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statpearls_NBK430685\article-101481_2	Spirometry -- Introduction	The most important variables reported include total exhaled volume, known as the forced vital capacity (FVC), the volume exhaled in the first second, known as the forced expiratory volume in one second (FEV1), and their ratio (FEV1/FVC). [1] These results are represented on a graph as volumes and combinations of these volumes termed capacities and can be used as a diagnostic tool, as a means to monitor patients with pulmonary diseases, and to improve the rate of smoking cessation, according to some reports. [2]	Spirometry -- Introduction. The most important variables reported include total exhaled volume, known as the forced vital capacity (FVC), the volume exhaled in the first second, known as the forced expiratory volume in one second (FEV1), and their ratio (FEV1/FVC). [1] These results are represented on a graph as volumes and combinations of these volumes termed capacities and can be used as a diagnostic tool, as a means to monitor patients with pulmonary diseases, and to improve the rate of smoking cessation, according to some reports. [2]
statpearls_NBK430685\article-101481_3	Spirometry -- Anatomy and Physiology	Lungs provide life-sustaining gas exchange by way of introducing oxygen for metabolism and eliminating the by-product carbon dioxide. Air-inspired will pass through the oropharynx to the trachea, which is a membranous tube covered by cartilage bifurcating at the carina as two bronchi at the level of C6. After passing the trachea, the air enters the right and left bronchi, which divide to give several million terminal bronchioles that end in alveoli. The alveoli and surrounding vessels provide a surface where the gas exchange takes place. [3]	Spirometry -- Anatomy and Physiology. Lungs provide life-sustaining gas exchange by way of introducing oxygen for metabolism and eliminating the by-product carbon dioxide. Air-inspired will pass through the oropharynx to the trachea, which is a membranous tube covered by cartilage bifurcating at the carina as two bronchi at the level of C6. After passing the trachea, the air enters the right and left bronchi, which divide to give several million terminal bronchioles that end in alveoli. The alveoli and surrounding vessels provide a surface where the gas exchange takes place. [3]
statpearls_NBK430685\article-101481_4	Spirometry -- Indications	Apart from being a key diagnostic test for asthma and chronic obstructive pulmonary disease, spirometry is indicated in several other places, as listed below:	Spirometry -- Indications. Apart from being a key diagnostic test for asthma and chronic obstructive pulmonary disease, spirometry is indicated in several other places, as listed below:
statpearls_NBK430685\article-101481_5	Spirometry -- Indications -- Diagnostic Indications	Evaluation of the signs and symptoms of a patient or their abnormal investigations and lab tests Evaluation of the effect a certain disease has on pulmonary function Screening and early detection of individuals who are at risk of pulmonary disease Assessing surgical patients for preoperative risk Assessing the severity and the prognosis of a pulmonary disease [4]	Spirometry -- Indications -- Diagnostic Indications. Evaluation of the signs and symptoms of a patient or their abnormal investigations and lab tests Evaluation of the effect a certain disease has on pulmonary function Screening and early detection of individuals who are at risk of pulmonary disease Assessing surgical patients for preoperative risk Assessing the severity and the prognosis of a pulmonary disease [4]
statpearls_NBK430685\article-101481_6	Spirometry -- Indications -- Monitoring Indications	Assessment of the efficiency of a therapeutic intervention such as bronchodilator therapy Describing the course and progression of a disease that is affecting pulmonary function, such as interstitial lung disease or obstructive lung disease Monitoring pulmonary function in individuals with high-risk jobs Sampling data that can be used for epidemiologic surveys [5]	Spirometry -- Indications -- Monitoring Indications. Assessment of the efficiency of a therapeutic intervention such as bronchodilator therapy Describing the course and progression of a disease that is affecting pulmonary function, such as interstitial lung disease or obstructive lung disease Monitoring pulmonary function in individuals with high-risk jobs Sampling data that can be used for epidemiologic surveys [5]
statpearls_NBK430685\article-101481_7	Spirometry -- Contraindications	Spirometry has proved itself as an accessible utility to assess lung function. However, it may not be for every patient, and care must be taken in some cases where it may be absolutely or relatively contraindicated.	Spirometry -- Contraindications. Spirometry has proved itself as an accessible utility to assess lung function. However, it may not be for every patient, and care must be taken in some cases where it may be absolutely or relatively contraindicated.
statpearls_NBK430685\article-101481_8	Spirometry -- Contraindications -- Absolute Contraindications	Hemodynamic instability Recent myocardial infarction or acute coronary syndrome Respiratory infection, a recent pneumothorax, or a pulmonary embolism A growing or large (>6 cm) aneurysm of the thoracic, abdominal aorta Hemoptysis of acute onset Intracranial hypertension Retinal detachment	Spirometry -- Contraindications -- Absolute Contraindications. Hemodynamic instability Recent myocardial infarction or acute coronary syndrome Respiratory infection, a recent pneumothorax, or a pulmonary embolism A growing or large (>6 cm) aneurysm of the thoracic, abdominal aorta Hemoptysis of acute onset Intracranial hypertension Retinal detachment
statpearls_NBK430685\article-101481_9	Spirometry -- Contraindications -- Relative Contraindications	Patients who cannot be instructed to use the device properly and are at risk of using the device inappropriately, such as children and patients with dementia Conditions that make it difficult to hold the mouthpiece, such as facial pain Recent abdominal, thoracic, brain, eye, ear, nose, or throat surgeries Hypertensive crisis [2] [3] [6]	Spirometry -- Contraindications -- Relative Contraindications. Patients who cannot be instructed to use the device properly and are at risk of using the device inappropriately, such as children and patients with dementia Conditions that make it difficult to hold the mouthpiece, such as facial pain Recent abdominal, thoracic, brain, eye, ear, nose, or throat surgeries Hypertensive crisis [2] [3] [6]
statpearls_NBK430685\article-101481_10	Spirometry -- Equipment	The first requirement for spirometry is physical space in order for the patient to be positioned comfortably. The minimum space recommended is a 2.5* 3m room with 120 cm side doors.	Spirometry -- Equipment. The first requirement for spirometry is physical space in order for the patient to be positioned comfortably. The minimum space recommended is a 2.5* 3m room with 120 cm side doors.
statpearls_NBK430685\article-101481_11	Spirometry -- Equipment	Spirometers are classified into closed-circuit and open-circuit spirometers. Closed-circuit spirometers are further sub-classified into wet and dry spirometers, which consist of a piston or a bellow acting as an air collecting system and a supported recording system that moves at the desired rate.	Spirometry -- Equipment. Spirometers are classified into closed-circuit and open-circuit spirometers. Closed-circuit spirometers are further sub-classified into wet and dry spirometers, which consist of a piston or a bellow acting as an air collecting system and a supported recording system that moves at the desired rate.
statpearls_NBK430685\article-101481_12	Spirometry -- Equipment	Open-circuit spirometers , which are more commonly used at present, do not have an air-collecting system and instead measure the airflow, integrate the results, and calculate the volume. The most commonly used open-circuit spirometer is the turbine flow meter, which records the rate at which turbines turn and derives the flow measurement based on proportionality. Pneumotachographs are another example, which measure the airflow by measuring the pressure difference generated as the laminar flow passes through a certain resistance. Hotwire spirometers, in which a hot metal wire is heated, and the air used to cool it is used to calculate the flow, are also an example of open-circuit spirometers. Ultrasound spirometers can be based on any of the aforementioned open-circuit spirometer principles. [7]	Spirometry -- Equipment. Open-circuit spirometers , which are more commonly used at present, do not have an air-collecting system and instead measure the airflow, integrate the results, and calculate the volume. The most commonly used open-circuit spirometer is the turbine flow meter, which records the rate at which turbines turn and derives the flow measurement based on proportionality. Pneumotachographs are another example, which measure the airflow by measuring the pressure difference generated as the laminar flow passes through a certain resistance. Hotwire spirometers, in which a hot metal wire is heated, and the air used to cool it is used to calculate the flow, are also an example of open-circuit spirometers. Ultrasound spirometers can be based on any of the aforementioned open-circuit spirometer principles. [7]
statpearls_NBK430685\article-101481_13	Spirometry -- Equipment	The minimum specifications for a spirometer are the ability to measure a volume of 8L with an accuracy of ±3% or ±50ml with a flow measurement range of ±141 and a sensitivity of 200ml/s. It is recommended that the spirometer record at 15 s of the expiration time for the forced maneuver. [8] [9]	Spirometry -- Equipment. The minimum specifications for a spirometer are the ability to measure a volume of 8L with an accuracy of ±3% or ±50ml with a flow measurement range of ±141 and a sensitivity of 200ml/s. It is recommended that the spirometer record at 15 s of the expiration time for the forced maneuver. [8] [9]
statpearls_NBK430685\article-101481_14	Spirometry -- Personnel	The personnel performing the procedure must be familiar with respiratory symptoms and signs. They have to undergo training to understand the technical and physiological background of the tests in order to be competent in performing the techniques of the operation of the device, be able to apply the universal precautions, instruct the patients properly to avoid complications, and act accordingly if any of the complications arise. The personnel should be able to identify responses to therapy, the need for initiating therapy, or discontinuing an inefficient one. Continuity of training and periodic retraining is a must for staff in charge of spirometry. [10]	Spirometry -- Personnel. The personnel performing the procedure must be familiar with respiratory symptoms and signs. They have to undergo training to understand the technical and physiological background of the tests in order to be competent in performing the techniques of the operation of the device, be able to apply the universal precautions, instruct the patients properly to avoid complications, and act accordingly if any of the complications arise. The personnel should be able to identify responses to therapy, the need for initiating therapy, or discontinuing an inefficient one. Continuity of training and periodic retraining is a must for staff in charge of spirometry. [10]
statpearls_NBK430685\article-101481_15	Spirometry -- Preparation	All patients must be informed that they must abstain from smoking and physical exercise in the hours before the procedure. Any bronchodilator therapy must also be stopped beforehand.	Spirometry -- Preparation. All patients must be informed that they must abstain from smoking and physical exercise in the hours before the procedure. Any bronchodilator therapy must also be stopped beforehand.
statpearls_NBK430685\article-101481_16	Spirometry -- Preparation	The procedure must be carefully explained to the patient focusing on the importance of the patient’s cooperation to provide the most accurate results. The patient’s weight and height must be recorded with the patient barefoot and wearing only light clothing. In the case of chest deformities such as kyphoscoliosis, the span should be measured from the tip of one middle finger to the tip of the other middle finger with the hands crossed, and the height can be estimated from the formula: height = span/1.06. The patient’s age must be recorded. The procedure should be performed with the patient sitting upright, wearing light clothing, and without crossing their legs. Children can perform the test sitting or standing, but the same procedure should be done for the same individual every time.	Spirometry -- Preparation. The procedure must be carefully explained to the patient focusing on the importance of the patient’s cooperation to provide the most accurate results. The patient’s weight and height must be recorded with the patient barefoot and wearing only light clothing. In the case of chest deformities such as kyphoscoliosis, the span should be measured from the tip of one middle finger to the tip of the other middle finger with the hands crossed, and the height can be estimated from the formula: height = span/1.06. The patient’s age must be recorded. The procedure should be performed with the patient sitting upright, wearing light clothing, and without crossing their legs. Children can perform the test sitting or standing, but the same procedure should be done for the same individual every time.
statpearls_NBK430685\article-101481_17	Spirometry -- Preparation	During the procedure, the back must be supported by a backrest and not lead forward. Dentures have to be removed if they interfere with the procedure. Manual occlusion of the nares with the help of nose clips helps to prevent air leakage through the nasal passages, although it is not mandatory to occlude nasal passage. The calibration of the spirometer has to be confirmed on the day of the test. Any contraindications or infectious diseases that require special measures will lead to a delay in the procedure. [8] [9] [10]	Spirometry -- Preparation. During the procedure, the back must be supported by a backrest and not lead forward. Dentures have to be removed if they interfere with the procedure. Manual occlusion of the nares with the help of nose clips helps to prevent air leakage through the nasal passages, although it is not mandatory to occlude nasal passage. The calibration of the spirometer has to be confirmed on the day of the test. Any contraindications or infectious diseases that require special measures will lead to a delay in the procedure. [8] [9] [10]
statpearls_NBK430685\article-101481_18	Spirometry -- Technique or Treatment	The patient must place the mouthpiece in their mouth, and the technician must ensure that there are no leaks, and the patient is not obstructing the mouthpiece. The procedure is carried out as follows:	Spirometry -- Technique or Treatment. The patient must place the mouthpiece in their mouth, and the technician must ensure that there are no leaks, and the patient is not obstructing the mouthpiece. The procedure is carried out as follows:
statpearls_NBK430685\article-101481_19	Spirometry -- Technique or Treatment	The patient must breathe in as much air as they can with a pause lasting for less than 1s at the total lung capacity. The mouthpiece is placed just inside the mouth between the teeth soon after the deep inhalation. The lips should be sealed tightly around the mouthpiece to prevent air leakage. Exhalation should last at least 6 seconds or as long as advised by the instructor. If only the forced expiratory volume is to be measured, the patient must insert the mouthpiece after performing step 1 and must not breathe from the tube. If any of the maneuvers are incorrectly performed, the technician must stop the patient in order to avoid fatigue and re-explain the procedure to the patient. The procedure is repeated in intervals separated by 1 minute until two matching and acceptable results are acquired. [11] [12]	Spirometry -- Technique or Treatment. The patient must breathe in as much air as they can with a pause lasting for less than 1s at the total lung capacity. The mouthpiece is placed just inside the mouth between the teeth soon after the deep inhalation. The lips should be sealed tightly around the mouthpiece to prevent air leakage. Exhalation should last at least 6 seconds or as long as advised by the instructor. If only the forced expiratory volume is to be measured, the patient must insert the mouthpiece after performing step 1 and must not breathe from the tube. If any of the maneuvers are incorrectly performed, the technician must stop the patient in order to avoid fatigue and re-explain the procedure to the patient. The procedure is repeated in intervals separated by 1 minute until two matching and acceptable results are acquired. [11] [12]
statpearls_NBK430685\article-101481_20	Spirometry -- Complications	The complications of spirometry are fairly limited and will render the procedure inaccurate or ineffective once they occur. They include: [10] [11] [12] Respiratory alkalosis as a result of hyperventilation Hypoxemia in a patient whose oxygen therapy has been interrupted Chest pain Fatigue Paroxysmal coughing Bronchospasm Dizziness Urinary incontinence Increased intracranial pressure Syncopal symptoms	Spirometry -- Complications. The complications of spirometry are fairly limited and will render the procedure inaccurate or ineffective once they occur. They include: [10] [11] [12] Respiratory alkalosis as a result of hyperventilation Hypoxemia in a patient whose oxygen therapy has been interrupted Chest pain Fatigue Paroxysmal coughing Bronchospasm Dizziness Urinary incontinence Increased intracranial pressure Syncopal symptoms
statpearls_NBK430685\article-101481_21	Spirometry -- Clinical Significance	Spirometry has proved crucial in diagnosing lung disease, monitoring patients' pulmonary function, and assessing their fitness for various procedures. With further research, solid evidence can arise for the role of spirometry in assisting patients in quitting smoking. The American College of Physicians guidelines do not recommend spirometry testing for patients undergoing nonthoracic surgery. There, of course, are exceptions if the patient has preoperative asthma or COPD.	Spirometry -- Clinical Significance. Spirometry has proved crucial in diagnosing lung disease, monitoring patients' pulmonary function, and assessing their fitness for various procedures. With further research, solid evidence can arise for the role of spirometry in assisting patients in quitting smoking. The American College of Physicians guidelines do not recommend spirometry testing for patients undergoing nonthoracic surgery. There, of course, are exceptions if the patient has preoperative asthma or COPD.
statpearls_NBK430685\article-101481_22	Spirometry -- Clinical Significance	Recent evidence also supports the use of spirometry in nonthoracic surgeries. A recent retrospective observational study found that lower preoperative spirometry FVC may predict postoperative pulmonary complications in high-risk patients undergoing abdominal surgery. [13] In another retrospective observational study, the authors found that %VC (FVC/predicted VC) may be a predictor for postoperative pneumonia in patients undergoing colorectal cancer surgery. [14] More studies are needed, but spirometry may be an important tool in identifying nonthoracic surgical patients who are at high risk of postoperative pulmonary complications.	Spirometry -- Clinical Significance. Recent evidence also supports the use of spirometry in nonthoracic surgeries. A recent retrospective observational study found that lower preoperative spirometry FVC may predict postoperative pulmonary complications in high-risk patients undergoing abdominal surgery. [13] In another retrospective observational study, the authors found that %VC (FVC/predicted VC) may be a predictor for postoperative pneumonia in patients undergoing colorectal cancer surgery. [14] More studies are needed, but spirometry may be an important tool in identifying nonthoracic surgical patients who are at high risk of postoperative pulmonary complications.
statpearls_NBK430685\article-101481_23	Spirometry -- Clinical Significance	Lung volumes are essential to understand when evaluating a patient for surgery or evaluating a patient with preexisting lung disease. Tidal volume (TV) is the amount of air that can be exhaled or inhaled in one respiratory cycle. Normal tidal volume ranges from 6 to 8 ml/kg. Inspiratory reserve volume (IRV) is the forcible amount of air inhaled after normal TV. Expiratory reserve volume (ERV) is the amount of forcible air exhaled after exhalation of a normal TV. Residual Volume (RV) is the amount of air in the lungs after maximum exhalation. Both RV and functional residual volume (FRC) can not be measured directly by spirometry. RV can be indirectly calculated from the FRC and ERV.	Spirometry -- Clinical Significance. Lung volumes are essential to understand when evaluating a patient for surgery or evaluating a patient with preexisting lung disease. Tidal volume (TV) is the amount of air that can be exhaled or inhaled in one respiratory cycle. Normal tidal volume ranges from 6 to 8 ml/kg. Inspiratory reserve volume (IRV) is the forcible amount of air inhaled after normal TV. Expiratory reserve volume (ERV) is the amount of forcible air exhaled after exhalation of a normal TV. Residual Volume (RV) is the amount of air in the lungs after maximum exhalation. Both RV and functional residual volume (FRC) can not be measured directly by spirometry. RV can be indirectly calculated from the FRC and ERV.
statpearls_NBK430685\article-101481_24	Spirometry -- Clinical Significance	Lung capacities are the summation of lung volumes. Total lung capacity (TLC) is the summation of TV, IRV, ERV, and RV. This represents the maximum volume the lungs can accommodate. Vital capacity (VC) is the summation of TV, IR, and ERV. It represents the total air exhaled after maximum inhalation. Functional residual capacity (FRC) is the residual volume plus expiratory reserve volume. It is the volume of air remaining in the lungs after normal exhalation.	Spirometry -- Clinical Significance. Lung capacities are the summation of lung volumes. Total lung capacity (TLC) is the summation of TV, IRV, ERV, and RV. This represents the maximum volume the lungs can accommodate. Vital capacity (VC) is the summation of TV, IR, and ERV. It represents the total air exhaled after maximum inhalation. Functional residual capacity (FRC) is the residual volume plus expiratory reserve volume. It is the volume of air remaining in the lungs after normal exhalation.
statpearls_NBK430685\article-101481_25	Spirometry -- Clinical Significance	These static lung volumes and capacities can diagnose obstructive and restrictive lung patterns. Restrictive lung disease results in reduced lung compliance and a reduction in lung volumes and capacities. TLC is reduced greater than 80% or below the 5th percentile of the predicted value. Both FEV1 and FVC are reduced, but FVC is reduced more than FEV1. Therefore, the FEV1/FVC ratio is greater than 80%. [15]	Spirometry -- Clinical Significance. These static lung volumes and capacities can diagnose obstructive and restrictive lung patterns. Restrictive lung disease results in reduced lung compliance and a reduction in lung volumes and capacities. TLC is reduced greater than 80% or below the 5th percentile of the predicted value. Both FEV1 and FVC are reduced, but FVC is reduced more than FEV1. Therefore, the FEV1/FVC ratio is greater than 80%. [15]
statpearls_NBK430685\article-101481_26	Spirometry -- Clinical Significance	One of the most common causes of restrictive lung disease is obesity. Obese patients have a reduction in FRC, which becomes worse when moving from upright to a supine position. The weight of the chest wall pushes down on the lungs. The weight of the abdominal contents pushes against the diaphragm and base of the lungs, worsening the restrictive pattern. Other restrictive lung processes are chest wall diseases(scoliosis, chest trauma) and neuromuscular disorders (Myasthenia Gravis, Guillain-Barré syndrome). Obstructive lung disease is a disproportionate reduction in the maximum airflow from the lungs compared to the maximum air that can be displaced from the lungs. [15] This can be confirmed by an FEV/VC ratio below the 5th percentile of the predicted value. [15] The RV/TLC ratio will increase irrespective of whether VC increases or decreases. The TLC will either increase or stay the same.	Spirometry -- Clinical Significance. One of the most common causes of restrictive lung disease is obesity. Obese patients have a reduction in FRC, which becomes worse when moving from upright to a supine position. The weight of the chest wall pushes down on the lungs. The weight of the abdominal contents pushes against the diaphragm and base of the lungs, worsening the restrictive pattern. Other restrictive lung processes are chest wall diseases(scoliosis, chest trauma) and neuromuscular disorders (Myasthenia Gravis, Guillain-Barré syndrome). Obstructive lung disease is a disproportionate reduction in the maximum airflow from the lungs compared to the maximum air that can be displaced from the lungs. [15] This can be confirmed by an FEV/VC ratio below the 5th percentile of the predicted value. [15] The RV/TLC ratio will increase irrespective of whether VC increases or decreases. The TLC will either increase or stay the same.
statpearls_NBK430685\article-101481_27	Spirometry -- Clinical Significance	Complete spirometry exams will identify FEV1, forced vital capacity (FVC), vital capacity (VC), residual lung volume (RV), maximum voluntary minute ventilation (MMV), and total lung capacity (TLC). One parameter highly indicative of postoperative complications is predicted postoperative FEV 1 (PPO FEV 1). [16] FEV1 measures the volume of air forcefully exhaled in the first second during a forced expiration maneuver. Small airway disease often results in obstruction or narrowing of the small airways, leading to difficulty rapidly expelling air. Predicted postoperative FEV1 <30% are at a higher risk of postoperative pulmonary complications after thoracic surgery.	Spirometry -- Clinical Significance. Complete spirometry exams will identify FEV1, forced vital capacity (FVC), vital capacity (VC), residual lung volume (RV), maximum voluntary minute ventilation (MMV), and total lung capacity (TLC). One parameter highly indicative of postoperative complications is predicted postoperative FEV 1 (PPO FEV 1). [16] FEV1 measures the volume of air forcefully exhaled in the first second during a forced expiration maneuver. Small airway disease often results in obstruction or narrowing of the small airways, leading to difficulty rapidly expelling air. Predicted postoperative FEV1 <30% are at a higher risk of postoperative pulmonary complications after thoracic surgery.
statpearls_NBK430685\article-101481_28	Spirometry -- Enhancing Healthcare Team Outcomes	Spirometry is an apparatus used to assess pulmonary function for diagnostic or monitoring purposes. The procedure must be explained thoroughly to the subject patient by competent personnel who underwent training under supervision by a specialist mentor and will undergo periodic retraining in order to ensure that the results obtained are as accurate as possible and the complications are kept to a minimum. The results are interpreted by a pulmonologist, and the consultation of an interprofessional group of specialists is recommended. [11] [12]	Spirometry -- Enhancing Healthcare Team Outcomes. Spirometry is an apparatus used to assess pulmonary function for diagnostic or monitoring purposes. The procedure must be explained thoroughly to the subject patient by competent personnel who underwent training under supervision by a specialist mentor and will undergo periodic retraining in order to ensure that the results obtained are as accurate as possible and the complications are kept to a minimum. The results are interpreted by a pulmonologist, and the consultation of an interprofessional group of specialists is recommended. [11] [12]
statpearls_NBK430685\article-101481_29	Spirometry -- Review Questions	Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article.	Spirometry -- Review Questions. Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article.
statpearls_NBK430685\article-101507_0	Fuchs Uveitis Syndrome -- Continuing Education Activity	Fuchs uveitis syndrome (FUS) is a chronic and typically unilateral form of mild anterior uveitis characterized by a distinctive clinical feature known as heterochromia, observed in approximately 13.9% of affected individuals. First described by Ernst Fuchs in 1906, its precise origin remains elusive, with various theories proposed over time, though the infectious theory remains one of the more plausible explanations. This condition leads to changes in vision, primarily due to ensuing complications (eg, cataracts and glaucoma), often affecting patient prognosis. Notably, heterochromia arises from anterior iris stromal atrophy, resulting in the lightening of the affected eye—a phenomenon more pronounced in individuals with lighter-colored irises than those with darker irises, where the atrophy's visibility is reduced.	Fuchs Uveitis Syndrome -- Continuing Education Activity. Fuchs uveitis syndrome (FUS) is a chronic and typically unilateral form of mild anterior uveitis characterized by a distinctive clinical feature known as heterochromia, observed in approximately 13.9% of affected individuals. First described by Ernst Fuchs in 1906, its precise origin remains elusive, with various theories proposed over time, though the infectious theory remains one of the more plausible explanations. This condition leads to changes in vision, primarily due to ensuing complications (eg, cataracts and glaucoma), often affecting patient prognosis. Notably, heterochromia arises from anterior iris stromal atrophy, resulting in the lightening of the affected eye—a phenomenon more pronounced in individuals with lighter-colored irises than those with darker irises, where the atrophy's visibility is reduced.
statpearls_NBK430685\article-101507_1	Fuchs Uveitis Syndrome -- Continuing Education Activity	The demographics of FUS patients exhibit variability across geographic regions, showcasing differences in incidence rates, onset age, and complication frequencies among distinct subpopulations. This CME activity reviews the uncertain etiology of FUS, its diverse epidemiological patterns, proposed pathophysiological mechanisms, clinical manifestations, and the interprofessional team's management of both the syndrome and its associated complications. By exploring these facets, healthcare practitioners can enhance their understanding and approach to effectively address FUS and its diverse clinical implications for patient care.	Fuchs Uveitis Syndrome -- Continuing Education Activity. The demographics of FUS patients exhibit variability across geographic regions, showcasing differences in incidence rates, onset age, and complication frequencies among distinct subpopulations. This CME activity reviews the uncertain etiology of FUS, its diverse epidemiological patterns, proposed pathophysiological mechanisms, clinical manifestations, and the interprofessional team's management of both the syndrome and its associated complications. By exploring these facets, healthcare practitioners can enhance their understanding and approach to effectively address FUS and its diverse clinical implications for patient care.
statpearls_NBK430685\article-101507_2	Fuchs Uveitis Syndrome -- Continuing Education Activity	Objectives: Identify the etiology of Fuchs uveitis syndrome (FUS). Assess the theorized pathophysiology of FUS. Interpret the findings that differentiate FUS from other common causes of uveitis. Collaborate with the interprofessional team to educate, treat, and monitor patients with FUS to improve patient outcomes. Access free multiple choice questions on this topic.	Fuchs Uveitis Syndrome -- Continuing Education Activity. Objectives: Identify the etiology of Fuchs uveitis syndrome (FUS). Assess the theorized pathophysiology of FUS. Interpret the findings that differentiate FUS from other common causes of uveitis. Collaborate with the interprofessional team to educate, treat, and monitor patients with FUS to improve patient outcomes. Access free multiple choice questions on this topic.
statpearls_NBK430685\article-101507_3	Fuchs Uveitis Syndrome -- Introduction	Fuchs uveitis syndrome (FUS) is a chronic, typically unilateral, mild anterior uveitis that was first described by Ernst Fuchs in 1906. FUS is also referred to as Fuchs heterochromic uveitis and Fuchs heterochromic iridocyclitis. The exact etiology of FUS is unknown. Fuchs had many theories about what caused this unique pathology; however, these have been largely disproven over the years, with the infectious theory remaining one of the more probable causes.	Fuchs Uveitis Syndrome -- Introduction. Fuchs uveitis syndrome (FUS) is a chronic, typically unilateral, mild anterior uveitis that was first described by Ernst Fuchs in 1906. FUS is also referred to as Fuchs heterochromic uveitis and Fuchs heterochromic iridocyclitis. The exact etiology of FUS is unknown. Fuchs had many theories about what caused this unique pathology; however, these have been largely disproven over the years, with the infectious theory remaining one of the more probable causes.
statpearls_NBK430685\article-101507_4	Fuchs Uveitis Syndrome -- Introduction	The patient population demographics vary by geographic location, with different incidence rates, symptom presentation age, and complication rates depending on the subpopulation studied. Most patients with FUS experience changes in vision mainly due to secondary complications, such as cataracts and glaucoma. Treatment of these complications leads to a good prognosis. [1] [2] [3] [4]	Fuchs Uveitis Syndrome -- Introduction. The patient population demographics vary by geographic location, with different incidence rates, symptom presentation age, and complication rates depending on the subpopulation studied. Most patients with FUS experience changes in vision mainly due to secondary complications, such as cataracts and glaucoma. Treatment of these complications leads to a good prognosis. [1] [2] [3] [4]
statpearls_NBK430685\article-101507_5	Fuchs Uveitis Syndrome -- Introduction	Nonhereditary heterochromia, present in about 13.9% of patients with FUS, is caused by anterior iris stromal atrophy. [4] [5] As a result, the patient will notice a lightening in the affected eye. Heterochromia is predominantly seen in patients with a lighter-colored iris. Patients with a darker-colored iris have more pigment cells in the anterior border layer of the iris, making the atrophy in the iris less apparent. Consequently, these patients are less likely to develop heterochromia. [3] [4] [6] This article will discuss the etiology, epidemiology, proposed pathophysiology, clinical presentation, and management of FUS and its complications.	Fuchs Uveitis Syndrome -- Introduction. Nonhereditary heterochromia, present in about 13.9% of patients with FUS, is caused by anterior iris stromal atrophy. [4] [5] As a result, the patient will notice a lightening in the affected eye. Heterochromia is predominantly seen in patients with a lighter-colored iris. Patients with a darker-colored iris have more pigment cells in the anterior border layer of the iris, making the atrophy in the iris less apparent. Consequently, these patients are less likely to develop heterochromia. [3] [4] [6] This article will discuss the etiology, epidemiology, proposed pathophysiology, clinical presentation, and management of FUS and its complications.
statpearls_NBK430685\article-101507_6	Fuchs Uveitis Syndrome -- Etiology	The initial studies on FUS hypothesized its etiology ranging from adrenergic denervation, as in Horner syndrome, to infectious causes such as herpes simplex virus (HSV) and Toxoplasma gondii. One of the landmark studies by Quentin and Reiber proposed the now-predominant theory that FUS is caused by an inflammatory process involving rubella. The study analyzed the presence of intraocular antibody synthesis driven by rubella, HSV, varicella-zoster, measles, and toxoplasmosis. The results showed rubella oligoclonal antibodies in every sample of aqueous humor collected from patients with FUS, leading to a diagnostic criterion of 100% sensitivity. [7]	Fuchs Uveitis Syndrome -- Etiology. The initial studies on FUS hypothesized its etiology ranging from adrenergic denervation, as in Horner syndrome, to infectious causes such as herpes simplex virus (HSV) and Toxoplasma gondii. One of the landmark studies by Quentin and Reiber proposed the now-predominant theory that FUS is caused by an inflammatory process involving rubella. The study analyzed the presence of intraocular antibody synthesis driven by rubella, HSV, varicella-zoster, measles, and toxoplasmosis. The results showed rubella oligoclonal antibodies in every sample of aqueous humor collected from patients with FUS, leading to a diagnostic criterion of 100% sensitivity. [7]
statpearls_NBK430685\article-101507_7	Fuchs Uveitis Syndrome -- Etiology	Subsequently, multiple studies analyzed the presence of rubella RNA or rubella antibodies in the aqueous humor of patients with FUS. [5] [7] [8] These studies concluded that patients with FUS have the persistent presence of immunoglobulin G (IgG) oligoclonal rubella antibodies in the affected eye and that the presence of rubella viral RNA in the aqueous humor is not associated with the progression of FUS. [9] [10] [11] [12] [13]	Fuchs Uveitis Syndrome -- Etiology. Subsequently, multiple studies analyzed the presence of rubella RNA or rubella antibodies in the aqueous humor of patients with FUS. [5] [7] [8] These studies concluded that patients with FUS have the persistent presence of immunoglobulin G (IgG) oligoclonal rubella antibodies in the affected eye and that the presence of rubella viral RNA in the aqueous humor is not associated with the progression of FUS. [9] [10] [11] [12] [13]
statpearls_NBK430685\article-101507_8	Fuchs Uveitis Syndrome -- Etiology	The initially proposed mechanisms of FUS consisted of sympathetic nerve dysfunction, hereditary, ocular toxoplasmosis, vascular, and immunological theories, all of which have largely lost favor. [14] Other diseases theorized to manifest with FUS are retinitis pigmentosa, Usher syndrome, and chikungunya; however, other theories have limited support in the literature since the studies involve clinical diagnosis with no aqueous humor antibody analysis. No specific human leukocyte antigen (HLA) is associated with FUS. [15] [16] [17] [18]	Fuchs Uveitis Syndrome -- Etiology. The initially proposed mechanisms of FUS consisted of sympathetic nerve dysfunction, hereditary, ocular toxoplasmosis, vascular, and immunological theories, all of which have largely lost favor. [14] Other diseases theorized to manifest with FUS are retinitis pigmentosa, Usher syndrome, and chikungunya; however, other theories have limited support in the literature since the studies involve clinical diagnosis with no aqueous humor antibody analysis. No specific human leukocyte antigen (HLA) is associated with FUS. [15] [16] [17] [18]
statpearls_NBK430685\article-101507_9	Fuchs Uveitis Syndrome -- Epidemiology	In most studies conducted around the world, the age range of diagnosis is from 27 to 44.5 years, with no significant difference between genders. [19] [20] [21] [22] [23] [24] [25] In a cohort of 131 patients at the University of Illinois Eye and Ear Infirmary, the mean age of patients diagnosed with FUS was 43.9, plus or minus 14.3 years. [25]	Fuchs Uveitis Syndrome -- Epidemiology. In most studies conducted around the world, the age range of diagnosis is from 27 to 44.5 years, with no significant difference between genders. [19] [20] [21] [22] [23] [24] [25] In a cohort of 131 patients at the University of Illinois Eye and Ear Infirmary, the mean age of patients diagnosed with FUS was 43.9, plus or minus 14.3 years. [25]
statpearls_NBK430685\article-101507_10	Fuchs Uveitis Syndrome -- Epidemiology	In this study, 4.48% of patients presenting to the clinic from 1919 to 1958 had FUS before and after rubella vaccination. [25] The decade after the rubella vaccination was introduced in 1969, only 1.18% of patients had FUS, with decreasing rates in the subsequent decades. [25] Even though the rubella vaccination decreased the overall incidence of FUS, the proportion of patients diagnosed with FUS born outside the United States has increased.	Fuchs Uveitis Syndrome -- Epidemiology. In this study, 4.48% of patients presenting to the clinic from 1919 to 1958 had FUS before and after rubella vaccination. [25] The decade after the rubella vaccination was introduced in 1969, only 1.18% of patients had FUS, with decreasing rates in the subsequent decades. [25] Even though the rubella vaccination decreased the overall incidence of FUS, the proportion of patients diagnosed with FUS born outside the United States has increased.
statpearls_NBK430685\article-101507_11	Fuchs Uveitis Syndrome -- Pathophysiology	New studies have led to the infectious pathway, which has gained increasing traction within the scientific community. It has been proposed that patients with FUS harbor rubella infection, leading to chronic inflammation manifested as chronic anterior or intermediate uveitis. [7] A study that focused on analyzing the cellular infiltrates identified the presence of mainly T-lymphocytes of CD8 + phenotype, further enforcing the theory of a viral pathological mechanism. [26] [27] Even though the exact mechanism of FUS is unknown, the relationship between rubella oligoclonal antibodies and CD8 + T-lymphocytes in the aqueous humor sheds light on the pathway. [7] [11] [12] [27]	Fuchs Uveitis Syndrome -- Pathophysiology. New studies have led to the infectious pathway, which has gained increasing traction within the scientific community. It has been proposed that patients with FUS harbor rubella infection, leading to chronic inflammation manifested as chronic anterior or intermediate uveitis. [7] A study that focused on analyzing the cellular infiltrates identified the presence of mainly T-lymphocytes of CD8 + phenotype, further enforcing the theory of a viral pathological mechanism. [26] [27] Even though the exact mechanism of FUS is unknown, the relationship between rubella oligoclonal antibodies and CD8 + T-lymphocytes in the aqueous humor sheds light on the pathway. [7] [11] [12] [27]