- Oral or genital ulcers
- Skin rashes/lumps or bumps
- Family/ancestors from Turkey, Middle East, central Asia
- *BRVO (vasculitic changes) with posterior uveitis*
- Anterior uveitis with shifting/sterile hypopyon + white eye
- Macular retinitis
- Smoky vitreous without condensations (vitritis)
- ONH neuropathy (risk becoming atrophic) – life threatening! Refer to medics
- Inflammatory markers – FBC / CRP / ESR
- Syphilis serology and Quantiferon-TB Gold test – rule out the differentials
- MRI brain – if neurological involvement
- FFA – determine areas of ischaemia for treatment
- Refer to physician
Differential diagnosis: TB ; Syphilis
- Anterior uveitis – treat aggressively with topical steroids and mydrilates.
- Laser photocoagulation – areas of ischaemia or macular oedema.
- Neurology symptoms – physician involvement urgently
- For any neurology associated symptoms or vasculitis or macular retinitis – pulsed IVMP then oral prednisolone (long-term). This is followed by immunosuppression.
- Immunosuppression – mycophenolate mofetil (common) ; alternatives – cyclosporin or azathioprine.
- Biologics – anti TNF agents (infliximab or adalimumab).
- Interferon alpha.
- RRD – rare – usually after intravitreal steroid treatment or tractional related cause from prolonged vitritis – treat with scleral buckle or PPV
BRVO: Branch retinal vein occlusion; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; FBC: full blood count; FFA: fundus fluorescein angiogram; IVMP: intravenous methylprednisolone; ONH: optic nerve head; PPV: pars plana vitrectomy; RRD: retinal detachment; TNF: Tumour necrosis factor