Uveitis or Iritis of Unknown Etiology: Inflammation in the eye for unknown reasons

Uveitis or Iritis of Unknown Etiology: Inflammation in the eye for unknown reasons

Uveitis is inflammation of the uveal tract, which is further subdivided into anterior (front) and posterior (back part of eye) components. 

The anterior tract is composed of the iris and ciliary body. Inflammation of the iris is called iritis.
The posterior tract includes choroid. 

Uveitis is inflammation of any of these components and may also include other surrounding tissues such as sclera, retina, and optic nerve.

Uveitis can be due to many causes.

The most common is idiopathic, which means, all blood test are normal and we do not know why the inflammation is there. 
Other causes are:
1. Trauma
2. Autoimmune Disease or immune reaction: (ie from Rheumatoid Arthritis, Inflammatory Bowel Disease, Crohn’s)
3. Infections: from virus, bacteria
4. Cancer

The red coloring below represents the uveal tract. 

First episode of non-granulomatous iritis (a type of iritis or eye inflammation and the most common) usually does not require an extensive work up. If there are no other finding on a general physical examination, we follow the patient to see if another episode occurs. 

However, if there is any risk of Lyme, Herpes disease, we would recommend a baseline Lyme, Herpes titers. 

If iritis (or uveitis) recurrs multiple times, the standard of care for blood tests are as follows: 

1. CBC, 

2. ESR, 

3. CRP, 

4. HLA-B27

5. RPR, 

6. FTA-ABS, 

7. ACE level, 

8. Lyme titer, 

9. Toxoplasmosis titer, 

10. PPD, 

11. urinalysis, 

12. Chest X-ray, 

13. HIV. 

If the patient has diarrhea or a history of Inflammatory Bowel Disease (Crohn’s Disease or Ulcerative Colitis), we will recommend: 

14. test for anti-Saccharomyces cerevisiae antibodies (ASCA): more common in Crohn disease 

15. perinuclear anti-neutrophil cytoplasmic antibody (pANCA):more common in Ulcerative Colitis 

Studies have shown a nonspecific approach to laboratory work-up in the initial diagnosis of iritis/uveitis is both inefficient and cost-intensive. Thus a focused history and examination would determine which labs tests are most appropriate so we do not order 15 labs.

For patients who we suspect of having Inflammatory Bowel Disease:

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