Uveitis

Definitions 📚

• Uvea: middle layer of the eye (outer = sclera; inner = retina), extending anteriorly to structures visualizable by inspection (iris, ciliary body) & posteriorly as the choroid, which is visualizable by fundoscopy (i.e. chorioretinitis)

Stratification ↔️

• Anterior uveitis: defined as inflammation of the iris +/- ciliary body (iridocyclitis) resulting in presence of leukocytes within the anterior chamber (”keratic precipitates”), pain/redness/photophobia, & often a constricted pupil (spasm of ciliary body)

• Posterior uveitis: inflammatory findings of the choroid +/- retina on fundoscopy (i.e. chorioretinitis) resulting in vision loss +/- floaters, & no pain/redness (i.e. choroid & retina are not innervated by nocicepters), unless the posterior pathology begins to “spill over” anteriorly (i.e. pan-uveitis)

• Pan-uveitis: simultaneous inflammation of anterior chamber → retina

Complications 💀

• Cataracts
• Secondary glaucoma
• Iris-lens adhesions (posterior synechiae) resulting in pupil distortion
• Corneal calcium deposits (band keratopathy)
• Cystoid macular edema

Divergent Pathophysiology 💥

• While the uveal tract is continuous, its anatomic environment is not homogenous. The anterior uvea (iris & ciliary body) sits right behind the cornea & therefore has nearly direct contact with the external environment via the corneal surface, whereas the posterior uvea (choroid) is a vascular bed sandwiched between the retina & sclera, without said communication to the outside world

• For this reason, the anterior uvea is more predisposed to external diseases (e.g. contact lens-associated organisms), & the posterior uvea is more predisposed to hematogenously-spreading infections (e.g. bartonella, syphilis)

• Additionally, the anterior chamber is an “immunologically privileged” site; therefore, non-infectious, autoimmune causes of anterior uveitis require highly specific autoimmune predispositions (e.g. HLA-B27 SpA)

Laterality & Pathophysiology ↔️

• Anterior uveitis is frequently unilateral (53% of cases), while intermediate, posterior, & panuveitis are typically bilateral (79%, 57%, and 75% of cases, respectively), thus supporting the common nature of hematogenous/infectious mechanisms of disease in posterior uveitis

• Uveitis: Etiology, clinical manifestations, and diagnosis

• Eye Infections (NEJM)

• Uveitis in Adults: A Review (JAMA)

• Uveitis: The Collaborative Diagnostic Evaluation (AAFP)

• Figure (Ocular immunosuppressive microenvironment and novel drug delivery for control of uveitis)

• Uveitis: A search for a cause

12-11-2025 - Seeing Systemic Autoimmunity Through a New Lens: A 50 Year Journey

Seeing Systemic Autoimmunity Through a New Lens: A 50 Year Journey Speaker – Michael Paley, MD, PhD Assistant Professor of Medicine Division of Rheumatology Department of Medicine Washington University in St. Louis

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