Uveitis and Infectious Retinitis

Uveitis is classified by anatomic location, and each type has characteristic features and treatments.

• Anterior uveitis affects the front of your eye, commonly causing pain, redness (often perilimbal), a small or irregular pupil from synechiae, and light sensitivity.
• Intermediate uveitis involves the vitreous/pars plana, often presenting with prominent floaters and minimal redness; snowballs and snowbanking are typical exam findings.
• Posterior uveitis affects the retina and choroid and may be less symptomatic early yet more vision-threatening due to macular or optic nerve involvement.
• Panuveitis involves inflammation in all segments of the eye and warrants urgent care.

Multiple underlying conditions can cause uveitis; targeted evaluation guides therapy.

• Autoimmune and autoinflammatory diseases such as rheumatoid arthritis, sarcoidosis, lupus, inflammatory bowel disease, Behçet disease (often HLA-B51–associated), and multiple sclerosis.
• Infections due to viruses, bacteria, fungi, or parasites including herpes viruses, syphilis, tuberculosis, and toxoplasmosis.
• Eye injuries or inflammation related to prior eye surgeries.
• Immune system disorders including HIV/AIDS or reactions to medications (e.g., checkpoint inhibitors, rifabutin, bisphosphonates, and, rarely, topical prostaglandin analogs; avoid prostaglandins in active herpetic disease).
• Genetic associations such as HLA-B27 (acute anterior uveitis) and HLA-A29 (birdshot chorioretinopathy) in specific entities.
• Masquerade syndromes (for example, intraocular lymphoma) that can mimic posterior/panuveitis, especially in older adults.
• Unknown causes, which account for many cases after an appropriate workup.

Early recognition helps protect vision and reduce complications.

• Red, painful eyes that may worsen in bright light, with perilimbal injection in anterior uveitis.
• Light sensitivity (photophobia).
• Blurred or decreased vision that may develop suddenly or gradually.
• New floaters or dark spots; floaters are especially common in intermediate uveitis.
• Eye discomfort or pain that can be intermittent or constant.
• Headaches associated with eye inflammation.
• Distorted or wavy vision if the macula is involved.

We use targeted, evidence-informed testing to identify causes and grade inflammation.

• Comprehensive slit-lamp and dilated fundus examination to localize and grade inflammation, including documentation of snowballs/snowbanking when present.
• Optical Coherence Tomography (OCT) for cross-sectional retinal imaging and detection of macular edema or structural changes.
• Fluorescein and Indocyanine Green (ICG) angiography, with widefield imaging when appropriate, to assess retinal and choroidal circulation and inflammatory leakage.
• Targeted laboratory testing when indicated, such as syphilis serology (treponemal and nontreponemal), HLA-B27/A29, HIV screening in posterior uveitis, interferon-gamma release assay for tuberculosis (especially in BCG-vaccinated individuals), and chest imaging when sarcoidosis is suspected; serum ACE/lysozyme have limited specificity.
• Aqueous or vitreous sampling in selected cases for PCR-based pathogen detection and cytology; when lymphoma is suspected, additional studies may include interleukin-10/6 ratio and flow cytometry.
• Baseline fundus photography (including widefield) to document disease extent and response.

Treatment is tailored to the type, severity, and cause of inflammation while minimizing side effects.

• Corticosteroids delivered as drops, oral therapy, periocular injections, intravitreal injections, or sustained-release implants (dexamethasone and fluocinolone acetonide 0.18 mg/0.19 mg/0.59 mg) to rapidly reduce inflammation.
• For anterior uveitis, intensive topical corticosteroids plus a cycloplegic/mydriatic (such as homatropine or atropine) are first-line to relieve pain and prevent synechiae; intraocular pressure is monitored and treated with aqueous suppressants when needed.
• Steroid-sparing immunomodulators such as methotrexate, mycophenolate mofetil, azathioprine, cyclosporine, or tacrolimus for chronic control.
• Biologic therapies, including adalimumab (on-label for noninfectious intermediate, posterior, and panuveitis), with infliximab or tocilizumab used in selected refractory cases under specialist care.
• Targeted antimicrobial therapy (antivirals, antibiotics, antiparasitics, or antifungals) when infection is identified or strongly suspected.
• Careful monitoring and follow-up to adjust treatment and minimize side effects; avoid corticosteroids without antimicrobial coverage when an infectious cause is suspected.

While not all cases are preventable, proactive steps can lower risk and improve comfort.

• Schedule regular eye exams and seek prompt evaluation for new symptoms.
• Wear protective eyewear during sports and work activities.
• Coordinate age-appropriate vaccinations with your medical team; the recombinant zoster vaccine is preferred prior to systemic immunosuppression when eligible, and live vaccines are generally avoided during significant immunosuppression.
• Avoid smoking, which contributes to systemic inflammation.
• Use UV-protective sunglasses outdoors for comfort and glare reduction.
• Follow closely if you have a history of ocular inflammation or systemic autoimmune disease.

Uveitis is inflammation that can be infectious or noninfectious and may involve the front, middle, or back of the eye, whereas infectious retinitis specifically refers to infection-driven inflammation that primarily involves the retina itself.

Both are serious and can cause permanent vision loss if not treated promptly, but early diagnosis and appropriate therapy often preserve good vision.

Some cases resolve fully, while others require ongoing management to control inflammation and prevent relapses; outcomes depend on cause, severity, and response to treatment.

The eye inflammation itself is not contagious, though certain underlying infections may be transmissible and require appropriate medical treatment and hygiene.

Treatment may include anti-inflammatory medications, immunomodulators, and/or antimicrobial medicines with regular follow-up to monitor response and adjust therapy.

Acute cases may resolve within weeks, while chronic conditions can require months or long-term maintenance tailored to your diagnosis and response.

Either one or both eyes can be involved depending on the underlying condition, so both eyes are examined and monitored closely.

Some complications, such as retinal detachment in necrotizing retinitis, epiretinal membrane, or persistent vitreous opacities, may require laser or surgical treatment based on specialist assessment.