Posterior Uveitis

 Posterior Uveitis





Definition:

Posterior uveitis is inflammation of the choroid, retina, or optic nerve head (back portion of the uveal tract). It can involve adjacent structures like the retinal vessels, retinal pigment epithelium (RPE), and vitreous.


Causes:

Posterior uveitis can be infectious or non-infectious.


✅ Infectious Causes:

  • Toxoplasmosis (most common)

  • Cytomegalovirus (CMV)

  • Herpes simplex/zoster virus

  • Tuberculosis

  • Syphilis

  • HIV/AIDS-related infections


✅ Non-Infectious Causes:

  • Autoimmune diseases (e.g., sarcoidosis, Behçet’s disease)

  • Idiopathic

  • Vogt-Koyanagi-Harada (VKH) disease

  • Birdshot chorioretinopathy


Symptoms:

  • Blurred or decreased vision

  • Floaters

  • Visual field defects

  • Photopsia (flashing lights)

  • Painless (usually)


Signs:

  • Vitritis (cells in vitreous)

  • Chorioretinal lesions (active or scarred)

  • Retinal vasculitis

  • Optic disc swelling

  • Macular edema


Diagnosis:

  • Fundus examination (indirect ophthalmoscopy)

  • OCT (to assess macula)

  • Fluorescein angiography (retinal vessels)

  • Indocyanine green angiography (choroid)

  • Blood tests (e.g., toxoplasma IgG/IgM, TB screening, syphilis tests)

  • PCR of aqueous/vitreous sample (for infections)


Treatment:

Infectious:

  • Specific antimicrobial therapy (e.g., pyrimethamine-sulfadiazine for toxoplasmosis, anti-TB drugs)


Non-infectious:


  • Corticosteroids (oral, intravitreal, or periocular)


  • Immunosuppressive agents (e.g., methotrexate, azathioprine)


  • Biologics (in severe or refractory cases)


Complications:

  • Permanent vision loss

  • Retinal detachment

  • Cystoid macular edema

  • Optic neuropathy

  • Choroidal neovascularization


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