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Infectious uveitis
Last reviewed: 05.07.2025
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[ What causes infectious uveitis?
- Cytomegalovirus
- Histoplasmosis
- Aspergillus
- Candida
- Herpes viruses
- Lyme disease
- Coccidioidomycosis
- Pneumocystis jiroveci (P. carinii)
- Syphilis
- Cryptococcus
- Toxocariasis
- Cysticercosis
- Tuberculosis
- Leprosy
- Toxoplasmosis
- Leptospirosis
- Onchocerciasis
- Tropheryma whippelii
Herpes virus
Herpes simplex virus causes anterior uveitis. In herpes zoster virus, uveitis occurs less frequently, the incidence increasing with age. Symptoms include ocular pain, photophobia and decreased vision, conjunctival injection and inflammatory infiltrate in the anterior chamber, often associated with keratitis; decreased corneal sensitivity; sudden increase in intraocular pressure and patchy or sectoral iris atrophy. Treatment should include a topical glucocorticoid with a mydriatic. Acyclovir 400 mg 5 times daily for herpes simplex and 800 mg 5 times daily for herpes zoster may also be prescribed.
Much less commonly, herpes zoster and herpes simplex viruses cause a rapidly progressive form of retinitis called acute retinal necrosis (ARN), which is associated with retinal occlusive vasculitis and moderate to severe vitreous inflammation. ARN becomes bilateral in 1/3 of cases and 1/4 result in retinal detachment. ARN can also develop in patients with HIV/AIDS, but vitreous inflammation is less severe in immunocompromised patients. Vitreous biopsy for culture and PCR may be helpful in the diagnosis of ARN. Treatment includes intravenous acyclovir with intravenous or intravitreal ganciclovir or foscanet. Oral valganciclovir may also be used.
Toxoplasmosis
Toxoplasmosis is the most common cause of retinitis in immunocompromised patients. It is congenital in most cases, although it is often acquired. Symptoms of floaters and decreased vision may be due to cells in the vitreous and lesions or scars in the retina. Anterior segment involvement may occur, resulting in eye pain, redness, and photophobia. Laboratory testing should include serum antitoxoplasma antibody titers. Treatment is recommended for patients with optic nerve or macular lesions and for immunocompromised patients. Drug combination therapy is usually prescribed, including pyrimethamine, sulfonamides, clindamycin, and occasionally systemic glucocorticoids. Glucocorticoids should not be used without concomitant antimicrobial coverage.
Cytomegalovirus
Cytomegalovirus is the most common cause of retinitis in immunocompromised patients, affecting 25% to 40% of patients with AIDS when the CD4 count falls below 50 cells/mm3. Rarely, CMV infection may also occur in neonates and in patients with drug-induced immunosuppression. Diagnosis is by fundoscopy with direct or indirect ophthalmoscopy; serologic tests are of limited use. Treatment in patients with HIV/AIDS is with systemic or topical ganciclovir, systemic foscanet, or systemic valganciclovir. Treatment is usually continued until immune reconstitution is achieved with combination antiretroviral therapy (usually when the CD4 count is >100 cells/L for at least 3 months).