Posterior Uveitis (Choroiditis)

The choroid sits between the retina and the sclera (the white outer wall of the eye). It supplies oxygen and nutrients to the outer layers of the retina, including the photoreceptors responsible for sharp, detailed vision. When inflammation develops in this layer, it can disrupt blood flow, damage photoreceptors, and cause fluid to leak into or beneath the retina.

Uveitis is classified by the part of the eye it affects. Anterior uveitis involves the iris and ciliary body at the front of the eye, intermediate uveitis targets the vitreous cavity, and posterior uveitis centers on the choroid and retina. Panuveitis refers to inflammation affecting all segments simultaneously. Posterior uveitis tends to be more vision-threatening than anterior forms because it directly involves the structures responsible for central vision. Uveitis is responsible for approximately 10 percent of blindness in the United States (National Eye Institute), underscoring the importance of early detection and treatment.

Choroiditis can present in several patterns. Focal choroiditis involves a single area of inflammation, while multifocal choroiditis produces several scattered lesions across the choroid. Diffuse choroiditis affects a broader area and may signal a systemic inflammatory or infectious process. The pattern of inflammation often gives our retina specialists important clues about the underlying cause.

Our retina specialists begin with a comprehensive dilated eye examination to assess the degree and pattern of inflammation. Optical coherence tomography (OCT) provides detailed cross-sectional images of the retina and can reveal macular edema, subretinal fluid, or structural damage. Fluorescein angiography may be used to evaluate blood vessel leakage and areas of poor blood flow. In some cases, indocyanine green angiography offers additional detail about choroidal inflammation that other imaging methods may miss.

Because posterior uveitis is frequently associated with systemic diseases or infections, blood tests and imaging studies are often part of the evaluation. Common tests include a complete blood count, inflammatory markers, tuberculosis screening, syphilis serology, and angiotensin-converting enzyme (ACE) levels for sarcoidosis. A chest X-ray or CT scan may be ordered to look for evidence of sarcoidosis or tuberculosis. Coordinating with other medical specialists such as rheumatologists or infectious disease physicians is sometimes necessary.

Corticosteroids are typically the first line of treatment for controlling active inflammation. Depending on the severity, steroids may be delivered as eye drops, periocular injections (around the eye), intravitreal injections (directly into the eye), or oral medications. Intravitreal steroid implants can provide sustained drug release over months, reducing the need for repeated injections. While effective at suppressing inflammation, long-term steroid use carries risks including elevated eye pressure and cataract progression, so our retina specialists monitor these factors closely.

For patients with recurrent or chronic posterior uveitis, steroid-sparing immunosuppressive medications may be recommended. Agents such as methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine help control the immune response while reducing dependence on corticosteroids. Biologic therapies, including adalimumab (the first FDA-approved biologic for non-infectious intermediate, posterior, and panuveitis), target specific immune pathways and can be highly effective for refractory cases.

When an infection is identified as the cause, targeted antimicrobial therapy is essential. Toxoplasmosis is treated with a combination of antiparasitic and antibiotic medications, often alongside corticosteroids to control the inflammatory response. Tuberculosis-related uveitis requires systemic antitubercular therapy, and syphilitic uveitis is treated with intravenous penicillin. Prompt identification of the infectious agent ensures the correct treatment is started without delay.

Posterior uveitis often requires ongoing monitoring even after inflammation appears to be controlled. Regular follow-up visits with OCT imaging allow our retina specialists to detect early signs of recurrence or complications such as subretinal fluid changes before they affect your vision significantly. Treatment adjustments are made based on how the inflammation responds, and tapering medications too quickly can lead to flare-ups.