Uveitis

Acute anterior uveitis (AAU) is the most common form of uveitis, characterized by acute eye pain, redness, and photophobia. It is strongly associated with HLA-B27, and local treatment with steroid eye drops and mydriatics is the mainstay.

An acute inflammatory disease characterized by multiple disc-shaped white spots at the level of the retinal pigment epithelium in the posterior pole of both eyes. It predominantly affects young adults in their 20s to 30s, tends to resolve spontaneously, but attention should be paid to the complication of central nervous system vasculitis.

Rapidly progressive necrotizing herpetic retinitis caused by herpesviruses (HSV, VZV). First reported in Japan in 1971 by Urayama et al. as "Kirisawa-type uveitis," this is an ophthalmic emergency requiring early treatment based on the ASAP principle (antiviral therapy, anti-inflammatory therapy, antithrombotic therapy, and prevention of retinal detachment).

An acute outer retinal disorder of unknown cause. Despite minimal fundus findings, it presents acutely with photopsia and visual field defects. It predominantly affects young myopic women. The key diagnostic findings are loss of the ellipsoid zone on OCT and reduced multifocal ERG amplitudes.

This article explains the mechanism of action, indications, administration, side effects, and treatment evidence of the biologic agent adalimumab (Humira) for non-infectious uveitis.

This article explains the concept, epidemiology, symptoms, diagnostic criteria, and treatment (colchicine, cyclosporine, infliximab, adalimumab) of Behçet's disease based on the uveitis treatment guidelines and TNF inhibitor usage guidelines.

A chronic bilateral posterior uveitis characterized by fundus lesions resembling shotgun pellet scars, distributed from the posterior pole to the equator in both eyes. A strong association with HLA-A29 has been reported in Caucasians, and long-term immunomodulatory therapy centered on mycophenolate mofetil and adalimumab is required.

A rare monogenic autoinflammatory disease caused by a gain-of-function mutation in the NOD2 gene. It is characterized by the triad of granulomatous dermatitis, arthritis, and uveitis, and typically presents in childhood.

A comprehensive explanation of eye drops used in the management of uveitis. Indicates the selection and precautions for steroids, mydriatics, and intraocular pressure-lowering drugs.

This article explains the use, efficacy, side effects, and drug interactions of the calcineurin inhibitor cyclosporine in ophthalmology for non-infectious uveitis.

Diagnosis and treatment of cytomegalovirus (CMV) anterior uveitis and corneal endotheliitis in immunocompetent individuals. Characterized by high intraocular pressure, coin-shaped keratic precipitates, linear keratic precipitates, and corneal endothelial cell loss. Treatment mainly involves ganciclovir gel eye drops and oral valganciclovir.

Necrotizing retinitis of the full thickness of the retina caused by cytomegalovirus (CMV). It is an opportunistic infection that occurs in immunocompromised individuals such as those with AIDS, post-organ transplant, or on immunosuppressive therapy. The mainstays of treatment are anti-CMV therapy centered on ganciclovir and prevention of retinal detachment.

A severe infection where bacteria spread hematogenously into the eye from sepsis, liver abscess, etc. Klebsiella pneumoniae is the main causative organism, and progression is rapid. Early triple-route antibiotic administration and vitrectomy determine the prognosis.

Fuchs heterochromic iridocyclitis (FHI) is a unilateral uveitis characterized by the triad of iris heterochromia, chronic iridocyclitis, and cataract. Stellate keratic precipitates, iris atrophy, and Amsler sign are characteristic. Steroids are ineffective, so observation is generally recommended. An association with rubella virus has been suggested.

Endophthalmitis caused by various fungi migrating into the eye. Most cases are endogenous (hematogenous metastasis), with IVH patients and candidemia as major risk factors. Standard treatment includes systemic administration of antifungal agents such as fluconazole and voriconazole, along with vitrectomy.

Granulomatosis with polyangiitis (GPA) is an ANCA-associated vasculitis characterized by necrotizing granulomatous vasculitis of small to medium vessels. It can affect almost all ocular tissues, including the orbit, sclera, and cornea, and also involves the upper respiratory tract, lungs, and kidneys.

A rare subtype of sarcoidosis characterized by four main symptoms: anterior uveitis, parotid gland swelling, facial nerve palsy, and fever. Also known as uveoparotid fever, it occurs in 4–6% of sarcoidosis patients.

Anterior uveitis caused by intraocular reactivation of herpes simplex virus (HSV). It is a representative cause of unilateral anterior uveitis with elevated intraocular pressure, accounting for 5–10% of all uveitis cases.

Anterior or posterior uveitis caused by reactivation of varicella-zoster virus (VZV). It occurs in 40–60% of herpes zoster ophthalmicus (HZO) cases and is characterized by elevated intraocular pressure, chronicity, and sectoral iris atrophy.

Idiopathic multifocal choroiditis (IMFC) is a bilateral autoimmune disease characterized by multiple inflammatory lesions in the retina and choroid, predominantly affecting young myopic women, with choroidal neovascularization as a serious complication.

This section explains ocular complications such as uveitis, scleritis, and chorioretinopathy associated with Crohn's disease and ulcerative colitis. It focuses on HLA-B27-related acute anterior uveitis, and TNF-α inhibitors can simultaneously control inflammation in the gut and eyes.

Infliximab is a mouse/human chimeric anti-TNF-α monoclonal antibody that plays an important role as a steroid-sparing treatment for refractory non-infectious ocular inflammation, particularly uveitis associated with Behçet's disease and JIA.

A vasculitis of medium-sized arteries primarily affecting children, and the most common cause of acquired heart disease in children in developed countries. Ocular symptoms (conjunctivitis, anterior uveitis) frequently occur but are mostly self-limiting.

A multi-organ infectious disease caused by Borrelia spirochetes transmitted through ticks. It has three stages, and ocular symptoms range from conjunctivitis in stage 1 to uveitis, keratitis, and cranial nerve palsy in stages 2 and 3. In Japan, Ixodes persulcatus and Ixodes ovatus are vectors, with northern Japan (mainly Hokkaido) being endemic. It is a Class IV infectious disease under the Infectious Diseases Control Law.

The most widely used immunomodulatory drug for non-infectious uveitis. It is an antimetabolite with antifolate activity, used globally as a first-line steroid-sparing agent.

A chronic bilateral disease presenting with multiple inflammatory lesions at the level of the retinal pigment epithelium and choriocapillaris. It is distinguished from punctate inner choroidopathy by the presence of anterior chamber and vitreous inflammation.

An acute inflammatory disease typically affecting one eye in young myopic women. Transient dysfunction of the outer retina and ellipsoid zone leads to gray-white spots that resolve spontaneously within weeks.

An antimetabolite immunosuppressant used for non-infectious uveitis. It selectively inhibits IMPDH to suppress lymphocyte proliferation and is positioned as a steroid-sparing agent with a favorable side effect profile.

Rapidly progressive necrotizing retinitis caused by herpes viruses (HSV, VZV, CMV). It is an ophthalmic emergency that presents as acute retinal necrosis (ARN) in immunocompetent individuals and progressive outer retinal necrosis (PORN) in immunocompromised individuals.

Ocular corticosteroid therapy includes five routes: eye drops, subconjunctival, sub-Tenon's, intracameral, and intravitreal. It is the first-line treatment for uveitis and postoperative inflammation, but caution is needed for steroid-induced glaucoma and cataracts, and it should be avoided in infectious inflammation. This article systematically explains the drugs, doses, indications, and side effects for each route.

Comprehensive overview of various ocular complications associated with HIV infection. Covers the pathology, diagnosis, and treatment of HIV retinopathy, cytomegalovirus retinitis, opportunistic infections, malignancies, and immune recovery uveitis (IRU) that appear according to CD4-positive T lymphocyte count.

Systemic lupus erythematosus (SLE) is an autoimmune disease that causes chronic inflammation in multiple organs, with ocular symptoms occurring in approximately 30–50% of patients. It presents with various ocular lesions such as dry keratoconjunctivitis and lupus retinopathy, and in severe cases can lead to visual impairment.

A condition characterized by acute, unilateral, recurrent elevation of intraocular pressure with mild anterior chamber inflammation. First reported by Posner and Schlossman in 1948. Strongly associated with CMV infection, and recurrent attacks increase the risk of secondary glaucoma.

This article describes the clinical features, diagnosis, and treatment of uveitis associated with psoriasis and psoriatic arthritis. Anterior uveitis is predominant, and caution is needed regarding new onset or exacerbation risk when using IL-17 inhibitors.

An idiopathic inflammatory choroidal disease that predominantly affects young myopic women. It presents with small yellowish-white lesions in the posterior pole and is frequently complicated by choroidal neovascularization (CNV).

Rituximab, an anti-CD20 monoclonal antibody, is a biologic agent targeting B cells and is used for refractory non-infectious uveitis. It is internationally positioned as a third-line option after adalimumab and infliximab.

Sarcoidosis is a systemic granulomatous disease and is the leading cause of uveitis. Non-caseating granulomas form within the eye, presenting as anterior, intermediate, posterior, or panuveitis. This article provides a comprehensive overview of diagnosis, treatment, and complication management.

A chronic progressive posterior uveitis of unknown etiology affecting the retinal pigment epithelium, choriocapillaris, and choroid. It is characterized by serpiginous atrophic lesions extending from the peripapillary area, leading to irreversible vision loss when the fovea is involved.

A rare autoimmune disease that causes bilateral granulomatous uveitis following penetrating trauma or intraocular surgery in one eye. Rapid systemic corticosteroid therapy combined with immunosuppressive agents is the mainstay of treatment.

Intraocular inflammation caused by Treponema pallidum. Known as the "great imitator," it presents with diverse ocular findings and has been increasing as a re-emerging infection. Cases with HIV co-infection tend to be more severe. High-dose penicillin therapy, as for neurosyphilis, is standard.

A rare systemic inflammatory disease characterized by acute tubulointerstitial nephritis and bilateral anterior uveitis. It predominantly affects adolescent females and is thought to be immune-mediated. Renal prognosis is generally good, but uveitis tends to become chronic and recurrent.

Tocilizumab, an IL-6 receptor inhibitor, is a biologic agent reported to be effective for refractory non-infectious uveitis and uveitic cystoid macular edema that are resistant to TNF-α inhibitors. In juvenile idiopathic arthritis-associated uveitis, a phase II study reported some response.

Retinochoroiditis caused by intraocular infection with Toxoplasma gondii. It is the most common cause of infectious uveitis and can occur both as a recurrence of congenital infection and as acquired infection.

Uveitis caused by intraocular infection or immune reaction to Mycobacterium tuberculosis. Presents with three major lesions: occlusive retinal phlebitis, choroidal miliary tuberculosis, and tuberculoma. Standard treatment is multidrug antitubercular therapy.

This article explains the mechanism of action, indications, administration, side effects, and monitoring of TNF inhibitors (infliximab, adalimumab, etanercept), which are biologic agents for refractory non-infectious uveitis.

Macular edema secondary to uveitis, a major cause of visual impairment. Steroid administration is the mainstay of treatment, but new therapies such as suprachoroidal injection and dexamethasone implant have emerged in recent years.

Chronic uveitis complicating juvenile idiopathic arthritis (JIA). It accounts for up to 47% of pediatric uveitis cases and is a refractory ocular disease that often progresses asymptomatically, leading to visual impairment.

Ocular and orbital immune-related adverse events caused by immune checkpoint inhibitors (ICIs) used in cancer immunotherapy. They present with various conditions such as dry eye, uveitis, orbital myositis, and retinal vasculitis.

Explanation of the concept, symptoms, staging, diagnostic criteria, and treatment of Vogt-Koyanagi-Harada disease (VKH disease). It is an autoimmune disease against melanocytes, and standard treatment involves steroid pulse therapy combined with immunosuppressive drugs. The latest evidence including the steroid-sparing effects of MTX and MMF from the FAST trial is described.