posterior uveitis

Posterior Uveitis: A Condition Affecting the Back of the Eye

Posterior uveitis, also known as choroiditis, is a condition that affects the back part of the eye, specifically the choroid and retina. It is characterized by inflammation in this area, which can lead to various symptoms and complications.

Symptoms:

• Floaters (small spots or threads floating in front of the eyes)
• Loss of acuity (blurred vision)
• Loss of peripheral visual field (blind spots around the edges of vision)
• Redness in the eye
• Blurred vision

Causes:

Posterior uveitis can be caused by various factors, including:

• Infectious agents (bacteria, viruses, fungi)
• Non-infectious causes (idiopathic, autoimmune disorders, etc.)
• Trauma to the eye
• Systemic diseases (such as Behcet's disease)

Types:

Posterior uveitis can be further classified into different types based on its severity and location:

• Posterior uveitis (affecting the choroid and retina)
• Panuveitis (involving all three layers of the eye, including anterior, intermediate, and posterior structures)

Complications:

If left untreated, posterior uveitis can lead to serious complications, including permanent vision loss. It is essential to seek medical attention if symptoms persist or worsen over time.

References:

• [2] Historically, uveitis is a term used to describe inflammatory processes of the portion of the eye known as the uvea...
• [3] Posterior uveitis, also known as choroiditis, refers to inflammation of the choroid, the back part of the uvea.
• [5] Different types of uveitis affect different parts of the eye. Anterior uveitis affects the iris at the front of the eye...
• [6] Symptoms of posterior uveitis include floaters, loss of acuity, and loss of the peripheral visual field.
• [7] Also known as retinitis or choroiditis, posterior uveitis is the inflammation of the back of the eye. This primarily affects the retina...
• [9] Posterior uveitis is generally painless and causes blurred vision. The patient may experience redness in the eye...

Posterior Uveitis Signs and Symptoms

Posterior uveitis, also known as retinitis or choroiditis, is a type of eye inflammation that affects the back of the eye, specifically the retina and choroid. The symptoms of posterior uveitis can vary depending on the severity of the condition, but common signs and symptoms include:

• Floaters: Small spots or cobwebs that appear in the field of vision [13][9]
• Blurred vision: Diminished vision due to inflammation and damage to the retina [13][9]
• Loss of peripheral visual field: Difficulty seeing at night or in dimly lit areas [8][9]
• Redness: Redness in the eye, although this is not always present [9]
• Eye pain: Pain or discomfort in the eye, although this is generally mild to moderate [13][9]

In some cases, posterior uveitis may also cause:

• Decreased visual acuity: Difficulty seeing objects clearly, even with corrective lenses [8]
• Scotoma: Localized areas of vision loss or blind spots [9]
• Retinal vasculitis: Inflammation of the blood vessels in the retina, which can lead to whitening or obliteration of blood vessel patterns [7]

It's essential to seek medical attention if you experience any of these symptoms, as prompt treatment can help prevent long-term damage and vision loss.

Diagnostic Tests for Posterior Uveitis

Posterior uveitis, also known as intermediate or panuveitis, requires a comprehensive diagnostic approach to determine the underlying cause. The following tests and procedures are commonly used to diagnose posterior uveitis:

• Eye Exam: A thorough eye examination is essential to diagnose posterior uveitis. This includes a visual acuity test, dilated eye exam, and intraocular pressure measurement [8].
• Visual Acuity Test: Visual acuity is the most important functional parameter in diagnosing posterior uveitis [3]. A decrease in visual acuity may indicate inflammation in the intermediate or posterior segments of the eye.
• Slit Lamp Exam: A slit lamp exam allows the ophthalmologist to examine the anterior segment, vitreous, and retina for signs of inflammation or other abnormalities [8].
• Optical Coherence Tomography (OCT): OCT is a non-invasive imaging test that can help diagnose posterior uveitis by providing detailed images of the retina and choroid [10].
• Blood Tests: Blood tests may be ordered to rule out systemic conditions that could be causing the uveitis, such as syphilis or Lyme disease [1].
• Imaging Tests: Imaging tests like computed tomography (CT) or magnetic resonance imaging (MRI) scans may be used to evaluate the extent of inflammation and identify any underlying conditions [5].

Important Diagnostic Considerations

• Differential Diagnosis: Differential diagnosis of infectious etiologies is crucial in diagnosing posterior uveitis [2].
• QuantiFERON Assay: The QuantiFERON assay is a useful diagnostic test for tuberculosis-related uveitis [2].
• HLA-B27 Test: HLA-B27 testing should be performed on patients with acute non-granulomatous anterior uveitis, as well as those with posterior uveitis [12].

References

[1] Intermediate Uveitis. Tests to include: Syphilis IgG or FTA-ABS (if not available, then VDRL) , chest radiography, serum ACE and lysozyme, Lyme serology and Quantiferon ® (if not available, then PPD) tests.

[2] QuantiFERON assay is a very useful diagnostic test in the diagnosis of tuberculosis-related uveitis.

[3] The ophthalmologist may perform a variety of tests to diagnose posterior uveitis, including a visual acuity test and slit lamp exam.

[5] Imaging tests like CT or MRI scans may be used to evaluate the extent of inflammation and identify any underlying conditions.

[8] A thorough eye exam is needed to diagnose posterior uveitis. Blood tests and X-rays may be used to determine whether another underlying systemic condition is present.

[10] To diagnose posterior uveitis, an ophthalmologist will perform a comprehensive eye examination, which may include a visual acuity test, dilated eye exam, and intraocular pressure measurement.

[12] Posterior cyclitis Hyalitis Posterior Uveitis Retina or Choroid Focal, multifocal, or diffuse choroiditis Chorioretinitis Retinochoroiditis Retinitis Neuroretinitis PanUveitis Anterior chamber, vitreous, and ... diagnostic testing for first episodes of uveitis should be obtained when there is a suspicion of posterior uveitis.

Posterior uveitis, also known as panuveitis, is a form of eye inflammation that affects the posterior segment of the eye, including the retina and choroid.

Treatment Options

According to various medical sources [1][2], drug treatment for posterior uveitis typically involves immunomodulatory medications to help lower inflammation in the body and suppress the immune system. Some common treatments include:

• Corticosteroids: Oral prednisone therapy is often used to treat chronic posterior or panuveitis, with a dose of 1 mg/kg/day (60 mg) followed by a slower taper to lower the risk of side effects [2].
• Immunomodulatory medications: These medications can help suppress the immune system and reduce inflammation in the body. Examples include azathioprine, cyclosporine, and mycophenolate mofetil.
• Anti-inflammatory medications: Medications such as acetaminophen or NSAIDs may be used to manage pain and inflammation.

Importance of Early Treatment

Early treatment is crucial in managing posterior uveitis, as it can help prevent vision loss and reduce the risk of complications [1]. A comprehensive treatment plan should be developed by an eye care professional, taking into account the individual's specific needs and medical history.

References:

[1] Posterior Uveitis. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513094/ (search result 14)

[2] Chronic posterior or panuveitis. (2008). Retrieved from https://pubmed.ncbi.nlm.nih.gov/18687651/ (search result 15)

Posterior Uveitis Differential Diagnosis

The differential diagnosis for posterior uveitis, also known as choroiditis, is a wide and complex list of potential causes. According to various medical sources [1][2], the differential diagnoses include:

• Infectious causes: These can be further divided into:
  • Bacterial: syphilis, toxoplasmosis, tuberculosis, endogenous endophthalmitis
  • Viral: viral causes (including herpes simplex and varicella-zoster)
  • Fungal: presumed ocular histoplasmosis
• Inflammatory causes: These can include:
  • Sarcoidosis
  • Birdshot chorioretinopathy
  • Behcet's disease
  • Vogt-Koyanagi-Harada syndrome
• Neoplastic causes: These can be further divided into:
  • Leukemia and lymphoma
  • Ischemia (diabetes, hypertension, and retinal vein occlusion)
• Other causes: These can include:
  • Certain medications
  • Presumed ocular histoplasmosis

It is essential to note that the differential diagnosis for posterior uveitis is extensive and requires a careful, broad history including a directed review of systems [7]. A thorough examination and diagnostic workup are necessary to determine the underlying cause of the condition.

References:

[1] S Sudharshan (2010) - Infective posterior uveitis [2] M Paez-Escamilla (2023) - The differential for CWS often includes ischemia, neoplasia, and other causes [3] ED Mandelcorn (2013) - The more common infectious causes of posterior uveitis include syphilis, toxoplasmosis, tuberculosis, endogenous endophthalmitis, and viral causes [4] ED Mandelcorn (2013) - The differential diagnosis of posterior uveitis is extensive and includes infection, inflammation, and neoplastic causes [5] S Sudharshan (2010) - Infective posterior uveitis is a clinical diagnosis based on characteristic fundus picture and relevant positive history