Uveitis. An internist's view

The utility of an evaluation for systemic disease in a patient with uveitis is controversial. To address this issue, we reviewed the records of 236 consecutive patients with uveitis who were referred primarily by ophtalmologists to an internist in a university-based clinic. Patients were referred for a variety of purposes, including differential diagnosis, treatment recommendations, and desire for a second opinion. The study population included 121 male patients and 115 female patients. In 40% of all patients, a systemic disease thought to be causally related to the eye inflammation was diagnosed or its diagnosis was confirmed. While 53% of patients with anterior uveitis had a causally related systemic illness, only 17% of patients with posterior uveitis and 22% of patients with chorioretinitis had an associated systemic disease. The most frequently diagnosed systemic diseases were Reiter's syndrome, ankylosing spondylitis, Sjogren's syndrome, and sarcoidosis. These diagnoses were usually not known prior to referral. An internist can make a significant contribution to the evaluation of many patients with uveitis. Futhermore, most diagnoses can be established by a thorough history and physical examination, without extensive laboratory testing.