Ocular Ultrasound as a Key to Diagnosing Uveitis Masked Syndromes, Tips and Tricks

Background and Objectives: Uveitis-masked syndromes or masquerade syndromes (UMSs) are a group of ocular conditions with several systemic underlying causes, malignant or nonmalignant, that mimic the inflammatory status of the uvea. They are often difficult to detect and diagnose with traditional techniques, such as ophthalmic exams. Ocular B (bidimensional)-ultrasound (OBU) is a non-invasive, repeatable, rapid ultrasound method effective in indirect signs that lead back to systemic diseases. It is comparable in effectiveness with other imaging tools. The cause of UMSs can often be serious, and therefore early diagnosis and prompt treatment are very critical. This study aims to identify the sonographic signs of these forms that can help physicians discover the cause underlying UMS. Materials and Methods: This is a consecutive, retrospective, nonrandomized study. This study is conducted at University Hospital Polyclinic of Bari, Italy, from January 2022 to December 2024. A total of 186 patients were included, from 10 to 85 years old. They all were undergone to B-scan ultrasonography (Quantel Medical ABSolu Ocular Ultrasound). Results: All patients reported blurred vision, that it can be accompanied by visual reduction (<20/40, Snellen charts), photophobia, floaters, flashes, proptosis, redness. In all cases we have noticed peculiar ultrasonographic signs which discriminate underlying systemic diagnosis, such as vitreous corpuscles, choroid thickening, solid tumors primitive or metastatic. Finally, they were identified different diseases, such as primary intraocular lymphoma (PIOL), and other lymphoproliferative conditions, orbital plasmacytoma, uveal melanoma, metastasis, endogenous endophthalmitis, retinal detachment, central serous retinopathy, metallic foreign bodies, ocular amyloidosis, toxoplasmosis, sarcoidosis, tuberculosis, syphilis, birdshot chorioretinitis, and drug-induced UMSs. lymphoma, other lymphoproliferative conditions, toxoplasmosis, sarcoidosis, tuberculosis, syphilis, UMSs caused by drugs, and others. Conclusion: Making a firm diagnosis of UMS is not easy, and the various forms are often underdiagnosed. Early detection of these forms is imperative. The use of OBU can help diagnose indirect signs of these forms early and treat them promptly. It compares well with other diagnostic imaging techniques, such as MRI, but this does not mean that it replaces them; it can be an added value in multimodal imaging.