests for Lyme disease: interlaboratory variability. Arch Int Med 150:761, 1990

166. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR 44:590, 1995

167. Magnarelli LA, Anderson JF, Johnson RC: Crossreactivity in serological tests of Lyme disease and other spirochetal infections. J Infect Dis 149:789, 1987

168. Keymeulen B, Somers G, Naessens A, Verbruggen LA: False positive ELISA serologic test for Lyme borreliosis in patients with connective tissue diseases. Clin Rheumatol 12:526, 1993

169. Prior C, Barbee RA, Evans PM et al: Lavage versus serum measurements of lysozyme, angiotensin converting enzyme and other inflammatory markers in pulmonary sarcoidosis. Eur Respir J 3:1146, 1990

170. Carson DA: Rheumatoid factor. In Kelley WN, Harris ED Jr, Ruddy S, Sledge CB (eds): Textbook of Rheumatology, 3rd ed, pp 664–679. Philadelphia, WB Saunders, 1989

171. Hart G: Syphilis tests in diagnostic and therapeutic decision making. Ann Intern Med 104:368, 1986

172. Halperin LS: Neuroretinitis due to seronegative syphilis associated with human immunodeficiency virus. J Clin Neuro Ophthalmol 12:171, 1992

173. Turner BJ, Hecht FM, Ismail RB: CD4+ T-lymphocyte measures in the treatment of individuals infected with human immunodeficiency virus type 1: a review for clinical practitioners. Arch Intern Med 154:1561, 1994

174. Zurlo JJ, Wood L, Gaglione MM, Polis MA: Effect of splenectomy on T lymphocyte subsets in patients infected with the human immunodeficiency virus. Clin Infect Dis 20:768, 1995

175. Weiss MJ, Velazquez N, Hofeldt AJ: Serologic tests in the diagnosis of presumed toxoplasmic retinochoroiditis. Am J Ophthalmol 109:407, 1990

176. Phaik CS, Seah S, Guan OS et al: Anti-Toxoplasma serotitres in ocular toxoplasmosis. Eye 5:636, 1991

177. Norose K, Tokushima T, Yano A: Quantitative polymerase chain reaction in diagnosing ocular toxoplasmosis. Am J Ophthalmol 121:441, 1996

178. Manners RM, O'Connell S, Guy EC et al: Use of the polymerase chain reaction in the diagnosis of acquired ocular toxoplasmosis in immunocompetent adults. Br J Ophthalmol 78:583, 1994

179. Chan CC, Palestine AG, Li Q, Nussenblatt RB: Diagnosis of ocular toxoplasmosis by the use of immunocytology and the polymerase chain reaction. Am J Ophthalmol 117: 803, 1994

180. Gillespie SH, Bidwell D, Voller A et al: Diagnosis of human toxocariasis by antigen capture enzyme linked immunosorbent assay. J Clin Pathol 46:551, 1993

181. Jacquier P, Gottstein B, Stingelin Y, Eckert J: Immunodiagnosis of toxocariasis in humans: evaluation of a new enzyme-linked immunosorbent assay kit. J Clin Microbiol 29:1831, 1991

182. Freeman WR, Wiley CA, Gross JG et al: Endoretinal biopsy in immunosuppressed and healthy patients with retinitis. Ophthalmology 96:1559, 1989

183. Nichols CW, Eagle RC, Yanoff M, Menocal NG: Conjunctival biopsy as an aid in the evaluation of the patient with suspected sarcoidosis. Ophthalmology 87:287, 1980

184. De Laey J-J: Fluorescein angiography in posterior uveitis. Int Ophthalmol Clin 35:33, 1995

185. Pflugfelder SC, Whitcher JP, Daniels TE: Sjögren syndrome. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 23, pp 313-33. St. Louis, Mosby, 1996

186. Cunningham ET Jr, Short GA, Irvine AR et al: Acquired immunodeficiency syndrome-associated herpes simplex virus retinitis: clinical description and use of a polymerase chain reaction-based assay as a diagnostic tool. Arch Ophthalmol 114:834, 1996

187. McCann JD, Margolis TP, Wong MG et al: A sensitive and specific polymerase chain reaction-based assay for the diagnosis of cytomegalovirus retinitis. Am J Ophthalmol 120:219, 1995

188. Yamamoto S, Pavan-Langston D, Kinoshita S et al: Detecting herpesvirus DNA in uveitis using the polymerase chain reaction. Br J Ophthalmol 80:465, 1996

189. de Boer JH, Verhagen C, Bruinenberg M et al: Serologic and polymerase chain reaction analysis of intraocular fluids in the diagnosis of infectious uveitis. Am J Ophthalmol 121:650, 1996

190. Short GA, Margolis TP, Kuppermann DB et al: A polymerase chain reaction based assay for diagnosing varicella-zoster virus retinitis in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 123:157, 1997

191. Freeman WR: Application of vitreoretinal surgery to inflammatory and infectious disease of the posterior segment. Int Ophthalmol Clin 32:15, 1992

192. Israel HL, Albertine KH, Park CH, Patrick H: Whole-doby gallium 67 scans: role in diagnosis of sarcoidosis. Am Rev Respir Dis 144:1182, 1991

193. Robbins SE, Morse MH: Is the acquisition of a separate view of the sacroiliac joints in the prone position justified in patients with back pain? Clin Radiol 51:637, 1996

194. Friedman L, Silberberg PJ, Rainbow A, Butler R: A limited, low-dose computed tomography protocol to examine the sacroiliac joints. Can Assoc Radiol J 44:267, 1993

195. Wittram C, Whitehouse GH: Normal variation in the magnetic resonance imaging appearances of the sacroiliac joints: pitfalls in the diagnosis of sacroiliitis. Clin Radiol 50:371, 1995

196. Schlaegel TF Jr, Weber JC: Double-blind therapeutic trial of isoniazid in 344 patients with uveitis. Br J Ophthalmol 53:425, 1969

197. Martin P: The tuberculin skin test. NZ Med J 107:310, 1994

198. Rose DN, Schechter CB, Adler JJ: Interpretation of the tuberculin skin test. J Gen Intern Med 10:635, 1995

199. Wright PW, Crutcher JE, Holiday DB: Selection of skin test antigens to evaluate PPD anergy. J Fam Pract 41:59, 1995

200. Caiaffa WT, Graham NMH, Galai N et al: Instability of delayed-type hypersensitivity skin test anergy in human immunodeficiency virus infection. Arch Intern Med 155:2111, 1995

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