ConditionEyes & vision
Posterior Uveitis
Posterior uveitis is inflammation of the back of the eye: the choroid (the blood-rich layer under the retina) and often the retina itself, called chorioretinitis. It typically causes floaters, blurred vision and blind spots, often without pain or redness, so it can go unnoticed until vision is affected. Causes include infections such as toxoplasmosis, CMV and syphilis, and immune conditions such as sarcoidosis, Behçet's disease and birdshot chorioretinopathy. Prompt diagnosis and treatment with antimicrobials or anti-inflammatory medicines protect vision.
Also called: Choroiditis, chorioretinitis, retinochoroiditis, inflammation of the back of the uvea
At a glance
- What it is
- Inflammation of the choroid and retina at the back of the eye.
- Symptoms
- Floaters, blurred or distorted vision, blind spots; usually little pain or redness.
- Causes
- Infections (toxoplasmosis, CMV, syphilis, TB, herpes viruses) and autoimmune or inflammatory diseases.
- Diagnosis
- Dilated eye exam, retinal imaging, blood tests, sometimes eye fluid sampling.
- Treatment
- Antimicrobials for infection; steroids and immune-modulating drugs for non-infectious causes.
When to get help
Call 911 or go to the ER
- Sudden severe loss of vision, or a curtain over vision
- Eye pain and vision loss after eye surgery or injection
See a doctor within a day or two
- New floaters or blurred vision in someone with a weakened immune system (HIV, transplant, chemotherapy)
- Floaters, blurred vision or blind spots that are new and persistent, especially in one eye
- Vision changes with fever, rash, mouth or genital ulcers
Book a routine appointment
- Gradually worsening floaters or blurred vision
- Known uveitis with new or changing symptoms
Types of uveitis by location
The uvea is the middle layer of the eye, made up of the iris, ciliary body and choroid. Uveitis is classified by where the inflammation is:
| Type | Location | Typical symptoms |
|---|---|---|
| Anterior uveitis (iritis) | Iris | Painful red eye, light sensitivity |
| Intermediate uveitis | Vitreous gel | Floaters, blurred vision |
| Posterior uveitis | Choroid and retina | Floaters, blurred vision, blind spots, often painless |
| Panuveitis | All layers | Combination |
See uveitis for an overview.
Symptoms
- floaters: spots, threads or cobwebs drifting in vision
- blurred vision or hazy vision
- blind spots or areas of distorted vision
- flashing lights
- reduced night or color vision
- usually little or no pain or redness, which can delay diagnosis
It can affect one or both eyes.
Causes
Infectious causes
- Toxoplasmosis: the most common cause of posterior uveitis worldwide; a white patch of retinitis next to an old scar ("headlight in the fog")
- Cytomegalovirus: in people with advanced HIV or after transplant
- Syphilis: can mimic many patterns; always tested for
- Tuberculosis
- Herpes viruses: acute retinal necrosis, a rapidly destructive infection
- Toxocara, fungal infections (for example candida in IV drug users or with central lines)
Non-infectious causes
- Sarcoidosis
- Behçet's disease: with mouth and genital ulcers
- Birdshot chorioretinopathy: cream-colored spots, linked to the HLA-A29 gene
- Vogt-Koyanagi-Harada disease and sympathetic ophthalmia
- Serpiginous choroiditis and white dot syndromes
- Multiple sclerosis
- Masquerade syndromes: intraocular lymphoma, which can mimic uveitis in older adults
Diagnosis
An eye doctor (ideally a uveitis specialist) will:
- examine the back of the eye after dilation
- perform optical coherence tomography (OCT) to look for retinal swelling (macular edema)
- use fluorescein and indocyanine green angiography to show inflamed vessels and choroid
- order blood tests: syphilis serology, TB testing, toxoplasma antibodies, HIV, ACE and other inflammatory markers, HLA typing when relevant
- order chest imaging for sarcoidosis or TB
- sometimes sample fluid from the eye for PCR testing of infections
Treatment
Infectious posterior uveitis
- toxoplasmosis: antiparasitic antibiotics, sometimes with steroids
- CMV and herpes: antiviral medicines by mouth, IV or injection into the eye
- syphilis: IV penicillin
- TB: anti-tuberculosis treatment
Non-infectious posterior uveitis
- corticosteroids: tablets, eye injections or long-acting implants
- immunosuppressive and steroid-sparing medicines: methotrexate, mycophenolate, azathioprine, cyclosporine
- biologic medicines: adalimumab is approved for non-infectious intermediate, posterior and panuveitis
- treatment of macular edema
Treatment often continues for months to years with regular monitoring.
Complications
- macular edema
- retinal scarring and detachment
- glaucoma and cataract, including from steroid treatment
- new blood vessel growth under the retina
- permanent vision loss if untreated
Frequently asked questions
What are the symptoms of posterior uveitis?
The main symptoms are floaters, blurred or hazy vision, blind spots and sometimes flashing lights. Unlike anterior uveitis, there is usually little pain or redness, so people may not realize something serious is happening.
What causes posterior uveitis?
Causes include infections such as toxoplasmosis, CMV, syphilis, tuberculosis and herpes viruses, and immune or inflammatory conditions such as sarcoidosis, Behçet's disease and birdshot chorioretinopathy. In many cases, a specific cause is found with testing.
Can posterior uveitis cause blindness?
Yes, if untreated. Inflammation can damage the retina and cause macular swelling, scarring and detachment. Early diagnosis and appropriate treatment greatly reduce the risk of permanent vision loss.
How is posterior uveitis treated?
Infections are treated with specific antibiotics, antivirals or antiparasitic medicines. Non-infectious uveitis is treated with steroids and, often, longer-term immune-modulating or biologic medicines to control inflammation and protect vision.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Uveitis; Posterior uveitis
- National Eye Institute: Uveitis
- Standardization of Uveitis Nomenclature (SUN) Working Group: Classification criteria
- MedlinePlus: Uveitis
- Ocular Immunology and Uveitis Foundation: Posterior uveitis