Retina specialist recommends targeted approach to diagnosing uveitis

Key takeaways:

• Avoid a “kitchen sink” work-up, instead focusing on history, findings and imaging.
• Treatment options include antimicrobials and steroids.

KOLOA, Hawaii — Start with the patient’s chief complaint when making a differential diagnosis in uveitis, a retina specialist said at Retina 2025.

“You see a new uveitis patient on your schedule, and you’re thinking this is kind of a clinic killer, because these patients definitely take a little more time,” Roger A. Goldberg, MD, MBA, said.

While many factors go into uveitis diagnosis, Goldberg said it is important to avoid a “kitchen sink” workup. Instead, he suggested that clinicians should target their approach based on history, findings and imaging. However, he always checks patients for syphilis.

Goldberg also said it is important to focus on the top of the chart when determining a diagnosis, starting with the chief complaint/history of present illness, exposures and past medical history.

“With uveitis, you have to listen to the patient,” he said. “The signs in ophthalmology are very specific, symptoms usually nonspecific. But it’s helpful to listen to the symptoms the patient is complaining about.”

Goldberg said anterior uveitis comes with pain, light sensitivity and redness; intermediate uveitis comes with floaters and blurred vision; posterior uveitis comes with blurred vision, blind spot and flashes or photopsias; and, “panuveitis is a little bit of all of the above,” he said.

Goldberg also told clinicians to look at the whole patient, including their age, gender, ethnicity and appearance. Things like rashes, poliosis, scleritis or episcleritis can be seen without a slit lamp and help determine a diagnosis.

Although there is grading system for uveitis, Goldberg said it can have high interobserver variability. Instead, he likes to quantify the number of cells per high-powered field and measure the height of the hypopyon.

Imaging also plays an important role, according to Goldberg. He said OCT can help identify which layers of the retina are involved, infrared imaging can help look for changes above the retinal pigment epithelium, and fundus autofluorescence can help monitor disease activity in choroiditis.

Clinicians have a number of treatment options available for uveitis, including antimicrobials for infectious uveitis and local steroids delivered topically for anterior or intermediate or intravitreally for intermediate or posterior, Goldberg said.

“I will prescribe systemic steroids — oral steroids — for patients,” Goldberg said. “I will not prescribe steroid-sparing agents. I work with a rheumatologist.”

He noted that Genentech is developing a new treatment called vamikibart, an anti-IL-6 antibody.

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Sources/Disclosures

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Source:

Goldberg RA. Uveitis from a retina specialist’s perspective: Pearls for clinical practice. Presented at: Retina 2025; Jan. 18-24, 2025; Koloa, Hawaii.

Disclosures:
Goldberg reports having financial ties to 4DMT, AbbVie, AffaMed, Alexion, Alimera, Annexon, Apellis, Boehringer Ingelheim, Clearside, Cognition, Emmetrope Ophthalmics, EyePoint, Genentech, Janssen, Neurotech/LMRI, Novo Nordisk, Ocular Therapeutix, Orasis, Regeneron, Stealth Bio, Unity Bio and Zeiss.

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