The rear part of the uvea, chorioidea, is strongly related to the retina; so, inflammatory changes within one structure almost always pass on to the other. Therefore, in practice are often equally used synonymous terms of the posterior uveitis: chorioiditis and chorioretinitis.
Inflammation of all parts of the uvea (iris + cillliary body + choroid) is called panuveitis.
Disorders in panuveitis are the same as in iridocyclitis, i.e. anterior uveitis.
Any form of uveitis is a serious disease which can severely damage the vision, and it requires treatment as soon as possible and search for cause. Possible consequences of uveitis are secondary glaucoma, cataract, retinal detachment and vision loss. As uveitis tends to recur, one needs regular ophthalmic monitoring.
The result of the eye background depends on the stage of chorioretinis. In the initial stage whitish exudates and sometimes bleeding are visible. If the blood vessels are severely affected there can be seen a sign of vasculitis: white humor around blood vessels. At specific inflammations there are granulomatous changes (granulomatous uveitis). In the vitreous body float dusty and/or rag-like shades. Later at the site of exudate appear pale or hyperpigmented atrophic scars. Smaller blurs of the vitreous body are absorbed by the end of inflammation in several weeks, and the bigger ones stay permanently. Visual impairment depends on the size and site of a scar – the nearer the scar to macula, the greater the damage.
The disease lasts from several days to several weeks. The period between relapses lasts from several weeks to several years.
Inflamatory changes of the choroid and the retina
In isolated chorioretinitis, i.e. posterior uveitis, the patient notices flies or spots before the eye, and decreased visual acuity. Chorioretinitis may be asymptomatic, or with very few difficulties, so the patient does not even notice them or does not pay attention to them. Namely, the closer the inflammation to the macula, the lower visual acuity, while the inflammatory focus on the distant periphery of the retina does not affect visual acuity. Blur of the vitreous body, which the patient perceives as flies or spots before the eye also may, but need not, reduce visual acuity.
Although the anterior and posterior uveitis occur in association with over one hundred different diseases and disorders, the exact cause is rarely found. From the known causes of posterior uveitis toxoplasmosis is the most common. Other common causes include tuberculosis, sarcoidosis and other systemic connective tissue diseases, and viruses from the herpes group.
The most common causes:
INFECTIONS: toxoplasmosis, tuberculosis, citerpesa simplex, syphilis
SYSTEMIC CONNECTIVE TISSUE DISEASES: sarcoidosis, ulcerative colitis, pauciarticular rheumatoid arthritis, ankylosing spondylitis, Behcet’s disease, Reiter’s syndrome
OTHER: psoriasis, trauma of the eye (especially with children), multiple sclerosis
Steroids form the basis of treatment in the anterior and posterior uveitis. They are given topically, periocularly, and, in severe cases, systemically. In the most severe cases, cytostatics (e.g., cyclosporine) are given.