Medical expert of the article
New publications
Infectious uveitis
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
[What causes infectious uveitis?
- Cytomegalovirus
- Histoplasmosis
- Aspergillus
- Candida
- Herpes viruses
- Lyme disease
- Coccidioidomycosis
- Pneumocystis jiroveci (P. Carinii)
- Syphilis
- Cryptococcus
- Toxocarosis
- Cysticercosis
- Tuberculosis
- Leprosy
- Toxoplasmosis
- Leptospirosis
- Onchocerciasis
- Tropheryma whippelii
Herpes virus
Herpes simplex virus causes anterior uveitis. With the herpes zoster virus, uveitis occurs less frequently, the frequency increases with age. Symptoms include pain in the eye, photophobia and decreased vision, conjunctiva injection and inflammatory infiltration in the anterior chamber, often in combination with keratitis; decreased sensitivity of the cornea; sudden increase in intraocular pressure and spotted or sectoral atrophy of the iris. Treatment should include a local glucocorticoid with the mydriatic. Aciclovir 400 mg 5 times a day can also be prescribed for the treatment of herpes simplex and 800 mg 5 times a day for the treatment of herpes zoster.
Much less often, herpes zoster viruses cause a rapidly progressing form of retinitis called acute retinal necrosis (ONS), which is combined with occlusive retinal vasculitis and from moderate to inflammatory vitreous. In 1/3 of cases ONS becomes bilateral and / 4 ends with retinal detachment. ONS can also develop in patients with HIV / AIDS, but in patients with immunodeficiency the inflammation of the vitreous is less pronounced. In the diagnosis of ONS, a vitreous biopsy for seeding and PCR can be useful. Treatment includes the administration of acyclovir intravenously along with intravenous or intravitreal administration of ganciclovir or foscane. Valganciclovir (oral) may also be used.
Toxoplasmosis
Toxoplasmosis is the most common cause of retinitis in patients with immunosuppression. In most cases it is congenital, although it is often acquired. Symptoms of floating opacities and reduced vision may be due to cells in the vitreous humor and foci or scars in the retina. There may be an involvement of the anterior segment, which is manifested by pain in the eye, redness of the eye and photophobia. A laboratory test should include the determination of the titer of antitoxoplasmic antibodies in serum. Treatment is recommended for patients with lesions of the optic nerve or macula and patients with immunosuppression. Usually, medication complex therapy is prescribed, including pyrimethamine, sulfonamides, clindamycin and in some cases systemic glucocorticoids. Glucocorticoids should not be used without a concomitant antimicrobial cover.
Cytomegalovirus
Cytomegalovirus is the most common cause of retinitis in patients with immunosuppression, it affects between 25% and 40% of patients with AIDS when the CD4 count falls below 50 cells / μl. Rarely, cytomegalovirus infection can also occur in newborns and in patients with immunosuppression caused by taking medications. Diagnosis is based on examination of the fundus by direct or indirect ophthalmoscopy; serological tests have limited application. Treatment in patients with HIV / AIDS is systemically or locally ganciclovir, systemically foscanet or valganciclovir. Treatment usually continues until an immune reconstitution with combined antiretroviral therapy is achieved (usually when the amount of CD4 becomes more than 100 cells / L for at least 3 months).