Intraocular inflammation: uveitis and endophthalmitis
- Lesion
Inflammation inside the eye can come from immune disease, infection or injury; severe or lasting inflammation can shrink and blind the eye.
What it is
The uvea (iris, ciliary body and choroid) is vascular and immunologically active, so many systemic diseases inflame it. Uveitis can be anterior, intermediate, posterior or diffuse, and granulomatous or not. Infections such as toxoplasmosis, CMV, syphilis and tuberculosis cause retinitis and choroiditis. Endophthalmitis is a severe infection of the inner eye, usually after surgery or penetrating trauma; panophthalmitis adds the sclera and orbit. Sympathetic ophthalmia is a bilateral granulomatous uveitis after injury to one eye. Whatever the cause, an eye destroyed by inflammation or trauma may end as a small, disorganised phthisical globe.
Step by step
- Injury, infection or an immune trigger activates the uvea.
- Leaky iris vessels release protein and cells into the aqueous (flare and cells).
- Inflammatory cells collect on the corneal endothelium (keratic precipitates) and settle as hypopyon.
- Adhesions (synechiae) form; pressure may rise or fall; cataract and macular edema follow.
- Prolonged or severe disease leads to scarring, detachment and phthisis.
Main forms of intraocular inflammation
| Form | Cause | Pathology |
|---|---|---|
| Anterior uveitis (HLA-B27) | Spondyloarthritis, inflammatory bowel disease | Non-granulomatous iritis, hypopyon possible |
| Sarcoid uveitis | Sarcoidosis | Non-caseating granulomas, mutton-fat precipitates |
| Toxoplasma retinochoroiditis | Toxoplasma gondii | Full-thickness retinal necrosis next to an old scar |
| CMV retinitis | Cytomegalovirus in AIDS | Hemorrhagic necrotising retinitis with inclusions |
| Sympathetic ophthalmia | Penetrating injury of one eye | Bilateral granulomatous uveitis, Dalen-Fuchs nodules |
| Endophthalmitis | Bacteria or fungi after surgery, trauma or bacteremia | Suppurative inflammation of vitreous and retina |
| Toxocariasis | Toxocara larvae | Eosinophilic granuloma, can mimic retinoblastoma |
Clinical notes
- Uveitis causes pain, redness, photophobia and blurred vision (anterior) or floaters and visual loss (posterior); it needs prompt ophthalmic care.
- A Colombian multicentre study describes the causes of uveitis in the country, where toxoplasmosis is a leading infectious cause.
Test yourself
Think of the answer, then tap the question to see it.
What is sympathetic ophthalmia?
A bilateral granulomatous uveitis that follows penetrating injury to one eye, from an immune response to previously hidden ocular antigens.
Which infection is the most common cause of posterior uveitis in Colombia?
Ocular toxoplasmosis (toxoplasma retinochoroiditis).
What is phthisis bulbi?
The shrunken, disorganised end-stage eye after severe trauma or inflammation, often with intraocular bone.
Elsewhere in DurgiPedia
- The uvea: iris, ciliary body and choroid
- Rheumatic and autoimmune disease in the eye
- Systemic infections in the eye: syphilis, TB, toxoplasma
- HIV and the eye: CMV retinitis and more
- Sarcoidosis and Behçet disease in the eye
- Immune tolerance and how autoimmunity begins
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Uveitis: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Epidemiology, clinical features, and classification of 3,404 patients with uveitis: Colombian Uveitis Multicenter Study (COL-UVEA) (Europe PMC, 2026).
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Representative model, for educational purposes only.