Intermediate Uveitis

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Aetiology

  • Idiopathic: Pars Planitis
    • Most common form of intermediate uveitis (85-90%).
    • Young adults; Women > Men; 75% bilateral
    • Associated with HLA-DR15 and MS
    • Idiopathic; Diagnosis of exclusion!
  • Multiple sclerosis
  • Lyme disease
  • Sarcoidosis
  • Toxocara

Symptoms / Findings

  • Symptoms: Floaters/Mouches volantes, visual impairment
  • Snowballs (whitish “snowball-like” cell aggregates in the inferior vitreous) + Snowbanks (whitish-gray plaques in the lower Pars plana)
  • Few cells and mild flare in the anterior chamber, few endothelial precipitates, no synechiae
  • Posterior capsule opacification, band keratopathy
  • Peripheral retinal periphlebitis , hyperemic papilla, no chorioretinitis
  • Cystoid macular edema

Work-up

  • Laboratory: Differential blood count, CRP, ESR, ACE/Lysozyme, ANA, syphilis, Lyme disease, Quantiferon test, possibly Toxocara
  • Chest X-ray
  • MRI (if suspected multiple sclerosis)

Differential Diagnosis

  • Masquerade syndrome

Therapy for Pars Planitis

  • For mild vitritis without visual impairment: Observation is possible, no therapy
  • In case of visual impairment/visus-threatening secondary complications (e.g., macular edema)
    • Steroid therapy:
      • Local steroids as eye drops are usually not sufficient
      • Subtenon steroid injections (if unilateral), consider intravitreal steroids
      • Systemic steroid therapy (especially if bilateral)
        • CAUTION: Before starting systemic steroids, rule out infectious causes (e.g., syphilis, tuberculosis)
    • consider immunosuppressive/immunomodulatory therapy

Sources

  • EyeWiki Intermediate Uveitis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)