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posterior uveitis (choroiditis)
Inflammation of the vitreous, retina or choroid. It is more likely than anterior uveitis to be associated with a systemic disorder.
Etiology:
1) sarcoidosis
2) Behcet's syndrome
3) Vogt-Koyanagi-Harada syndrome
4) inflammatory bowel disease
5) toxoplasmosis
6) onchocerciasis
7) cysticercosis
8) coccidioidomycosis
9) toxocariasis
10) histoplasmosis
11) Candida
12) Pneumocystis carinii
13) Cryptococcus
14) Aspergillus
15) Herpes
16) Cytomegalovirus
17) syphilis
18) Lyme disease
19) tuberculosis
20) cat-scratch disease
21) Whipple's disease
22) brucellosis
23) multiple sclerosis (in periphery of retina)
24) pharmaceutical agents
a) rifabutin
b) cidofovir
c) ganciclovir
d) vidarabine
Pathology:
- may be associated with autoantibodies to UACA
- may be associated with autoantibodies to TRIB2
- iron-binding acute phase protein detected with variable frequency in serum of patients with posterior uveitis (non-specific)
Clinical manifestations:
1) ocular pain
2) photophobia
3) visual impairment
4) red eye: scleral erythema
5) vitreous inflammation & clouding
6) floaters [3]
7) clear cornea [4]
Laboratory: fundus examination
Management:
1) also see anterior uveitis
2) topical steroids - prednisolone (Pred Forte)
3) dilation of the pupil reduces pain & prevents formation of synechiae
4) treat underlying disorder
5) discontinue offending pharmaceutical agent(s)
6) referral to an ophthalmologist [3]
Specific
chorioretinitis; ocular toxoplasmosis
General
uveitis
choroid disease
References
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 165
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- NEJM Knowledge+. Question of the Week. Aug 9, 2016
http://knowledgeplus.nejm.org/question-of-week/1519/