Snapshot A 54-year-old woman is referred to the emergency department from her primary care physician's office due to decreased visual acuity and ocular pain. Past medical history is notable for a decreased donor liver transplant and is currently on tacrolimus and mycophenolate mofetil. Ophthalmology was consulted, and examination was notable for perilimbal erythema, hypopyon, and decreased visual acuity. She is started on intravenous ganciclovir and topical corticosteroids. Introduction Overview inflammation of the uvea Epidemiology Incidence most cases are idiopathic Risk factors human leukocyte antigen (HLA-B27) immunodeficiency ETIOLOGY Pathophysiology inflammatory response to the anterior or porsterior segment of the uvea Associated conditions infections herpes simplex and zoster virus cytomegalovirus toxoplasmosis syphilis tuberculosis cat-scratch disease West Nile virus systemic immune-mediated diseases spondyloarthritis (e.g., ankylosing spondylitis) sarcoidosis juvenile idiopathic arthritis psoriatic arthritis inflammatory bowel disease Behcet syndrome Sjogren syndrome syndromes restricted to the eye pars planitis immune recovery uveitis idiopathic sympathetic ophthalmia Anatomy Organ uvea can be divided into 2 portions anterior uvea iris ciliary body posterior uvea choroid Presentation Symptoms anterior uveitis infectious visual impairment traumatic iritis (traumatic uveitis) after trauma visual impariment conjunctival injection eye pain photophobia blurry vision sluggish pupil posterior uveitis visual impairment Physical exam anterior uveitis perilimbal erythema miosis ocular pain leukocytes in the anterior chamber of the eye (hypopyon) posterior uveitis more likely to be painless leukocytes in the vitreous humor chorioretinal inflammation STUDIES Slit lamp examination Differential Conjunctivitis differentiating factors inflammation confined to the conjunctiva Episcleritis differentiating factors vision is not affected episcleral discoloration secondary to vasodilatation without edema or thinning of the sclera diagnosis Diagnosis is made with slit lamp examination Treatment Medical antiviral therapy indication first-line for uveitis caused by a viral disease topical corticosteroids indication anterior uveitis first-line for noninfectious anterior uveitis systemic corticosteroids indication first-line for posterior uveitis bilateral uveitis unresponsive to topical corticosteroids Complications Band keratopathy calcium deposition in the corneal epithelium Posterior synechiae the iris is adhesed to the lens Intraocular hypertension Cataract Prognosis Chronic uveitis is higher risk for developing visual loss