Examqo › Examqo library › Ophthalmology › Uveitis and ocular inflammation · IMLE
Posterior uveitis and panuveitis
In posterior uveitis inflammation affects the retina, the choroid and their vessels, so vision is at risk; the first question is always infection or not — toxoplasmosis, CMV, herpes viruses, syphilis and tuberculosis are treated with antimicrobials — and only after infection is excluded are steroids and immunosuppression given.
Why it matters in the exam
The exam presents one identifying picture per entity. Toxoplasmosis — the commonest infectious cause: an active white focus next to an old pigmented scar, with vitreous haze over it ("headlight in the fog"); treat when the focus threatens the macula or optic nerve or in immunosuppressed patients, with trimethoprim-sulfamethoxazole or pyrimethamine, sulfadiazine and folinic acid, and a steroid only after the antibiotic has started. CMV retinitis — in AIDS with CD4 below 50, haemorrhage and white necrosis along the vessels, little vitreous inflammation; treatment with ganciclovir or valganciclovir.
Acute retinal necrosis — rapid peripheral necrosis with arteritis and marked vitritis, from VZV or HSV, in a healthy person; intravenous acyclovir at once, with a high risk of retinal detachment and involvement of the fellow eye. Behçet disease — well known in Israel and the Mediterranean: occlusive retinal vasculitis, a "shifting" hypopyon, oral and genital ulcers and pathergy; treatment with azathioprine and TNF inhibitors such as infliximab and adalimumab. VKH — bilateral granulomatous panuveitis with serous retinal detachment, headache, tinnitus, and later whitening of the lashes (poliosis) and vitiligo; high-dose steroids and early immunosuppression.
Sympathetic ophthalmia appears in both eyes weeks to years after penetrating injury or surgery in one eye. Birdshot is linked to HLA-A29. Pars planitis (intermediate uveitis) with "snowballs" and "snowbanks" is linked to multiple sclerosis. In an older adult with vitritis that does not respond to steroids, think of vitreoretinal lymphoma (masquerade) and perform a vitreous biopsy. Toxocara in a child appears as a granuloma and sometimes as a white pupil.
Key points
- In posterior uveitis infection is excluded first.
- Toxoplasmosis: "headlight in the fog" next to a scar.
- CMV: AIDS with CD4 below 50.
- Behçet disease and VKH: early immunosuppression.
- Resistant inflammation in an older adult → think of lymphoma.
Summary table
| Entity | Identifying sign | Who | Treatment |
|---|---|---|---|
| Toxoplasmosis | Active focus by a scar, "headlight in the fog" | Any age | TMP-SMX or pyrimethamine; steroid after antibiotics |
| CMV retinitis | Necrosis and haemorrhage along vessels | AIDS, CD4 below 50 | Ganciclovir or valganciclovir, antiretroviral therapy |
| Acute retinal necrosis | Peripheral necrosis, arteritis | Healthy people too | Intravenous acyclovir at once |
| Behçet disease | Occlusive vasculitis, shifting hypopyon | Israel, Mediterranean | Azathioprine, TNF inhibitors |
| VKH | Bilateral serous detachment, poliosis | Asian, Hispanic ancestry | High-dose steroids and immunosuppression |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Ophthalmology, Medical licensing exam (IMLE), Internal medicine.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- Standardization of Uveitis Nomenclature (SUN) Working Group: Classification criteria for uveitides, 2021 — Infectious and non-infectious posterior uveitis and panuveitis
- AAO Basic and Clinical Science Course, Section 9: Uveitis and Ocular Inflammation, 2024-2025 — Posterior uveitis and panuveitis
- Kanski's Clinical Ophthalmology, 9th edition (2020) — Uveitis
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.