History of Present Illness in Posterior Uveitis

1. Chief Ocular Symptoms

• Floaters - onset, duration, number, progression (vitreous cells/vitritis is the hallmark)
• Blurred / reduced vision - central vs. peripheral, which eye(s), gradual or sudden
• Scotomas - location (central, paracentral, peripheral), fixed or variable
• Metamorphopsia - distortion of images (suggests macular or subretinal involvement)
• Photopsias - flashing lights (very common in posterior uveitis, suggests vitreoretinal traction or retinal inflammation)
• Pain, redness, photophobia - if present, suggests associated anterior chamber inflammation (panuveitis); posterior uveitis by itself does NOT usually produce pain or redness

Wills Eye Manual, 12.3: "Blurred vision and floaters. Scotomas and metamorphopsia are common. Photopsias are often present in posterior uveitis. Pain, redness, and photophobia are often present due to anterior chamber inflammation."

2. Laterality and Chronology

• Which eye is affected? (unilateral vs. bilateral)
• Onset - sudden or gradual?
• Duration of current episode
• Is this the first episode or a recurrence?
• If recurrent: how many episodes, interval between episodes, any complete recovery between episodes?

3. Systemic Symptoms - Directed Review (Critical for Etiology)

• Recent fever, chills, weight loss, night sweats (TB, histoplasmosis, syphilis, endogenous endophthalmitis)
• Contact with cats or raw/undercooked meat (Toxoplasma)
• Tick bite, outdoor exposure, erythema migrans rash (Lyme disease)
• Risk factors for HIV/AIDS - immunocompromised state (CMV retinitis, toxoplasma, other opportunistic infections)
• Travel history - to endemic areas for histoplasmosis (Ohio/Mississippi Valley), coccidioidomycosis, onchocerciasis, cysticercosis (Africa, Central/South America)
• Recent skin lesions, vesicles, shingles history (HSV/VZV)
• IV drug use or central venous lines (Candida/fungal endogenous endophthalmitis)
• Sexual history, genital ulcers (syphilis)

• Oral ulcers, genital ulcers, skin lesions (Behçet disease)
• Joint pain, back pain (worse on awakening), heel pain (HLA-B27 spondyloarthropathy)
• Hearing loss, vitiligo, hair whitening/alopecia (Vogt-Koyanagi-Harada syndrome)
• Neurologic symptoms - headache, cognitive changes (VKH, CNS lymphoma, multiple sclerosis, Susac syndrome)
• Shortness of breath, cough, skin nodules, elevated calcium (sarcoidosis)
• Skin rash, joint pain, renal disease, serositis (SLE, ANCA-associated vasculitis)
• Rash and arthralgias in a young Black patient (sarcoidosis, sickle cell)

• Known history of lymphoma, leukemia, or melanoma
• Age >50 with persistent non-responsive vitreous cells (primary vitreoretinal lymphoma)

Kanski's Clinical Ophthalmology, 10th ed.: "A careful review for systemic symptoms is essential to detect any clues to underlying disease, with referral to a specialist physician for further assessment where appropriate. Many associations of uveitis can present with a wide range of systemic features."

4. Past Ocular History

• Previous eye surgery (especially intraocular surgery - risk for endophthalmitis or chronic postoperative uveitis)
• Previous penetrating trauma or intraocular foreign body
• History of prior uveitis - anterior, intermediate, or posterior
• History of vitrectomy or repeated intravitreal injections

5. Past Medical History

• Known systemic autoimmune disease (sarcoidosis, Behçet, IBD, RA, SLE)
• Prior TB exposure or positive PPD/IGRA
• History of syphilis or STIs
• Immunosuppression - HIV, organ transplant, biologics (TNF inhibitors can paradoxically cause or worsen uveitis)
• Malignancy (lymphoma, leukemia - masquerade syndromes)

6. Drug/Treatment History

• Current medications - any immunosuppressants, corticosteroids, biologics (especially rifabutin - causes uveitis; cidofovir; checkpoint inhibitors)
• Prior treatment for uveitis - what was used, response to steroids

7. Social and Exposure History

• Occupation (farmers, abattoir workers - Brucella, leptospirosis)
• Pet exposure (cats - Toxoplasma, Bartonella/cat-scratch; dogs - Toxocara)
• Sexual history (syphilis risk)
• IV drug use
• Alcohol use
• Geographic and travel history

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