Keratic Precipitates: The Underutilized Diagnostic Clue

ABSTRACT

The morphology of keratic precipitates (KPs) may yield important diagnostic clues. However, KPs have not been described in a standardized manner and the traditional classification of granulomatous or non-granulomatous KPs is not helpful in differentiating infectious from noninfectious uveitis. A granulomatous uveitis may initially appear non-granulomatous. We suggest three ways to examine KPs that may aid in differentiating the infectious from noninfectious etiologies. The first method is the in vivo confocal microscopy (IVCM) description and classification of KPs, in which the “non-granulomatous” subset of dendritiform and infiltrative KPs should be differentiated from smooth-rounded KPs and globular KPs which are “granulomatous.” The second and third clues are the distribution and color of the KPs. KPs that extend beyond the midline may suggest an infective cause, and fresh pigmented KPs suggest a viral cause. Careful examination of the KPs may immediately reveal the clues to the diagnosis, minimizing unnecessary tests and costs.

KEYWORDS:

• Keratic precipitates
• morphology
• uveitis
• infectious
• granulomatous
• confocal microscopy

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Disclosure of interest

Nicole Shu-Wen Chan has no financial disclosures or conflicts of interest.

Soon-Phaik Chee has financial relationship with:

1. AbbVie Pte. Ltd, Singapore: Consultant/Advisor, Grant Support

2. Alcon Laboratories, Inc. Singapore and USA: Consultant/Advisor, Lecture Fees, Grant Support

3. Allergan, Singapore: Grant Support

4. Bausch & Lomb Surgical, Singapore: Consultant/Advisor, Grant Support

5. Carl Zeiss Inc, Singapore: Consultant/Advisor, Lecture Fees, Grant Support

6. Gilead Sciences, Inc., USA: Grant Support

7. HOYA Medical Singapore Pte. Ltd: Consultant/Advisor, Grant Support

8. Johnson & Johnson Vision, Singapore and USA: Consultant/Advisor, Lecture Fees, Grant Support

9. Leica Microsystems Inc. Singapore: Consultant/Advisor, Grant Support

10. Santen Pharmaceutical Asia Pte. Ltd, Singapore: Lecture Fees, Grant Support

11. Ziemer Ophthalmics AG, Switzerland: Consultant/Advisor, Grant Support

Additional information

Funding

No funding was obtained.