Infectious Uveitis

Abstract

Infectious uveitis is one of the most common and visually devastating causes of uveitis in the US and worldwide. This review provides a summary of the identification, treatment, and complications associated with certain forms of viral, bacterial, fungal, helminthic, and parasitic uveitis. In particular, this article reviews the literature on identification and treatment of acute retinal necrosis due to herpes simplex virus, varicella virus, and cytomegalovirus. While no agreed-upon treatment has been identified, the characteristics of Ebola virus panuveitis is also reviewed. In addition, forms of parasitic infection such as Toxoplasmosis and Toxocariasis are summarized, as well as spirochetal uveitis. Syphilitic retinitis is reviewed given its increase in prevalence over the last decade. The importance of early identification and treatment of infectious uveitis is emphasized. Early identification can be achieved with a combination of maintaining a high suspicion, recognizing certain clinical features, utilizing multi-modal imaging, and obtaining specimens for molecular diagnostic testing.

Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation

“…[196] Specifically, infectious uveitis is the most common form, representing approximately 15–20% of all cases in the United States. [197] It is initiated through an immune response directed against exogenous pathogens such as viruses, fungi, parasites, and bacteria. [198] Infectious uveitis can affect different parts of the eye, leading to either anterior or posterior uveitis.…”

“…[198] Infectious uveitis can affect different parts of the eye, leading to either anterior or posterior uveitis. [197] However the most devastating cases are those causing posterior involvement such as acute retinal necrosis due to herpes viruses or toxoplasmosis retinochoroiditis. [197] …”

Challenges of Diagnosing Viral Anterior Uveitis

“…Inflammation may also be accompanied by Koeppe or Busacca nodules, or by nodules located in the iridocorneal life-long latency is a characteristic feature of this virus family. 29,30 These viruses may present with AU, keratitis, dermatitis and/or conjunctivitis. 29 Common features of AU due to HSV or VZV infection are the unilateral localization and acute course commonly associated with subsequent recurrences or development of chronicity.…”

“…Herpes simplex virus-associated keratitis typically shows stromal inflammation with associated endotheliitis and fine corneal dendrites without elevated appearance, while VZV-associated keratitis is interstitial with corneal ring infiltrates and rough dendrites lacking terminal bulbs that can have an elevated appearance. 29,30 Furthermore, patients with HSV or VZV-associated AU show decreased corneal sensation. 30,32,33 In contrast to HSV, VZV may show involvement of the vitreous.…”

“…29,30 Furthermore, patients with HSV or VZV-associated AU show decreased corneal sensation. 30,32,33 In contrast to HSV, VZV may show involvement of the vitreous. 34 HSV usually affects children and young adults, VZV is more often seen in elderly and immunocompromised patients.…”