Posterior Uveitis

Inflammatory disorder involving the posterior segment of the uveal tract, primarily affecting the choroid, and frequently extending to adjacent structures such as the retina, retinal vessels, vitreous, and optic disc

Aetiology

Infectious Causes

  • Toxoplasma gondii (most common worldwide)
  • Mycobacterium tuberculosis
  • Treponema pallidum (syphilis)
  • Cytomegalovirus (CMV)
  • Herpes simplex virus (HSV)
  • Varicella-zoster virus (VZV)
  • Candida and other fungi (immunocompromised patients)
  • Bartonella henselae

Non-Infectious / Immune-Mediated Causes

  • Sarcoidosis
  • Behçet disease
  • Vogt–Koyanagi–Harada (VKH) disease
  • Sympathetic ophthalmia
  • Multiple sclerosis–associated uveitis
  • Idiopathic retinal vasculitis

Idiopathic

  • No identifiable cause despite extensive evaluation

Clinical presentation

Symptoms

  • Blurred or decreased vision
  • Floaters
  • Scotomas
  • Metamorphopsia, micropsia, macropsia
  • Minimal pain and redness (unlike anterior uveitis)

Signs

  • Vitritis (“haze”)
  • Chorioretinal lesions (active or healed)
  • Retinal vasculitis (perivascular sheathing, hemorrhages)
  • Macular edema
  • Optic disc edema or hyperemia
  • Retinal necrosis in severe viral infections

Management

Infectious Posterior Uveitis

  • Targeted antimicrobial therapy:
    • Anti-toxoplasma therapy (e.g., pyrimethamine, sulfadiazine, folinic acid)
    • Antitubercular therapy
    • Antiviral therapy (e.g., ganciclovir for CMV)
  • Corticosteroids may be used adjunctively after initiation of antimicrobial treatment

Non-Infectious Posterior Uveitis

  • Systemic corticosteroids (first-line)
  • Steroid-sparing immunosuppressive agents (methotrexate, azathioprine, mycophenolate mofetil)
  • Biologic agents in refractory cases
  • Local therapy (peri- or intravitreal steroids) in selected cases