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Posterior Uveitis: Understanding Inflammation at the Back of the Eye
Who Is at Risk
Posterior uveitis can affect people of any age, but certain health conditions and exposures raise the risk. Knowing who is most vulnerable helps patients seek evaluation sooner.
Several autoimmune and inflammatory diseases are linked to posterior uveitis. Patients with any of the following conditions have a higher chance of developing choroidal or retinal inflammation.
- Sarcoidosis, a disease that causes clusters of inflammatory cells to form in multiple organs
- Behcet disease, a condition involving blood vessel inflammation throughout the body
- Vogt-Koyanagi-Harada syndrome, an autoimmune condition that affects pigmented tissues including the choroid
- Birdshot chorioretinopathy, a chronic inflammatory condition of the retina and choroid
- Multifocal choroiditis, which is seen most often in women between the ages of 20 and 60
These conditions often require long-term treatment in partnership with other specialists such as a rheumatologist.
Infections are among the most frequent triggers of posterior uveitis worldwide. Toxoplasmosis, a parasitic infection, is one of the most common causes. It can produce retinal scarring that leads to lasting blind spots. Other infectious triggers include herpes viruses, cytomegalovirus (CMV), tuberculosis, and syphilis. A thorough evaluation is needed to identify infectious causes, since antiviral or antiparasitic treatment must be used rather than immune-suppressing medications alone.
A prior history of uveitis increases the risk of future flare-ups. People with weakened immune systems, whether from medications or underlying health conditions, are more vulnerable to infectious forms of posterior uveitis. Posterior uveitis is the second most common form of uveitis overall, and uncontrolled uveitis of any type is estimated to account for roughly 10 percent of blindness in the United States. This makes early evaluation critical.
Recognizing the Symptoms
Posterior uveitis often develops without the redness or pain that people associate with eye problems. Knowing what to watch for can make the difference between early treatment and irreversible damage.
Symptoms typically develop gradually and may affect one or both eyes. The most common complaints include the following.
- Blurry or hazy vision
- Floaters, which appear as spots, strings, or cobwebs drifting across the field of vision
- Blind spots or dark areas in vision
- Sensitivity to light, also called photophobia
Unlike anterior uveitis, which affects the front of the eye and typically causes redness and pain, posterior uveitis often causes no significant discomfort. The retina and choroid do not contain pain-sensing nerves. Some people notice mild pressure or light sensitivity, but many experience only subtle visual changes. The absence of pain can be misleading and may delay a person from seeking care. Any unexplained change in vision should be evaluated promptly.
Some visual changes signal a serious complication such as retinal detachment or a severe inflammatory flare. If you experience any of the following, seek emergency eye care right away.
- A sudden shadow or curtain falling over part of your vision
- A rapid increase in floaters
- Flashes of light in your vision
- Sudden loss of vision in one eye
These symptoms should never be ignored or watched at home.
How Posterior Uveitis Is Diagnosed
Diagnosing posterior uveitis requires a detailed eye examination combined with advanced imaging and often laboratory testing. Our retina specialists use a full suite of diagnostic tools to identify the type and extent of inflammation.
A retina specialist begins with a comprehensive dilated eye exam. Eye drops are used to widen the pupil so the back of the eye can be viewed clearly. The specialist looks for white or yellow inflammatory spots on the choroid or retina, fluid beneath the retina, blood vessel changes, and signs of scarring. Both eyes are examined because some forms of posterior uveitis involve both sides simultaneously.
Imaging tests allow the retina specialist to assess inflammation in detail, track changes over time, and guide treatment decisions. The imaging tools available at our retina clinic include the following.
- Optical coherence tomography (OCT), which produces detailed cross-sectional images of the retina to detect swelling, fluid, and structural changes
- Fluorescein angiography (FA), in which a dye injected into a vein is photographed as it travels through the retinal blood vessels to reveal leakage or blockage
- Indocyanine green angiography (ICG), which provides deeper imaging of choroidal blood flow and helps detect inflammation beneath the retinal pigment epithelium
- Color fundus photography, which documents the appearance of the retina and choroid over time
- B-scan echography, an ultrasound technique useful when the view of the back of the eye is limited
Because posterior uveitis is often connected to an underlying infection or systemic disease, blood tests and other lab studies are frequently needed. Testing can screen for sarcoidosis, tuberculosis, syphilis, toxoplasmosis, and various autoimmune markers. Our retina specialists coordinate with rheumatologists and infectious disease specialists when needed to ensure the underlying cause is properly identified and treated.
Treatment Options for Posterior Uveitis
Treatment is guided by the cause and severity of inflammation. Our retina specialists tailor every treatment plan to the individual patient, using the most appropriate combination of medications and therapies.
Corticosteroids reduce inflammation quickly and remain a foundational treatment for non-infectious posterior uveitis. For inflammation affecting the back of the eye, intravitreal corticosteroids (injected directly into the eye) are often more effective than periocular injections (placed around the outside of the eye). One option is the Ozurdex dexamethasone intravitreal implant, which is FDA-approved for non-infectious posterior uveitis and releases medication gradually over approximately three to four months. Oral corticosteroids may be used for severe or bilateral disease, though long-term oral use carries systemic side effects that require monitoring.
For chronic autoimmune forms of posterior uveitis such as birdshot chorioretinopathy or multifocal choroiditis, corticosteroid-sparing immunosuppressive therapy is typically started early. These medications reduce the body's immune activity to prevent ongoing damage to the choroid and retina. Common agents include methotrexate and mycophenolate mofetil. Because immunosuppressive drugs can take several months to reach full effectiveness, early initiation helps limit long-term steroid exposure and its associated risks.
Adalimumab is currently the only FDA-approved biologic medication for non-infectious intermediate, posterior, and panuveitis (inflammation involving the entire eye). It works by blocking tumor necrosis factor (TNF), a protein that drives the inflammatory response. Adalimumab is typically considered when other immunosuppressive medications have not provided adequate control, or when a patient cannot tolerate those therapies.
When posterior uveitis is caused by an infection, the primary goal is treating the specific organism. Toxoplasmosis requires antiparasitic medications. Tuberculosis-related uveitis requires a full course of anti-tuberculosis therapy. Herpes-related or CMV-related inflammation is managed with antiviral medications. Anti-inflammatory therapy should not be used alone in infectious uveitis, as suppressing the immune response without treating the infection can cause it to worsen.
When posterior uveitis leads to choroidal neovascularization (abnormal blood vessel growth beneath the retina), anti-VEGF (vascular endothelial growth factor) injections may be used. These medications block the signals that drive abnormal vessel growth and leakage. Anti-VEGF agents are also used to treat macular edema (swelling at the center of the retina) that can develop as a complication of uveitis. Our retina specialists determine which agent is most appropriate based on each patient's specific condition.
Managing Posterior Uveitis Over Time
Posterior uveitis is often a long-term condition that requires consistent follow-up and lifestyle awareness. Staying engaged with your care is one of the most effective things you can do to protect your vision.
Even when inflammation appears controlled, regular monitoring is essential. Flare-ups can occur without warning, sometimes before symptoms become noticeable. A retina specialist may schedule visits every few weeks to every few months depending on the type and severity of uveitis. Imaging such as OCT is often repeated at follow-up visits to detect subtle changes in the retina before they affect vision.
Without adequate treatment, posterior uveitis can cause several serious complications. Understanding these risks underscores the importance of consistent care.
- Macular edema, or swelling at the center of the retina, which is one of the most common causes of vision loss in uveitis
- Choroidal neovascularization, where abnormal blood vessels grow under the retina and can leak or bleed
- Cataracts, which can develop as a result of prolonged inflammation or corticosteroid use
- Glaucoma (elevated eye pressure), which can result from inflammation itself or from corticosteroid treatment
- Retinal scarring that causes permanent blind spots
Patients should remain attentive to symptoms that may signal a flare-up, including new floaters, increased blurriness, or greater light sensitivity. Wearing sunglasses outdoors can help manage photophobia. Taking all medications exactly as prescribed is critical, particularly immunosuppressive drugs that require consistent dosing. Stopping these medications without guidance from a retina specialist can trigger a sudden return of inflammation and potential vision loss.
Frequently Asked Questions
These answers address common questions that go beyond the general information covered above, with practical guidance to help you make informed decisions about your care.
Yes, and whether it affects one or both eyes often depends on the underlying cause. Autoimmune conditions such as Vogt-Koyanagi-Harada syndrome and sarcoidosis frequently involve both eyes simultaneously. By contrast, toxoplasmosis-related posterior uveitis usually affects only one eye at a time. Because bilateral involvement can be subtle, your retina specialist will examine both eyes at every visit, even if only one eye has noticeable symptoms.
Any new or worsening visual symptom in a patient with known posterior uveitis should be reported promptly. A gradual increase in floaters or slight blurring may indicate early inflammation, while a sudden surge in floaters, new flashes of light, or a shadow over part of the visual field requires same-day emergency evaluation. These acute symptoms can signal retinal detachment or a severe inflammatory episode that demands immediate treatment. When in doubt, it is always safer to be seen right away rather than to wait.
The duration varies widely. Infectious posterior uveitis may resolve after the infection is treated, though follow-up continues to watch for recurrence. Non-infectious autoimmune forms often require months to years of immunosuppressive therapy, and some patients need indefinite low-dose treatment to prevent flare-ups. Your retina specialist will periodically reassess whether the current medication level is still needed. Decisions about tapering or stopping treatment are always made carefully, because stopping too soon is a common reason uveitis returns.
Long-term immunosuppressive therapy does carry risks, including increased susceptibility to infection and possible effects on the liver, kidneys, or blood cell counts. However, these risks are managed through regular blood monitoring, and adjustments are made as needed. For most patients with chronic posterior uveitis, the risk of uncontrolled inflammation causing severe or permanent vision loss significantly outweighs the risks of the medication itself. Your retina specialist will review these tradeoffs with you and adjust the treatment plan over time.
Recurrence is common, particularly with autoimmune forms of the disease. Some patients experience repeated flare-ups over many years, even after periods of apparent stability. This is one of the main reasons ongoing monitoring matters so much. Early detection of a returning flare allows treatment to begin before the retina sustains additional damage. Patients should contact their retina specialist at the first sign of new or changing symptoms rather than waiting for a scheduled appointment.
In many cases, yes. Posterior uveitis linked to systemic autoimmune disease is often best managed collaboratively. A rheumatologist may help oversee medications for conditions like sarcoidosis or Behcet disease. An infectious disease specialist may be involved if tuberculosis or another infection is identified as the cause. Open communication between all treating providers helps avoid gaps in care and ensures that treating one condition does not inadvertently worsen another.
Specialized Retina Care at The Eye Center
Our visiting retina specialists bring subspecialty-level expertise in uveitis, retinal disease, and complex ocular inflammation to patients throughout Northern Virginia. With advanced imaging including OCT, fluorescein and ICG angiography, and B-scan echography available at our retina clinic, The Eye Center is equipped to provide the thorough evaluation and ongoing care that posterior uveitis requires. We encourage anyone experiencing unexplained visual changes to contact us and schedule an evaluation as soon as possible.