Uveitis and Intraocular Tumors
Core concepts
Classify uveitis by location (anterior, intermediate, posterior, panuveitis) and by course (acute, chronic, recurrent). Know common causes: HLA-B27, sarcoidosis, tuberculosis, toxoplasmosis, herpes viruses, and Behçet disease. Recognise signs: cells and flare, keratic precipitates, iris nodules, snowballs, and retinal infiltrates.
Intraocular tumours: uveal melanoma (most common primary intraocular malignancy in adults), retinoblastoma (most common in children), and metastases. Know that uveal melanoma can present with a pigmented choroidal mass and may cause exudative detachment. Retinoblastoma presents with leukocoria and strabismus; genetic testing for RB1 is important.
Traps
- Assuming all uveitis is idiopathic; always screen for systemic disease.
- Forgetting that retinoblastoma can be bilateral and heritable.
- Confusing uveal melanoma with choroidal naevus (size and growth matter).
- Missing that toxoplasmosis causes a focal retinochoroidal scar with adjacent inflammation.
Rule of thumb
Leukocoria in a child = retinoblastoma until proven otherwise; refer urgently.
Worked example
A child presents with a white pupillary reflex. Perform fundus examination and imaging; suspect retinoblastoma, and involve oncology and genetics.