What causes uveitis?

Causes of Uveitis

Uveitis is primarily caused by autoimmune conditions or is idiopathic (50-60% of cases), with infectious causes accounting for only about 20% of cases in developed countries. 1

Primary Causes of Uveitis

Non-Infectious Causes (Most Common)

• Autoimmune/Idiopathic (50-60% of cases)

  • Approximately 27-51% of uveitis cases in the US and Europe are idiopathic 2
  • 37-49% are associated with systemic inflammatory diseases 2

• Systemic Inflammatory Conditions

  • Spondyloarthritis (most common cause in Western countries) 3
    • Presents as acute, unilateral anterior uveitis
    • HLA-B27 positive in 49.4% of anterior uveitis cases 4
  • Inflammatory bowel disease 1
  • Psoriasis and psoriatic arthritis 1
  • Sarcoidosis (occurs in 15% of cases, with predilection for middle-aged women) 3
  • Behçet's disease 4
  • Multiple sclerosis 4
  • Rheumatoid arthritis and other connective tissue diseases 1

Infectious Causes (Less Common)

• Viral (most common infectious cause)

  • Herpes simplex virus (HSV) 1, 5
  • Varicella zoster virus (VZV) 1, 5
  • Cytomegalovirus (CMV) 1, 5
  • Epstein-Barr virus 1

• Parasitic

  • Toxoplasma gondii (most common infectious cause of retinitis) 1, 6
  • Toxocara species 1
  • Onchocerca volvulus 1

• Bacterial

  • Mycobacterium tuberculosis 1, 6
  • Treponema pallidum (syphilis) - increasing in prevalence 5, 6
  • Borrelia burgdorferi (Lyme disease) 3

• Fungal

  • Candida species 1
  • Aspergillus species 1

Anatomical Classification and Causes

• Anterior uveitis (41-60% of cases) 2

  • Most commonly associated with HLA-B27-related diseases
  • Spondyloarthritis is a leading cause

• Intermediate uveitis (9-15% of cases) 2

  • Often idiopathic
  • Can be associated with multiple sclerosis

• Posterior uveitis (17-23% of cases) 2

  • Toxoplasmosis (29% of posterior uveitis cases) 4
  • Multifocal choroiditis (17.7% of posterior uveitis cases) 4
  • Viral causes (HSV, VZV, CMV)

• Panuveitis (7-32% of cases) 2

  • Often associated with systemic diseases like Behçet's disease
  • Can be caused by severe infections

Clinical Pearls and Pitfalls

• Important clinical consideration: Uveitis predominantly affects individuals aged 20-50 years 2

• Diagnostic pitfall: Uveitis is often overlooked due to its rarity, leading to delayed diagnosis of associated systemic diseases 4

• Management consideration: Early identification and treatment of infectious uveitis is crucial to prevent vision-threatening complications 5

• Interdisciplinary approach: Collaboration between ophthalmologists, rheumatologists, infectious disease specialists, and neurologists is essential for proper diagnosis and management 4

• Warning signs: Redness of the eye (with or without pain), blurred vision, and photosensitivity should prompt urgent ophthalmological evaluation 1

• Complication risk: Untreated uveitis can lead to cataracts, glaucoma, macular edema, retinal detachment, optic nerve damage, and permanent vision loss 2