Ordering specific test in Uveitis – Avoiding a scattershot approach
Ordering specific investigations in uveitis involves a systematic approach to identify the underlying cause and guide appropriate treatment, with the initial evaluation typically including a comprehensive eye examination, detailed medical history, and assessment of symptoms, carefully analysing risk factors and clues to diagnosis.
This short discouraging the blunderbuss approach to ordering tests and taking into account both sensitivity (how well the presence of a disease is predicted by a test) and specificity (how well the absence of a disease is predicted by a test), targeting a golden ratio of minimal amount of tests for maximum amount of data (The analogous blunderbuss was a a 17th- century large-bored gun firing balls or slugs which scattered projectiles in a broad range but lacked subtlety and precision).
Specific investigations may be ordered based on the clinical presentation and suspected aetiology of uveitis. Common tests include blood work to assess for infectious or autoimmune diseases, such as full blood count (FBC/CBC), inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), organ profile (LFT, U+E), Chest X-ray to look for TB or Sarcoidosis, Syphillis.
Other tests depend on the outcome of targeted history and examination, and include Serum ACE, Toxoplasma and Toxocara antibodies, HLA-A29, ANCA, ANA, Mantoux Test, Interferon Gamma Release Assay, Fundus Fluorescein Angiography, Indocyanine Green Angiography, Electrophysiology, CT Chest, CT Abdo/Pelvis, MRI Brain, Lumbar Puncture for CSF Studies, Conjunctival biopsies, Anterior chamber tap, Biopsy of vitreous/choroid - In infectious uveitis cases, polymerase chain reaction (PCR) testing of ocular fluids or serological tests for specific pathogens may be necessary
Sometimes doing routine immunological tests doesn’t really help as there are often weak positive anti-nuclear and other antibodies found in Uveitis which are not really interpretable, so
Tailor Those Investigations!
Featuring Pirates of the Caribbean’s Marty, Guardians of the Galaxy’s Mantis, Shawshank Redemption’s Warden Samuel Norton, the lab scene from Jurassic Park’s Isla Nublar, and the classic Knightmare CITV series (1987-1994) "Ooh, nasty!"
