OP6.4 | Systemic Uveitis Associations and Patient Counselling — Summary & Reflection

KEY TAKEAWAYS

Systemic associations of uveitis organised by anatomical type: ANTERIOR — HLA-B27 spondyloarthropathies (AS, reactive arthritis, psoriatic arthritis, IBD-related; NOT RA), JIA oligoarticular ANA-positive (asymptomatic — screen every 3 months), Behçet's disease (oral + genital ulcers + migratory hypopyon), herpetic (HSV/VZV — raised IOP, sectoral iris atrophy, antiviral treatment). INTERMEDIATE — multiple sclerosis, sarcoidosis, Lyme disease. POSTERIOR — toxoplasma retinochoroiditis (most common globally, pale lesion + old scar), CMV retinitis (HIV + CD4 <50), TB choroiditis (India — most important), ocular histoplasmosis. PANUVEITIS — VKH syndrome (bilateral panuveitis + meningism/tinnitus + vitiligo/alopecia, pigmented races, high-dose steroids), sympathetic ophthalmia (penetrating injury → exciting eye + sympathising eye; enucleation within 2 weeks prevents it; after 2 weeks enucleation does not). Counselling framework (5 domains): (1) understanding diagnosis; (2) medication purpose + taper; (3) recurrence recognition + emergency signs (red eye = same day); (4) systemic monitoring + referrals; (5) long-term outlook with honest calibrated reassurance. Common pitfalls: over-reassurance, jargon, omitting recurrence risk, not explaining taper rationale.

REFLECT

Think back to the 32-year-old man in the opening scenario. He has had three episodes of uveitis in two years — and until today, nobody connected his eye disease with his back pain. How does this case illustrate the broader principle that effective clinical care requires integrating specialist knowledge across system boundaries? In your future practice — whether as a general practitioner, physician, or ophthalmologist — how will you remain alert to the possibility that an 'eye complaint' is actually a systemic disease presenting in the eye? Now reflect on the counselling skill dimension: what would you do differently in the simulated encounter if the patient became visibly distressed when you mentioned the link to AS? Consider how you would modulate the information delivery — what would you say first, and what would you defer to a subsequent visit?