The document discusses the goals and process of diagnosing uveitis. The main goals are to accurately diagnose the condition, determine prognosis, and design an appropriate treatment plan. The diagnosis process involves 3 steps: 1) Creating a detailed "name" combining descriptive terms of the case. 2) "Meshing" the patient's profile with profiles of known uveitic entities to create a differential diagnosis list. 3) Ordering tests and consultations to rule in or out possibilities on the list to determine the final diagnosis. This process aims to correctly diagnose 75-85% of cases, but some may resist categorization or have atypical features requiring referral to a specialist.

1. Uveitis Diagnosis
Goals of Uveitis Management
 When dealing with uveitis, the main goal
of the clinical ophthalmologist is to
manage his patients properly.

2. Uveitis Diagnosis
Goals of Uveitis Management
To achieve this ultimate goal for each patient, he
must first make three important determination:
1. Diagnosis: Accurate diagnosis based on the
identification of the lesion and of its cause.
2. Prognosis: Determine the problem prognosis.
3. Therapy: Design the best possible therapeutic
regimen to be undertaken.

3. Diagnosis
1. Categorize the patient’s uveitis as accurately as
possible.
2. I.e. to identify the category of uveitis in which the
patient’s disease probably belongs.
3. This is important because the:
a. Clinical Course
b. Response to therapy and
c. complications
Of the various categories are
for the most part known and
predictable.

4. Diagnosis
 Once the diagnosis has been
determined, therefore, decisions
relative to:
1. Prognosis
2. Treatment
Can be made almost automatically

5. Diagnosis
 The number of “Common Uveitic Entities” is in fact
surprisingly small.
 It comprises only some 20-30 entities.
 Of course, a list of all possible entities would run into
the hundreds.

6. Diagnosis
 Fortunately we can ignore this huge list with impunity since our
smaller one covers 90% or more of the uveitis cases seen in the
general practice of ophthalmology.
 The list of “Likely Uveitis Entities” not only relatively short, but
most of the entities are different enough from others on the list to
make clinical differentiation relatively easy:

Signs and symptoms

Bilaterality

Response to laboratory tests

Predilection with respect to eye, sex and race etc.

7. Diagnostic Methods
 To place a case of uveitis in its proper
uveitic category, the following three steps
must be taken.
1. Naming
2. Meshing
3. Determining the final diagnosis

8. Naming
 Simple and effective approach
 Combine all of the terms descriptive of the
salient historical and clinical facts referable to
the case under study in a detailed “working”
name for the patient’s uveitis.

9. Examples of detailed “Naming”
 Example 1
 Ch, BL, NG, iridocyclitis, with band keratopathy, in
a 10 years-old white female with arthritic of the
right knee.
 Example 2
 Ch, UL, NG. Iridocyclitis with secondary cataract,
open angle glaucoma and heterochromia in 30-
years old white female.

10. Examples of detailed “Naming
 Example 3
 Ch, BL, diffuse granulomatous uveitis with 2ndry
retinal vasculitis in a 40-year old black female.
 Example 4
 Ch, BL diffuse granulomatous uveitis and serous
macular detachments in a 22-year old oriental
male with tinitis and alopecia areata

11. Meshing
1. The naming process creates a profile or template of
the clinical case in question .
2. The greater the detail, the finer and more sharply
etched the profile.

12. Meshing
3. The entities (20-30) on the list of “Likely Uveitis
Entities” also has a profile based on its clinical
characteristics.
4. Match the patients profile as closely as possible
with one or more of the known disease profiles
(meshing).

13. Meshing
5. When the profile of a patient closely resembles the profile of
the uveitic entity, we put the entity on the list of diagnostic
possibilities.
6. Put the entity with the best fitting (meshing) profile first and
the one with the poorest meshing profile last.

14. Naming and Meshing
 Applying the the naming and meshing
procedures to the four examples of
naming given above, the diagnostic
possibilities in order of likely would be
as follows:

15. Meshing
 Example 1
 Uveitis associated with Juvenile rheumatoid
arthritis.
 Sarcoid uveitis (less likely)
 Example 2
 Fuch’s Heterochronic iridocyclitis
 Acute recurrent NG iridocyclitis that has become
chronic.
 Posner – Schlossman syndrome
 Severe post-traumatic iridocyclitis
 2, 3, 4 – less likely

16. Meshing
 Example 3
 Sarcoid uveitis
 Syphilitis
 Tuberculosis
 Vogt – koyanagi-Harada syndrome
 Behects syndrome
 Example 4
 Vogt-Koyanagi-Harada syndrome
 Sarcoid uveitis
 Tuberculosis
Less likely
Possibilities only

17. Determining the final diagnosis
 Working with the small list of diagnostic
possibilities generated by the naming and
meshing processes, we can order:
1. Standard laboratory tests
2. Special tests
3. Request consultation with
other specialties
In order to rule in or
rule out the
suspected entities

18. Determining the final diagnosis
 Please note that it is only after the naming
and meshing steps that these tests and
consultation should be sought.
 Nothing should be ordered routinely .

19. Determining the final diagnosis
 All tests and consultations should be for the
purpose of answering specific diagnostic
questions
 This is in the interest of reducing the cost of
medical care, but even more importantly to
encourage clear thinking and speed up the
diagnostic process

20. Naming
Hx + PE
Clinical characteristics
of known Uveitis
Entities
Differential
Diagnostic List
Ordered
Differential
Diagnostic List
Reorder Based
on Mesh
Laboratory
Special Tests
Consultations
Uveitic
Diagnosis
PROPER
PATIENT
MANAGEMENT
Known Course
Known Complications
Known Response to Therapy
Naming-Meshing Diagram

21. Limitations of the naming and
meshing system
 By using the naming-meshing system and
supplementing it with the:
 Standard test tests
 Special tests
 Consultations
We should be able to make correct
presumption diagnosis of a case of uveitis in
75-85% of uveitis patients seen in general
clinical practice.

22. Limitations of the naming and
meshing system
 This means that 15-25% of cases will
either resist categorization or will
present special problems in response to
treatment or development of
complication.

23. Limitations of the naming and
meshing system
 All these problems will place such
cases beyond the scope of the method
of attack presented here.

24. Limitations of the naming and
meshing system
 There are after all, hundreds of uveitic
entities and we can dealing with a list of
only 20-30.
 When the rare entities occur, they will
always create diagnostic problems.

25. Limitations of the naming and
meshing system
 Recognizing the limitations of a system
is as important as recognizing its
virtues.

26. Limitations of the naming and
meshing system
 When clear diagnostic answers are not
forthcoming.
 When the disease does not follow its
expected course.
 When the anticipated response to therapy
does not occur.
 The rarities and the uveitis masquerade
syndromes should be considered and
patients should be referred if possible to a
uveitis center.