Uveitis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]

Differential Diagnosis

Uveitis must be differentiated from other diseases that cause conjunctival injection, eye pain, photophobia, or visual disturbance. Masquerade syndromes, which are ophthalmic disorders that clinically present as either an anterior or posterior uveitis but are not primarily inflammatory, must be differentiated from uveitis. As uveitis manifests in a variety of clinical etiologies, differentiation must also be established in accordance with the particular subtype.

Differentiating Uveitis from Other Diseases

Uveitis must be differentiated from other diseases that cause conjunctival injection, eye pain, photophobia, or visual disturbance.

• Acute closed angle glaucoma
• Acute conjunctivitis
• Corneal ulceration and Ulcerative keratitis
• Corneal abrasion
• HSV keratitis
• Intraocular foreign body
• Scleritis
• Endophthalmitis
• Ultraviolet keratitis

Masquerade syndromes

Masquerade syndromes are ophthalmic disorders that clinically present as either an anterior or posterior uveitis, but are not primarily inflammatory. The following are some of the most common:

• Anterior segment

• Intraocular foreign body
• Juvenile xanthogranuloma
• Leukemia
• Malignant melanoma
• Retinoblastoma
• Retinal detachment

• Posterior segment

• Lymphoma
• Malignant melanoma
• Multiple sclerosis
• Reticulum cell sarcoma
• Retinitis pigmentosa
• Retinoblastoma

Differential Diagnosis of Uveitis Subtypes by Clinical Features

As uveitis manifests in a variety of clinical etiologies, differentiation must also be established in accordance with the particular subtype. Etiologies of acute anterior unilateral infectious uveitis must be differentiated from other subtypes that cause conjuctival injection, pain, and photophobia, such as acute anterior bilateral non-infectious uveitis or chronic anterior uveitis. Diversely, posterior infectious uveitis must be differentiated from other subtypes that cause visual changes, such as intermediate non-infectious uveitis and infectious panuveitis.

Anterior Uveitis

Anterior uveitis can be differentiated according to the following presentation:

• Acute (>3 months of active symptoms)
  • Unilateral
    • Infectious: Cytomegalovirus, Herpes simplex, Varicella zoster, Syphilis
    • Non-infectious: seronegative spondyloarthropathy, relapsing polychondritis, systemic lupus erythematosus (SLE), Kawasaki disease
  • Bilateral
    • Infectious: Tuberculosis, Syphilils
    • Non-infectious: tubulointerstitial nephritis with uveitis (TINU syndrome)
• Chronic (>3 months of active symptoms)
  • Infectious: Tuberculosis
  • Non-infectious: juvenile idiopathic arthritis, Sjorgen syndrome, sarcoidosis

Intermediate Uveitis

Intermediate may present with unilateral or bilateral involvement. It can be differentiated according to the following etiologies:

• Infectious: Lyme disease, Whipple's disease
• Non-infectious: multiple sclerosis, sarcoidosis, tubulointerstitial nephritis with uveitis (TINU syndrome), lymphoma

Posterior Uveitis

Posterior uveitis may present with unilateral or bilateral involvement. It can be differentiated according to the following etiologies:

• Infectious: Toxoplasmosis, Cytomegalovirus, Tuberculosis, Syphilis, Toxocariasis, Herpes simplex, Varicella zoster, cat scratch disease
• Non-infectious:Vogt-Koyanagi-Harada syndrome, systemic lupus erythematosus, granulomatosis with polyangitis, Behcet's disease, lymphoma

Panuveitis

Panuveitis may present with unilateral or bilateral involvement. It can be differentiated according to the following etiologies:

• Infectious: Tuberculosis, Syphilis
• Non-infectious: juvenile idiopathic arthritis, Behcet's disease, sarcoidosis, Vogt-Koyanagi-Harada syndrome, Sjorgen syndrome