What are the other Names for this Condition? (Also known as/Synonyms)
What is Posterior Uveitis? (Definition/Background Information)
- Uveitis is inflammation of the uvea, which is a part of the eye structure. The uvea is a pigmented layer which lies beneath the whitish fibrous layer called sclera. It consists of the iris, ciliary body, and choroid. The uvea encloses, nourishes, and protects the retina
- There are 4 types of Uveitis, depending on which part of the uvea is involved:
- Anterior Uveitis
- Intermediate Uveitis
- Posterior Uveitis
- Posterior Uveitis is a condition involving inflammation of the choroid. Hence, it is also known as Choroiditis. The choroid is one of 3 parts that make up the uvea, and it is located in the back part of it
- Posterior Uveitis can be caused by both infectious and non-infectious factors and any individual may be affected. However, those that are more predisposed to varying types of infection and immunologic conditions may be at a higher risk for developing Posterior Uveitis
- A healthcare provider may use physical exams and various blood tests to diagnose Posterior Uveitis. Upon diagnosis, treatment options involving steroids or immunomodulators may be used to treat the condition
- Additionally, the healthcare provider will address any underlying conditions that may be contributing to the progression of Posterior Uveitis. An immediate medical attention is sought to achieve better outcomes
- The prognosis for Posterior Uveitis depends on each individual's signs and symptoms and is assessed on a case-by-case basis. With appropriate treatment, the prognosis is generally good. However, the condition can lead to permanent blindness if left undiagnosed or untreated
- Complications, such as glaucoma and cataract, can also worsen the prognosis. Avoiding infectious scenarios and treating underlying conditions that involve the eye early, can help minimize one’s risk for uveitis
Uvea: The uvea is a part of the eye that consists of 3 structures, namely the iris, the ciliary body, and the choroid.
- Iris: It is the colored portion of the eye. The iris surrounds the pupil of the eye
- Ciliary body: It is located between the iris and choroid portion of uvea. Ciliary bodies help in attaching the lens in the eye and also help provide nutrients to the lens. It secretes aqueous humour (transparent watery fluid) and plays an important role in maintaining intraocular pressure
- Choroid: It is a portion of the uvea that is predominantly made up of blood vessels. Choroid provides nutrients to the retina, keeping it healthy
Who gets Posterior Uveitis? (Age and Sex Distribution)
- Posterior Uveitis can present itself at any age, but is more likely to occur between the ages of 20 and 50 years
- Both males and females are affected
- Individuals of different racial and ethnic backgrounds can be affected and no particular preference is noted
What are the Risk Factors for Posterior Uveitis? (Predisposing Factors)
The risk factors for Posterior Uveitis may include a variety of conditions such as:
- Increased exposure to bacteria, parasites, viruses, or fungi, due to infections such as Lyme disease, tuberculosis, toxoplasmosis, or toxocariasis
- Autoimmune disorders that include psoriasis, juvenile rheumatoid arthritis, systemic lupus erythematosus, etc.
- Underlying immunologic (non-infectious) conditions such as Behcet’s syndrome, ankylosing spondylitis, sarcoidosis, etc.
- Participating in activities that have an increased risk for eye injuries
- Blood vessel inflammation or vasculitis
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Posterior Uveitis? (Etiology)
Posterior Uveitis is an eye condition that can have either an infectious or a noninfectious origin. In many cases, the cause of the condition remains unknown, termed Idiopathic Posterior Uveitis.
The infectious causes of Posterior Uveitis may include the following:
- Bacteria that may cause tuberculosis, syphilis, brucellosis, leptospirosis, Lyme disease, and other infections
- Fungi that may cause histoplasmosis (presumed ocular histoplasmosis syndrome)
- Viruses causing herpes zoster infection, herpes simplex infection, cytomegalovirus retinitis, and AIDS
- Parasites causing toxoplasmosis or toxocariasis
Noninfectious causes of Posterior Uveitis may include the following:
- A variety of immunologic (autoimmune) conditions such as rheumatoid arthritis, juvenile rheumatoid arthritis, Reiter’s syndrome (reactive arthritis), systemic lupus erythematosus, psoriatic arthritis, psoriasis, etc.
- Inflammatory bowel diseases such as ulcerative colitis
- Certain allergies
- Vasculitis or blood vessel inflammation, due to a variety of causes
- Malignancies, such as caused by large cell lymphomas
- Eye disorders such as acute posterior multifocal placoid pigment epitheliopathy, birdshot retinochoroidopathy, etc.
- Other conditions include sarcoidosis, Kawasaki disease, multiple sclerosis, Behcet’s syndrome, ankylosing spondylitis, etc.
- Injury to the eye resulting in Traumatic Posterior Uveitis
What are the Signs and Symptoms of Posterior Uveitis?
The signs and symptoms of Posterior Uveitis may vary between individuals. It may also be acute or chronic.
- Acute signs and symptoms have a sudden onset, develops rapidly and lasts a period of 3 months
- Chronic signs and symptoms develop slowly over a period of time; it usually persists for over 3 months
The signs and symptoms of Posterior Uveitis may include:
- Small specks, called floaters, that may be seen moving through one's field of vision
- Presence of blind spots, or scotoma, causing partial vision loss
- Subtle light-sensitivity and blurred vision
- Posterior Uveitis is usually a painless condition; however, some individuals experience pain that may rarely be very severe
- Usually only one eye is affected, but the condition may affect both eyes
Associated presentations of the underlying disorder, condition, or infection causing Posterior Uveitis may also be observed.
How is Posterior Uveitis Diagnosed?
Determining if an underlying infectious or immunological condition is causing Posterior Uveitis is crucial in its diagnosis. A healthcare professional may diagnose the condition using the following tests and procedures:
- Physical examination and analysis of previous medical history
- Eye examination by an eye specialist
- Fundoscopic (ophthalmoscopic) examination by an eye specialist, who examines the back part of the eye (or the fundus)
- Visual acuity test using a special and standardized test chart (Snellen chart)
- Slit-lamp examination: Examination of the eye structure using a special instrument called a slit-lamp. In this procedure, the pupils are dilated and the internal eye structure is examined
- Tonometry: Measurement of intraocular pressure or eye fluid pressure, especially to detect conditions such as glaucoma
- Fundus fluorescein angiography (FFA): In this technique, the eye blood vessels are examined using a fluorescein dye
- Fundus autofluorescence (FAF): It is a non-invasive diagnostic technique to examine the fundus of the eye without using a fluorescent dye by a specialized fundus camera
- Indocyanine green (ICG) angiography: It is used to examine the blood vessels of the choroid using a dye, called indocyanine green, particularly to study the choroid
- B-scan ultrasonography: Special ultrasound scan of the eye through a non-invasive diagnostic tool, to assess health of the eye structures
- Electroretinogram (ERG): It is a technique to measure electrical activities in the retinal cells
- Optical coherence tomography (OCT) of eye: It is an ocular imaging technique to visualize the eye structure
- Blood tests:
- To check for the presence of antibodies in blood
- Blood culture for infections
- Complete blood count (CBC) with differential
- Erythrocyte sedimentation rate (ESR)
- Tests to determine any underlying condition causing Posterior Uveitis
If individuals have other signs and symptoms, then the following tests may be performed:
- Chest X-rays
- Neuroimaging studies including MRI scan of brain
- Lumbar puncture: In this procedure, the cerebrospinal fluid is collected and analyzed
Note: In some cases, the individuals may not have any significant signs and symptoms, and it may be diagnosed during a routine eye exam.
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Posterior Uveitis?
The complications of Posterior Uveitis may include:
- Glaucoma: A condition that can cause blindness due to higher intraocular pressure
- Cataracts: When the lens of the eye becomes clouded and cause vision loss
- Retinal detachment: An eye condition wherein the retina gets separated from the eye structures that holds the retinal layers together
- Over time and due to a lack of proper treatment, the condition can affect other surrounding eye structures such as the lens, optic nerve, vitreous fluid, and retina
- Vision loss: Posterior Uveitis can lead to permanent blindness in some cases, if it is left untreated
- Kidney damage, high blood sugar, and high blood pressure, due to steroid treatment
- Recurrent Posterior Uveitis: The condition may recur if the underlying cause is not identified and treated appropriately
How is Posterior Uveitis Treated?
Early diagnosis and treatment of Posterior Uveitis is very crucial in preventing complications that may result in irreversible damage to the eye. In general, the management would involve decreasing eye pain and inflammation, addressing other associated symptoms, and stopping progression or deterioration of eye tissue damage with the goal of preserving vision.
Depending on the cause of Posterior Uveitis, the treatment can be short-term or long-term. With appropriate treatment, the chance of recurrence also decreases.
The treatment of Posterior Uveitis may include the following measures:
- Eye drops and oral medications (including pain medications)
- Oral corticosteroids are generally effective and may be given to control inflammation. Steroids may also be administered intravenously depending on the underlying cause
- Dark glasses may be prescribed for light-sensitivity
- Retisert can be used for the treatment of non-infectious Posterior Uveitis. It is a tiny surgical implant with a drug reservoir containing anti-inflammatory drugs. Retisert is an (US government) FDA-approved product for chronic, non-infectious Posterior Uveitis
- Addressing underlying conditions that may be contributing to progression of the disease, which may be infections, malignancies, autoimmune disorders, or other conditions, is often very important and forms an inherent part of the treatment plan
- If the underlying cause is unknown, then decreasing inflammation is the main step towards treating Posterior Uveitis
- Administration of immunomodulators, which are medications to control dysfunctional immune system
- In case of chronic uveitis that fails to get better with medication, surgery (such as vitrectomy) to treat the condition may be considered
It is important to note that steroids may not be used for all causes of uveitis, since it can worsen the condition. A healthcare provider will provide the best treatment options based upon each individual’s specific circumstances.
How can Posterior Uveitis be Prevented?
It may be difficult to prevent Posterior Uveitis, but the risk for the condition may be lowered through the following measures:
- Avoiding or minimizing contact with individuals who have infections
- Wearing protective gear (such as industrial goggles or protective glasses) during activities that have an increased risk for eye trauma
- Educating the individual and family members about the underlying cause and preventing the development of any modifiable risk factors associated with the underlying condition (where possible)
- Treating any underlying infections and immunologic conditions, as early as possible
- Maintaining long-term follow-up to watch out for any recurrences
What is the Prognosis of Posterior Uveitis? (Outcomes/Resolutions)
- The prognosis of Posterior Uveitis generally varies between individuals. It depends on the following set of factors:
- Severity of signs and symptoms
- Underlying cause of uveitis
- Overall health of the individual
- Response to treatment
- Individuals, who do not have severe signs and symptoms, lack complications, and generally respond well to treatment have a better prognosis. In such cases, the chance for vision loss is remote
- Individuals with complications, or those who do not avail adequate treatment, may have a poorer prognosis. Posterior Uveitis can result in permanent blindness in some cases
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