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The investigation and management of inflammatory eye disease is complex and relies on detailed history taking and examination. It is not therefore unexpected that many patients are over-investigated. A question that has caused much debate in the past is whether patients with intermediate uveitis (IU), particularly young Caucasian women with no neurological symptoms, should have routine neuroimaging to ‘screen’ for multiple sclerosis (MS). In this editorial, we discuss the key issues related to the clinical presentation of IU, its association with MS and the rationale for investigation; in particular, we put forward our view that neuroimaging should not be carried out as a screening tool for patients with IU.
IU is the term given to inflammation, which has the vitreous as its focal site. It can be caused by a number of infections including tuberculosis (TB), syphilis, Lyme disease, toxocariasis, Whipple's disease and Epstein–Barr virus. IU is also associated with a number of systemic autoimmune diseases such as sarcoidosis, inflammatory bowel disease and MS.1 Many patients will not have any underlying disease process, and in this group the term idiopathic IU or pars planitis is applied.
On examination, snow banking, vitreous snowballs, peripheral retinal vascular sheathing, vitreous cells and vitreous haze can be seen.1 It is important to clearly document the presence of these signs as well as the standardisation of uveitis nomenclature grading for vitreous inflammation.2 A number of other differential diagnoses must be considered in any patient presenting with posterior segment inflammation and it is important to exclude these before treatment is started and the clinical signs masked. The main diseases that need to be excluded are sarcoidosis, TB and masquerade syndromes such as primary intraocular lymphoma.
In our practice, patients who present with IU and no relevant medical history or concurrent systemic symptoms will …