Chronic Posterior Uveitis Guidelines

Autoimmune/Inflammatory Causes

Posterior uveitis occurs in less than 1% of patients with inflammatory bowel disease but can be sight-threatening if left untreated, according to the European Crohn's and Colitis Organisation 1, 2
Unlike episcleritis, which tends to reflect bowel disease activity, uveitis can be independent of bowel symptoms and may precede the onset of intestinal manifestations, as noted by the European Crohn's and Colitis Organisation 1, 2

Vogt-Koyanagi-Harada disease is characterized by bilateral, diffuse choroiditis with serous retinal detachments, typically affecting young adults and associated with neurologic, auditory, and integumentary manifestations, as described by the American Academy of Ophthalmology 3
White dot syndromes are a group of inflammatory disorders characterized by multiple white-yellow lesions at the level of the retinal pigment epithelium, choroid, or both, including acute posterior multifocal placoid pigment epitheliopathy (APMPPE), which presents with rapid onset, progressive marked vision loss, and often slow recovery, according to the American Academy of Ophthalmology 3

For non-infectious posterior uveitis, systemic immunomodulatory therapy is often required, with agents such as azathioprine, cyclosporine-A, or TNF inhibitors like adalimumab, as recommended by the American College of Rheumatology 4
Systemic corticosteroids should be used only in combination with immunosuppressive agents, not as monotherapy, to minimize adverse effects, according to the American College of Rheumatology 4
For sight-threatening posterior uveitis, prompt and aggressive treatment is essential to prevent permanent vision loss, as emphasized by the American Academy of Ophthalmology 4

Failure to identify infectious causes before initiating immunosuppressive therapy can lead to worsening of infection and poor outcomes, as warned by the Infectious Diseases Society of America 4
Screening for latent or active infections, particularly tuberculosis, is essential before starting systemic immunomodulatory therapy, as recommended by the Centers for Disease Control and Prevention 4
Regular monitoring by an ophthalmologist is essential during treatment and for at least 3 years after remission to detect recurrence early, according to the American Academy of Ophthalmology 4