Dr. Anupama Karanth
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International Uveitis Study Group (IUSG)

◦ Anatomic Classification of Uveitis
 Anterior
 Intermediate
 Posterior
 Panuveitis
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Infectious

◦ Bacterial / Viral / Fungal / Parasitic / Others
Non-infectious

◦ Known/No known systemic association
Masquerade

◦ Neoplastic / Non-neoplastic
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Non-infectious can be considered also as

immune related causes
Masquerade syndromes will be dealt with

separately
Idiopathic cause is included in all the uveitis

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Anterior uveitis
Immune
Idiopathic Infectious
related
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Intermediate uveitis
Immune
Idiopathic Infectious
related
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Posterior uveitis
Immune
Idiopathic Infectious
related
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Panuveitis
Immune
Idiopathic Infectious
related
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Idiopathic Infectious Immune related
• Most common • Herpes simplex • HLA B27+/
seronegative
• Diagnosis only • Herpes zoster
spondylo-
after other • Tuberculosis
arthropathies
causes are ruled • Syphilis
out • Juvenile
rheumatoid
arthritis (JRA)
• Lens or IOL
related
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Immune
Idiopathic Infectious
related
• Most • Tuberculosis • Sarcoidosis
common • Syphilis • Multiple
• Only after sclerosis
• Lyme disease
other causes
are ruled out
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Infectious Immune related
Idiopathic
• Less common • Toxoplasmosis • Sarcoidosis
• Toxocariasis • Collagen vascular
diseases
• Herpes
• Retinochoroidop
(ARN/PORN/CMV)
athies
• Tuberculosis,
syphilis
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Idiopathic Infectious Immune related
• After ruling out • Tuberculosis, • Sarcoidosis
other causes syphilis • Vogt – Kayanagi
• Lyme disease – Harada
syndrome
• Leptospirosis
• Sympathetic
• Infectious
ophthalmitis
endophthalmitis
• Beh et
syndrome
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List of diseases can be very long indeed

Patient is NOT investigated for ALL the

diseases
Narrow down the differential diagnosis

before ordering the lab tests
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Narrow down the differential diagnosis with

◦ Time course of disease
◦ Type of inflammation
◦ Characteristic pattern of the lesion
◦ Demographic data – age, sex, race, social history
◦ Associated systemic features
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Anterior uveitis is the most common type of

uveitis
Idiopathic form is the most common cause of

anterior uveitis
Infections are more common in posterior

uveitis
Sarcoidosis, tuberculosis and syphilis can

present in any or all locations
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Acute

 Sudden onset, lasting up to 6 weeks
Chronic

 Insiduous onset, lasting longer than 6 weeks
Recurrent

 Repeated attacks with disease free intervals
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Acute

 Idiopathic anterior uveitis
 VKH syndrome
Chronic

 JRA
 Tuberculous uveitis
 Sarcoidosis
Recurrent

 Idiopathic anterior uveitis
 VKH syndrome
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Granulomatous Non-granulomatous
Onset Insiduous Acute
Keratic precipitates  Large, greasy  Fine
 Mutton-fat, white  White coloured
 Macrophages and  Lymphocytes and
epithelioid cells plasma cells
Iris nodules Generally absent
 Koeppe (at pupillary
border)
 Busacca (on iris
surface)
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Granulomatous Non-granulomatous
Fundus Uncommon
Choroidal
nodules/granulomas
Course Chronic Maybe self limited
Posterior synechiae Broad based Fine
Causes  Suggestive of few  Many anterior uveitic
specific conditions diseases
 More commonly  Not helpful in
infectious formulating differential
diagnosis
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• Tuberculosis, syphilis
• Sarcoidosis
• Vogt – Koyanagi – Harada
Granulomatous
syndrome
uveitis
• Sympathetic ophthalmitis
• Intraocular foreign body
• Lens induced uveitis
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Children

 JRA (anterior)
 Toxocariasis (posterior)
Adults

 Ankylosing spondylitis, Reiter syndrome (anterior)
 VKH, Beh et syndrome (panuveitis)
Elderly

 Idiopathic
 Masquerade syndromes
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Any age
 Toxoplasmosis
 Tuberculosis
 Sarcoidosis
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Asians

 VKH, Beh et syndrome
Blacks

 Sarcoidosis
Whites

 Ankylosing spondylitis, Reiter syndrome
 HLA B27+
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Pets / cat feces
• Toxoplasmosis
contact
Contaminated water
• Leptospirosis
/ rodent urine
Farmers /
• Brucellosis
veterinarians
• Tuberculosis, syphilis, HIV
History of exposure
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