Advances in the diagnostic testing of ocular fluid for infectious uveitis: Targeted molecular, immunological, and sequencing-based approaches

Abstract

Uveitis is a sight-threatening inflammatory disorder of the eye and is one of the leading causes of preventable blindness. This article reviews current challenges and recent advances in the laboratory diagnosis of infectious uveitis. A narrative review of PubMed-indexed and grey literature published between 1990 and 2026 was performed and supplemented with key abstracts. Seventy-six references were selected for review, spanning topics that included polymerase chain reaction (PCR), the Goldmann-Witmer coefficient, metagenomic next-generation sequencing, cytokine profiling, flow cytometry, and emerging laboratory diagnostics. PCR of intraocular fluid remains a first-line diagnostic tool for infectious uveitis, achieving high sensitivity and specificity, while broad-range PCR allows the identification of a wide variety of targeted bacterial or fungal pathogens. Metagenomic sequencing has also demonstrated promise in its ability to identify rare and novel pathogens, and research into this technique has improved our understanding of pathogens leading to uveitis. The successful laboratory diagnosis of infectious uveitis requires integration of appropriate clinical context and ophthalmic findings to optimize current and future care paradigms.