There are several different descriptors that can be used to sensibly categorise intraocular inflammatory diseases [i]. The primary classification should be anatomical. By then describing a patient’s findings in with these additional terms and combining this classification with the demographics of the patient and relevant investigation findings, the differential diagnosis can be narrowed rapidly.
Jabs, D.A., Nussenblatt, R.B. and Rosenbaum, J.T. 2005. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 140(3) 509-516.
ACUTE ( <3 months)
Anterior segment ischaemia
Chronic ( >3 months)
Aetiologies from Clinical Features
Children with intermediate uveitis present many challenges:
The differential diagnosis of posterior uveitis is wide. A careful, broad history including a directed review of systems should be taken. Travel, pets, occupation, vaccinations, hobbies and sexual history are all relevant. Attempt to narrow down the diagnosis to an infection, inflammatory or an atypical cause, then proceed accordingly. Sight-threatening posterior uveitis requires immediate empirical treatment covering all reasonable elements of the differential. A vitreous biopsy is often required to confidently exclude infection in these cases.
Nematodes and Helminths
Retinal vasculitis is important as secondary occlusions can develop. The differential diagnosis is narrowed considerably by careful observation of which vessels are inflamed [ii]:
Talat, L., Lightman, S. and Tomkins-Netzer, O. 2014. Ischemic Retinal Vasculitis and Its Management. Journal of Ophthalmology 2014 197675.
Leads to ischaemia
Can be subtle when seen early (may need FFA to diagnose)
Common, non- specific
May be ischaemic
Sheathing can persist post resolution of inflammation
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