What is posterior uveitis?
Posterior uveitis is inflammation in the back part of the eye. The uvea is the middle layer of the eye that carries blood to important parts of the eye, including the retina, which helps you see. When the back of this layer becomes inflamed, it can affect the retina and nearby tissues and make vision blurry or distorted.
People with posterior uveitis may notice blurry, foggy, or “misty” vision. They may see floaters, which look like tiny spots, dots, or cobwebs moving in their sight. Some people see dark or dim areas in their vision or have trouble seeing clearly for reading or other daily tasks.
What cases posterior uveitis?
Posterior uveitis can have different causes, but they all lead to swelling in the back of the eye. Sometimes the body’s own defense system, called the immune system, gets confused. It starts to attack healthy eye tissue by mistake, as if it were an infection. This wrong attack can make the back of the eye red, swollen, and painful inside, even if the outside of the eye looks normal.
In some people, an infection can cause posterior uveitis. Tiny infections like viruses, bacteria, or parasites can get into the body and bother the eye. When this happens, the eye becomes inflamed as it tries to fight the infection. Treating the infection can help calm down the eye and protect vision.
There are also times when doctors cannot find a clear cause for posterior uveitis. Even after blood tests and eye scans, everything else may look normal. When this happens, the doctor may say the cause is “unknown” or use the word “idiopathic.” This means the eye is still inflamed, but the exact reason is not yet known.
How is posterior uveitis treated?
Treatment for posterior uveitis works to calm the swelling in the back of the eye and protect vision. The eye doctor will choose medicines based on how bad the swelling is and what is causing it. Treatment often starts right away, because waiting too long can lead to vision problems that are harder to fix.
Many people are treated with medicines called steroids. These medicines help reduce swelling inside the eye. Steroids can be given as eye drops, pills, or shots around the eye, and sometimes through an IV in the vein in the arm. The doctor will decide which type is best and will usually lower the dose slowly over time so the swelling does not come back too quickly.
If an infection is causing the posterior uveitis, other medicines are needed. These can include antibiotics, antivirals, or medicines for parasites, depending on the kind of infection. Treating the infection helps the eye heal and can stop the swelling from getting worse. It is very important to take these medicines exactly as the doctor says.
Some people need stronger medicines that calm down the immune system. These are called “immune-suppressing” or “immunomodulating” medicines. They are used when the swelling keeps coming back or is very hard to control with steroids alone. Because these medicines affect the whole body, the doctor may also do blood tests from time to time to make sure the medicine is safe.
Follow-up visits are a key part of treatment. At these visits, the doctor checks vision, looks at the back of the eye, and decides if medicines should be changed, raised, or lowered. If vision suddenly gets more blurry, if there is new pain, or if there are many more floaters, the person should call the eye doctor right away. Working closely with the doctor and keeping every visit gives the best chance to protect sight.
What is the prognosis of posterior uveitis?
Posterior uveitis is a serious eye problem, but with early treatment and regular checkups, many people can keep good vision. The swelling in the back of the eye can often be controlled with medicine, especially when treatment is started quickly. When people follow the treatment plan and see the eye doctor on schedule, the chances of protecting sight are much better.
If posterior uveitis is not treated, or if treatment is stopped too soon, it can lead to scars, weak areas, or other damage in the back of the eye. This damage can cause blurry vision, dark spots in vision, or even permanent vision loss. Because of this, it is very important to tell the doctor right away if vision gets worse, if there is new eye pain, or if there are many more floaters.
The long-term outlook, or prognosis, is different for each person. Some people have only one episode that gets better and does not come back. Others may have flare-ups from time to time and need medicine again. The eye doctor may also work with other doctors if there is a whole-body (systemic) disease causing the eye problem. Working together as a team helps give the eyes the best chance to stay as healthy and strong as possible.
It’s important to see a uveitis specialist (Like me!) to control inflammation early and aggressively, and use advanced treatments to get better long-term results and reduce the chance of permanent vision loss from non-infectious posterior uveitis.