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Infectious Uveitis


Infectious uveitis is one of the most common and visually devastating causes of uveitis in the US and worldwide. This review provides a summary of the identification, treatment, and complications associated with certain forms of viral, bacterial, fungal, helminthic, and parasitic uveitis. In particular, this article reviews the literature on identification and treatment of acute retinal necrosis due to herpes simplex virus and varicella virus as well as cytomegalovirus retinitis. While no agreed-upon treatment has been identified, the characteristics of Ebola virus panuveitis is also reviewed. In addition, forms of parasitic infection such as Toxoplasmosis and Toxocariasis are summarized, as well as spirochetal uveitis. Syphilitic retinitis is reviewed given its increase in prevalence over the last decade. The importance of early identification and treatment of infectious uveitis is emphasized. Early identification can be achieved with a combination of maintaining a high suspicion, recognizing certain clinical features, utilizing multi-modal imaging, and obtaining specimens for molecular diagnostic testing.

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  1. 1.

    Acharya NR, Tham VM, Esterberg E, et al. Incidence and prevalence of uveitis: results from the Pacific Ocular Inflammation Study. JAMA Ophthalmol. 2013;131(11):1405–12.

    Article  PubMed  Google Scholar 

  2. 2.

    Suhler EB, Lloyd MJ, Choi D, Rosenbaum JT, Austin DF. Incidence and prevalence of uveitis in Veterans Affairs Medical Centers of the Pacific Northwest. Am J Ophthalmol. 2008;146(6):890–6 e898.

    Article  PubMed  Google Scholar 

  3. 3.

    McCannel CA, Holland GN, Helm CJ, Cornell PJ, Winston JV, Rimmer TG. Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group. Am J Ophthalmol. 1996;121(1):35–46.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Rodriguez A, Calonge M, Pedroza-Seres M, et al. Referral patterns of uveitis in a tertiary eye care center. Arch Ophthalmol. 1996;114(5):593–9.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Nalcacioglu-Yuksekkaya P, Ozdal PC, Teke MY, Kara C, Ozturk F. Presumed herpetic anterior uveitis: a study with retrospective analysis of 79 cases. Eur J Ophthalmol. 2014;24(1):14–20.

    Article  PubMed  Google Scholar 

  6. 6.

    Esmaeli-Gutstein B, Winkelman JZ. Uveitis associated with varicella virus vaccine. Am J Ophthalmol. 1999;127(6):733–4.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Lin P, Yoon MK, Chiu CS. Herpes zoster keratouveitis and inflammatory ocular hypertension 8 years after varicella vaccination. Ocul Immunol Inflamm. 2009;17(1):33–5.

    Article  PubMed  Google Scholar 

  8. 8.

    Naseri A, Good WV, Cunningham ET Jr. Herpes zoster virus sclerokeratitis and anterior uveitis in a child following varicella vaccination. Am J Ophthalmol. 2003;135(3):415–7.

    Article  PubMed  Google Scholar 

  9. 9.

    Wong RW, Jumper JM, McDonald HR, et al. Emerging concepts in the management of acute retinal necrosis. Br J Ophthalmol. 2013;97(5):545–52.

    Article  PubMed  Google Scholar 

  10. 10.

    Young NJ, Bird AC. Bilateral acute retinal necrosis. Br J Ophthalmol. 1978;62(9):581–90.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  11. 11.

    Holland GN. Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society. Am J Ophthalmol. 1994;117(5):663–7.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Lau CH, Missotten T, Salzmann J, Lightman SL. Acute retinal necrosis features, management, and outcomes. Ophthalmology. 2007;114(4):756–62.

    Article  PubMed  Google Scholar 

  13. 13.

    Schaal S, Kagan A, Wang Y, Chan CC, Kaplan HJ. Acute retinal necrosis associated with Epstein–Barr virus: immunohistopathologic confirmation. JAMA Ophthalmol. 2014;132(7):881–2.

    PubMed Central  Article  PubMed  Google Scholar 

  14. 14.

    Ganatra JB, Chandler D, Santos C, Kuppermann B, Margolis TP. Viral causes of the acute retinal necrosis syndrome. Am J Ophthalmol. 2000;129(2):166–72.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Tran TH, Stanescu D, Caspers-Velu L, et al. Clinical characteristics of acute HSV-2 retinal necrosis. Am J Ophthalmol. 2004;137(5):872–9.

    Article  PubMed  Google Scholar 

  16. 16.

    Van Gelder RN, Willig JL, Holland GN, Kaplan HJ. Herpes simplex virus type 2 as a cause of acute retinal necrosis syndrome in young patients. Ophthalmology. 2001;108(5):869–76.

    Article  PubMed  Google Scholar 

  17. 17.

    Martinez J, Lambert HM, Capone A, et al. Delayed bilateral involvement in the acute retinal necrosis syndrome. Am J Ophthalmol. 1992;113(1):103–4.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Clarkson JG, Blumenkranz MS, Culbertson WW, Flynn HW Jr, Lewis ML. Retinal detachment following the acute retinal necrosis syndrome. Ophthalmology. 1984;91(12):1665–8.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Meghpara B, Sulkowski G, Kesen MR, Tessler HH, Goldstein DA. Long-term follow-up of acute retinal necrosis. Retina. 2010;30(5):795–800.

    Article  PubMed  Google Scholar 

  20. 20.

    Tibbetts MD, Shah CP, Young LH, Duker JS, Maguire JI, Morley MG. Treatment of acute retinal necrosis. Ophthalmology. 2010;117(4):818–24.

    Article  PubMed  Google Scholar 

  21. 21.

    Park JJ, Pavesio C. Prophylactic laser photocoagulation for acute retinal necrosis. Does it raise more questions than answers? Br J Ophthalmol. 2008;92(9):1161–2.

    Article  PubMed  Google Scholar 

  22. 22.

    Holland GN, Togni BI, Briones OC, Dawson CR. A microscopic study of herpes simplex virus retinopathy in mice. Invest Ophthalmol Vis Sci. 1987;28(7):1181–90.

    CAS  PubMed  Google Scholar 

  23. 23.

    Hillenkamp J, Nolle B, Bruns C, Rautenberg P, Fickenscher H, Roider J. Acute retinal necrosis: clinical features, early vitrectomy, and outcomes. Ophthalmology. 2009;116(10):1971–5 e1972.

    Article  PubMed  Google Scholar 

  24. 24.

    Engstrom RE Jr, Holland GN, Margolis TP, et al. The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology. 1994;101(9):1488–502.

    Article  PubMed  Google Scholar 

  25. 25.

    Accorinti M, Gilardi M, Pirraglia MP, et al. Cytomegalovirus anterior uveitis: long-term follow-up of immunocompetent patients. Graefe’s Arch Clin Exp Ophthalmol. 2014;252(11):1817–24.

    CAS  Article  Google Scholar 

  26. 26.

    de Schryver I, Rozenberg F, Cassoux N, et al. Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis. Br J Ophthalmol. 2006;90(7):852–5.

    PubMed Central  Article  PubMed  Google Scholar 

  27. 27.

    •• van Boxtel LA, van der Lelij A, van der Meer J, Los LI. Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients. Ophthalmology. 2007;114(7):1358–62. This article provided one of the earlier larger case series demonstrating CMV as a cause for hypertensive uveitis in immunocompetent patients.

    Article  PubMed  Google Scholar 

  28. 28.

    Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008;145(5):834–40.

    Article  PubMed  Google Scholar 

  29. 29.

    Chee SP, Jap A. Cytomegalovirus anterior uveitis: outcome of treatment. Br J Ophthalmol. 2010;94(12):1648–52.

    Article  PubMed  Google Scholar 

  30. 30.

    Sandy CJ, Bloom PA, Graham EM, et al. Retinal detachment in AIDS-related cytomegalovirus retinitis. Eye. 1995;9(Pt 3):277–81.

    Article  PubMed  Google Scholar 

  31. 31.

    •• de Groot-Mijnes JD, de Visser L, Rothova A, Schuller M, van Loon AM, Weersink AJ. Rubella virus is associated with fuchs heterochromic iridocyclitis. Am J Ophthalmol. 2006;141(1):212–4. This article showed compelling evidence that FHI was caused by rubella virus rather than herpes family viruses or Toxo plasmosis.

    Article  PubMed  Google Scholar 

  32. 32.

    •• Birnbaum AD, Tessler HH, Schultz KL, et al. Epidemiologic relationship between fuchs heterochromic iridocyclitis and the United States rubella vaccination program. Am J Ophthalmol. 2007;144(3):424–8. This epidemiologic study provided strong corroborative evidence supporting rubella as a cause for FHI.

    Article  PubMed  Google Scholar 

  33. 33.

    Varkey JB, Shantha JG, Crozier I, et al. Persistence of Ebola Virus in ocular fluid during convalescence. New Engl J Med. 2015. doi:10.1056/NEJMoa1500306.

    Google Scholar 

  34. 34.

    Chan CK, Limstrom SA, Tarasewicz DG, Lin SG. Ocular features of west nile virus infection in North America: a study of 14 eyes. Ophthalmology. 2006;113(9):1539–46.

    Article  PubMed  Google Scholar 

  35. 35.

    Khairallah M, Ben Yahia S, Ladjimi A, et al. Chorioretinal involvement in patients with West Nile virus infection. Ophthalmology. 2004;111(11):2065–70.

    Article  PubMed  Google Scholar 

  36. 36.

    Jo T, Mizota A, Hatano N, Tanaka M. Frosted branch angiitis-like fundus following presumed influenza virus type A infection. Jpn J Ophthalmol. 2006;50(6):563–4.

    Article  PubMed  Google Scholar 

  37. 37.

    Khairallah M, Chee SP, Rathinam SR, Attia S, Nadella V. Novel infectious agents causing uveitis. Int Ophthalmol. 2010;30(5):465–83.

    Article  PubMed  Google Scholar 

  38. 38.

    Khairallah M, Kahloun R, Ben Yahia S, Jelliti B, Messaoud R. New infectious etiologies for posterior uveitis. Ophthalmic Res. 2013;49(2):66–72.

    Article  PubMed  Google Scholar 

  39. 39.

    Aldave AJ, King JA, Cunningham ET Jr. Ocular syphilis. Curr Opin Ophthalmol. 2001;12(6):433–41.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Wickremasinghe S, Ling C, Stawell R, Yeoh J, Hall A, Zamir E. Syphilitic punctate inner retinitis in immunocompetent gay men. Ophthalmology. 2009;116(6):1195–200.

    Article  PubMed  Google Scholar 

  41. 41.

    Gass JD, Braunstein RA, Chenoweth RG. Acute syphilitic posterior placoid chorioretinitis. Ophthalmology. 1990;97(10):1288–97.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Pichi F, Ciardella AP, Cunningham ET Jr, et al. Spectral domain optical coherence tomography findings in patients with acute syphilitic posterior placoid chorioretinopathy. Retina. 2014;34(2):373–84.

    Article  PubMed  Google Scholar 

  43. 43.

    Lima BR, Mandelcorn ED, Bakshi N, Nussenblatt RB, Sen HN. Syphilitic outer retinopathy. Ocul Immunol Inflamm. 2014;22(1):4–8.

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Chao JR, Khurana RN, Fawzi AA, Reddy HS, Rao NA. Syphilis: reemergence of an old adversary. Ophthalmology. 2006;113(11):2074–9.

    Article  PubMed  Google Scholar 

  45. 45.

    Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA. 2014;312(18):1905–17.

    Article  PubMed  Google Scholar 

  46. 46.

    Centers for Disease C, Prevention. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Weekly Rep. 1995;44(31):590–1.

    Google Scholar 

  47. 47.

    Winterkorn JM. Lyme disease: neurologic and ophthalmic manifestations. Surv Ophthalmol. 1990;35(3):191–204.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Rathinam SR. Ocular manifestations of leptospirosis. J Postgrad Med. 2005;51(3):189–94.

    CAS  PubMed  Google Scholar 

  49. 49.

    De Luigi G, Mantovani A, Papadia M, Herbort CP. Tuberculosis-related choriocapillaritis (multifocal-serpiginous choroiditis): follow-up and precise monitoring of therapy by indocyanine green angiography. Int Ophthalmol. 2012;32(1):55–60.

    Article  PubMed  Google Scholar 

  50. 50.

    Wroblewski KJ, Hidayat AA, Neafie RC, Rao NA, Zapor M. Ocular tuberculosis: a clinicopathologic and molecular study. Ophthalmology. 2011;118(4):772–7.

    Article  PubMed  Google Scholar 

  51. 51.

    Heysell SK, Houpt ER. The future of molecular diagnostics for drug-resistant tuberculosis. Expert Rev Mol Diagn. 2012;12(4):395–405.

    CAS  Article  PubMed  Google Scholar 

  52. 52.

    Singh R, Toor P, Parchand S, Sharma K, Gupta V, Gupta A. Quantitative polymerase chain reaction for Mycobacterium tuberculosis in so-called Eales’ disease. Ocul Immunol Inflamm. 2012;20(3):153–7.

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    • Taravati P, Lam D, Van Gelder RN. Role of molecular diagnostics in ocular microbiology. Curr Ophthalmol Rep. 2013;1(4):181–9. This review provides an excellent overview of the utility of PCR to diagnose infectious causes of uveitis.

    Article  Google Scholar 

  54. 54.

    Couto C, Rossetti S, Schlaen A, Hurtado E, D’Alessandro L, Goldstein DA. Chronic postoperative Mycobacterium gordonae endophthalmitis in a patient with phakic intraocular lens. Ocul Immunol Inflamm. 2013;21(6):491–4.

    Article  PubMed  Google Scholar 

  55. 55.

    Kuznetcova TI, Sauty A, Herbort CP. Uveitis with occult choroiditis due to Mycobacterium kansasii: limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity). Int Ophthalmol. 2012;32(5):499–506.

    Article  PubMed  Google Scholar 

  56. 56.

    Nishida T, Ishida K, Niwa Y, Kawakami H, Mochizuki K, Ohkusu K. An eleven-year retrospective study of endogenous bacterial endophthalmitis. J Ophthalmol. 2015;2015:261310.

    PubMed Central  PubMed  Google Scholar 

  57. 57.

    Do T, Hon do N, Aung T, Hien ND, Cowan CL Jr. Bacterial endogenous endophthalmitis in Vietnam: a randomized controlled trial comparing vitrectomy with silicone oil versus vitrectomy alone. Clin. Ophthalmol. 2014;8:1633–40.

    PubMed Central  Article  PubMed  Google Scholar 

  58. 58.

    Brooks RG. Prospective study of Candida endophthalmitis in hospitalized patients with candidemia. Arch Intern Med. 1989;149(10):2226–8.

    CAS  Article  PubMed  Google Scholar 

  59. 59.

    Donahue SP, Greven CM, Zuravleff JJ, et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology. 1994;101(7):1302–9.

    CAS  Article  PubMed  Google Scholar 

  60. 60.

    Lin P, Wynn P, Stewart JM. Management of a recalcitrant candidal chorioretinal abscess. Retinal cases and brief reports. Summer. 2012;6(3):280–4.

    Google Scholar 

  61. 61.

    Pearson PA, Piracha AR, Sen HA, Jaffe GJ. Atovaquone for the treatment of toxoplasma retinochoroiditis in immunocompetent patients. Ophthalmology. 1999;106(1):148–53.

    CAS  Article  PubMed  Google Scholar 

  62. 62.

    • Felix JP, Lira RP, Zacchia RS, Toribio JM, Nascimento MA, Arieta CE. Trimethoprim-sulfamethoxazole versus placebo to reduce the risk of recurrences of Toxoplasma gondii retinochoroiditis: randomized controlled clinical trial. Am J Ophthalmol. 2014;157(4):762–76 e761. This study demonstrated a potential prophylactic strategy to prevent recurrence of Toxoplasmosis retinochoroiditis using trimethoprim/sulfamethoxazole.

    CAS  Article  PubMed  Google Scholar 

  63. 63.

    Baharivand N, Mahdavifard A, Fouladi RF. Intravitreal clindamycin plus dexamethasone versus classic oral therapy in toxoplasmic retinochoroiditis: a prospective randomized clinical trial. Int Ophthalmol. 2013;33(1):39–46.

    Article  PubMed  Google Scholar 

  64. 64.

    Lasave AF, Diaz-Llopis M, Muccioli C, Belfort R Jr, Arevalo JF. Intravitreal clindamycin and dexamethasone for zone 1 toxoplasmic retinochoroiditis at twenty-four months. Ophthalmology. 2010;117(9):1831–8.

    Article  PubMed  Google Scholar 

  65. 65.

    Stewart JM, Cubillan LD, Cunningham ET Jr. Prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis. Retina. 2005;25(8):1005–13.

    Article  PubMed  Google Scholar 

  66. 66.

    Lagace-Wiens PR, Dookeran R, Skinner S, Leicht R, Colwell DD, Galloway TD. Human ophthalmomyiasis interna caused by Hypoderma tarandi, Northern Canada. Emerg Infect Dis. 2008;14(1):64–6.

    PubMed Central  Article  PubMed  Google Scholar 

  67. 67.

    Gass JD, Braunstein RA. Further observations concerning the diffuse unilateral subacute neuroretinitis syndrome. Arch Ophthalmol. 1983;101(11):1689–97.

    CAS  Article  PubMed  Google Scholar 

  68. 68.

    Vezzola D, Kisma N, Robson AG, Holder GE, Pavesio C. Structural and functional retinal changes in eyes with DUSN. Retina. 2014;34(8):1675–82.

    Article  PubMed  Google Scholar 

  69. 69.

    Muccioli C, Belfort R Jr. Hypopyon in a patient with presumptive diffuse unilateral subacute neuroretinitis. Ocul Immunol Inflamm. 2000;8(2):119–21.

    CAS  Article  PubMed  Google Scholar 

  70. 70.

    Casella AM, Farah ME, Belfort R Jr. Antihelminthic drugs in diffuse unilateral subacute neuroretinitis. Am J Ophthalmol. 1998;125(1):109–11.

    CAS  Article  PubMed  Google Scholar 

  71. 71.

    Takkar B, Chandra P, Kumar K, Vanathi M. Toxic granulomatous anterior uveitis in live intracameral cysticercosis masquerading as leukocoria. Can J Ophthalmol. 2014;49(6):e140–1.

    Article  PubMed  Google Scholar 

  72. 72.

    Wani VB, Kumar N, Uboweja AK, Kazem MA. A case of submacular cysticercosis treated by pars plana vitrectomy in Kuwait. Oman J Ophthalmol. 2014;7(3):144–6.

    PubMed Central  Article  PubMed  Google Scholar 

  73. 73.

    Fekkar A, Bodaghi B, Touafek F, Le Hoang P, Mazier D, Paris L. Comparison of immunoblotting, calculation of the Goldmann-Witmer coefficient, and real-time PCR using aqueous humor samples for diagnosis of ocular toxoplasmosis. J Clin Microbiol. 2008;46(6):1965–7.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  74. 74.

    Talabani H, Asseraf M, Yera H, et al. Contributions of immunoblotting, real-time PCR, and the Goldmann-Witmer coefficient to diagnosis of atypical toxoplasmic retinochoroiditis. J Clin Microbiol. 2009;47(7):2131–5.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

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Dr. Phoebe Lin has no conflicts of interest to declare.

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This article is part of the Topical collection on Ocular Therapy.

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Lin, P. Infectious Uveitis. Curr Ophthalmol Rep 3, 170–183 (2015).

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  • Infectious uveitis
  • Molecular diagnostics
  • Multi-modal ophthalmic imaging