AAOpt 2024: The importance of systemic workup in posterior uveitis

At the 2024 American Academy of Optometry meeting in Indianapolis, Indiana, Carolyn Majcher, OD, FAAO, professor and director of residency programs at the Oklahoma College of Optometry, highlighted the critical role of systemic workups in diagnosing and managing posterior uveitis during her lecture on the topic. In collaboration with Komal Patel, OD, FAAO, Dipl ABO, Majcher led a discussion on rare but significant causes of posterior and panuveitis, including histoplasmosis, toxoplasmosis, Vogt-Koyanagi-Harada (VKH) disease, and neuroretinitis. These conditions, while uncommon, require early recognition and prompt intervention to prevent vision loss and systemic complications.

One of the key takeaways from the session is the subtlety with which posterior uveitis can present. Unlike anterior uveitis, which is often accompanied by classic symptoms like light sensitivity, redness, and decreased vision, posterior uveitis may have few overt symptoms. Patients may present with only mild visual disturbances, such as a slight decrease in vision or floaters, and sometimes remain asymptomatic. This can make it challenging to detect without thorough clinical examination and advanced imaging techniques like OCT and fundus autofluorescence.

Majcher shared a compelling case of an early diagnosis of ocular syphilis, where the patient exhibited only mild vision loss—from 20/20 to 20/30—along with floaters and a central scotoma. Initial examination suggested a posterior vitreous detachment, but further investigation using OCT revealed retinal and choroidal inflammation. Lab work confirmed syphilis as the underlying cause, and after appropriate treatment, the patient’s vision fully recovered. This case underscores the importance of a comprehensive systemic workup in any case of posterior uveitis, as systemic diseases like syphilis, tuberculosis, or sarcoidosis can often manifest in the eye.

As Majcher emphasizes, treating the underlying systemic condition is crucial not only for managing ocular inflammation but also for preventing recurrence and preserving vision. Optometrists should maintain a high index of suspicion for systemic associations in cases of posterior uveitis, particularly when uncommon findings like choroidal inflammation are present. Early diagnosis, coupled with targeted treatment, can significantly improve outcomes and quality of life for patients.

The lecture on posterior uveitis reinforced the need for optometrists to be vigilant in their diagnostic approach. Thorough systemic workups and the use of advanced imaging are key components in identifying the cause of ocular inflammation and providing optimal care for patients with this complex condition.