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For further information, see CMDT Part 7-12: Uveitis

Key Features

Essentials of Diagnosis

  • Usually immunologic but possibly infective or neoplastic

  • Inflammation may be confined to the eye or may be systemic

  • Acute anterior uveitis: sudden redness and blurry vision, often with photophobia

  • Posterior uveitis: gradual loss of vision, commonly with floaters (moving spots or strands like cobwebs in the visual field), in a variably inflamed eye

General Considerations

  • Intraocular inflammation (uveitis) is classified

    • By its clinical presentation: acute or chronic and nongranulomatous or granulomatous

    • By its distribution: anterior, intermediate, posterior, or panuveitis


  • Systemic disorders associated with acute nongranulomatous anterior uveitis include

    • Ankylosing spondylitis

    • Reactive arthritis

    • Psoriasis

    • Ulcerative colitis

    • Crohn disease

  • Chronic nongranulomatous anterior uveitis occurs in juvenile idiopathic arthritis

  • Behçet syndrome produces

    • Anterior uveitis, with recurrent hypopyon

    • Posterior uveitis, characteristically with branch retinal vein occlusions

  • Both herpes simplex and herpes zoster infections may cause nongranulomatous anterior uveitis as well as retinitis

  • Diseases that produce granulomatous anterior uveitis also tend to be causes of posterior uveitis and include

    • Sarcoidosis

    • Toxoplasmosis

    • Tuberculosis

    • Syphilis

    • Vogt-Koyanagi-Harada disease

    • Sympathetic ophthalmia following penetrating ocular trauma

  • In toxoplasmosis, there may be evidence of previous episodes of retinochoroiditis

  • In HIV infection, principal pathogens responsible for ocular inflammation are

    • Cytomegalovirus (CMV)

    • Herpes simplex and herpes zoster viruses

    • Mycobacteria

    • Cryptococcus

    • Toxoplasma

    • Candida

  • Retinal vasculitis and intermediate uveitis

    • Predominantly manifest as posterior uveitis with central or peripheral retinal abnormalities in retinal vasculitis and far peripheral retinal abnormalities (pars planitis) in intermediate uveitis

    • Retinal vasculitis can be caused by a wide variety of infectious agents and noninfectious systemic conditions but also may be idiopathic

    • Intermediate uveitis is often idiopathic but can be due to multiple sclerosis or sarcoidosis

Clinical Findings

Symptoms and Signs

  • Anterior uveitis

    • Characterized by inflammatory cells and flare within the aqueous humor

    • In severe cases, there may be hypopyon and fibrin within the anterior chamber

    • Cells may also be seen on the corneal endothelium as keratic precipitates

  • In granulomatous uveitis, the keratic precipitates are large, and iris nodules may be seen

  • In nongranulomatous uveitis,

    • The keratic precipitates are smaller or absent with no iris nodules

    • The pupil is usually small, and with the development of posterior synechiae, it also becomes irregular

  • Nongranulomatous anterior uveitis tends to present acutely with unilateral pain, redness, photophobia, and visual loss

  • In juvenile idiopathic arthritis, there tends to be an indolent, often initially asymptomatic, process with a high risk of sight-threatening complications

  • Granulomatous anterior uveitis is more frequently indolent, causing blurred vision in a variably inflamed eye

  • Posterior uveitis

    • Can be unilateral or bilateral with floaters and visual loss

    • Symptoms are commonly slower in onset, though acute presentations can occur

    • Inflammatory lesions may be present in the retina or choroid

    • New retinal lesions are yellow, with indistinct margins, ...

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