Changing trends in the etiologic diagnosis of uveitis

Just as different fads that seize the imagination of the general public are often carried to excess, so diagnostic or therapeutic fads may take over in the practice of medicine. Analysis of 33 surveys of the causes of uveitis reported by ophthalmologists over the course of 120 years shows how some diagnoses such as syphilis and tuberculosis fell from favor because tests ruled out these diseases, whereas others such as toxoplasmosis became popular because of the finding of the organism in a few cases by a famous ophthalmic pathologist. Yet others (pars planitis, sarcoidosis) were not even causes of disease, but rather merely descriptive, or the ocular component of a systemic disease whose etiology and pathogenesis remain unknown. We will examine the waxing and waning of these diagnostic categories and the impressive confidence of some clinicians in their own diagnostic acumen as they made diagnoses often unsupported by objective evidence.