[Uveitis: Diagnostic work-up. Recommendations from an expert committee].

Area of Science:

• Ophthalmology
• Rheumatology
• Internal Medicine

Background:

• Uveitis diagnosis presents significant uncertainties.
• Etiological investigations should consider epidemiology and focus on severe or treatable conditions.
• This work establishes recommendations for uveitis diagnosis.

Purpose of the Study:

• To establish evidence-based recommendations for the diagnostic work-up of uveitis.
• To propose a standardized strategy for etiological diagnosis.
• To improve diagnostic efficiency in uveitis cases.

Main Methods:

• Developed by a multidisciplinary panel of 15 experts.
• Based on literature review and the ULISSE study (prospective assessment of a standardized diagnostic strategy).
• Excludes children, immunocompromised patients, severe retinal vasculitis, and specific ophthalmological entities.

Main Results:

• History and physical examination should guide initial investigations.
• Serological screening for syphilis is universally recommended.
• Further investigations are guided by anatomic characteristics: HLA B27 (unilateral acute anterior non-granulomatous uveitis), ACE/IFN-γ/CT (chronic uveitis), MRI/AC tap (intermediate/posterior uveitis >40 yrs).
• Unfocused investigations are generally unhelpful.

Conclusions:

• A strategy for the etiologic diagnosis of uveitis is proposed.
• Recommendations require regular updates.
• The efficiency of more invasive investigations needs further evaluation.