Uveitis (Intraocular Inflammation)

Uveitis denotes inflammation of the uveal tract—iris, ciliary body, and choroid—and adjacent structures (retina, vitreous, sclera). Standardization of Uveitis Nomenclature (SUN) classifies uveitis anatomically: anterior uveitis (iris/ciliary body, ~60%), intermediate uveitis (vitreous), posterior uveitis (retina/choroid), and panuveitis (all segments). Etiologies include infectious (herpetic HSV/VZV/CMV, toxoplasmosis, tuberculosis, syphilis, Lyme), immune-mediated systemic disease (HLA-B27 spondyloarthritis, sarcoidosis, Behçet disease, juvenile idiopathic arthritis, multiple sclerosis, Vogt-Koyanagi-Harada, sympathetic ophthalmia), and idiopathic (~30-50%). Uveitis accounts for 10-15% of legal blindness in working-age adults globally.

Clinical presentation varies: acute anterior uveitis (HLA-B27, idiopathic) presents with painful red eye, photophobia, and blurred vision with classic 'cells and flare' on slit lamp examination, keratic precipitates, posterior synechiae, and possibly hypopyon (Behçet). Intermediate uveitis presents with floaters and decreased vision from vitritis, vitreous snowballs, and pars plana snowbanking. Posterior uveitis manifests as floaters, scotoma, and decreased vision with retinal/choroidal lesions on fundoscopy and OCT. Workup is etiology-driven: laboratory (CBC, ACE, lysozyme, ANA, HLA-B27, RPR/FTA-ABS, QuantiFERON, Lyme), imaging (chest CT for sarcoid/TB, MRI for MS), and ocular tests (OCT for macular edema, fluorescein angiography, ultrasound).

Treatment is etiology- and severity-driven. Anterior uveitis: topical corticosteroids (prednisolone acetate 1% q1-2h tapered), cycloplegic (cyclopentolate, atropine) for pain and synechiae prevention; for severe cases, periocular triamcinolone or systemic steroids. Intermediate/posterior/panuveitis: systemic corticosteroids (oral prednisone, IV methylprednisolone for severe); steroid-sparing immunomodulators (methotrexate, mycophenolate mofetil, azathioprine, cyclosporine) for chronic disease or steroid-dependent cases; biologics (adalimumab approved for non-infectious uveitis, infliximab for Behçet); intraocular dexamethasone (Ozurdex) or fluocinolone (Yutiq, Iluvien) implants. Infectious uveitis requires specific antimicrobial therapy (acyclovir/valacyclovir for herpetic, pyrimethamine-sulfadiazine for toxoplasmosis, RIPE for TB, penicillin for syphilis). Complications—cataract, glaucoma, macular edema, posterior synechiae, band keratopathy, retinal detachment—require coordinated management.