Which investigations should be performed in a patient with suspected uveitis to determine the underlying cause?

In a patient with suspected uveitis, a targeted approach to investigations is essential to identify the underlying cause and guide management. Initial investigations should include a detailed clinical history and examination, followed by specific laboratory and imaging tests tailored to the suspected aetiology.

Basic blood tests should include a full blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to assess for systemic inflammation NICE NG65. Screening for infectious causes is critical; therefore, tests for tuberculosis (e.g., interferon-gamma release assay or Mantoux test) and syphilis serology should be performed NICE NG65,NICE NG33.

Autoimmune and inflammatory markers such as HLA-B27 typing are recommended, especially if spondyloarthritis or related conditions are suspected NICE NG65. Additional autoimmune screens may include antinuclear antibodies (ANA) and angiotensin-converting enzyme (ACE) levels to evaluate for sarcoidosis NICE NG65.

Imaging studies play a key role: chest X-ray or high-resolution CT scan can help detect pulmonary sarcoidosis or tuberculosis NICE NG65. In cases of intermediate or posterior uveitis, ocular imaging such as optical coherence tomography (OCT) and fluorescein angiography may be indicated to assess intraocular inflammation and complications Biju Mark et al. 2025.

Further specialized tests depend on clinical suspicion and may include lumbar puncture if infectious or inflammatory central nervous system involvement is suspected, or biopsy of accessible lesions if malignancy or granulomatous disease is considered NICE NG65.

This integrated approach combining guideline recommendations and recent literature ensures a comprehensive evaluation to identify infectious, autoimmune, or other systemic causes of uveitis, facilitating appropriate treatment NICE NG65 McClellan & Coster 1987Biju Mark et al. 2025.