Infectious Causes of Retinal Vasculitis - Posterior Segment & Ocular Disease Spring 2026

-retinal vasculitis

-focal or unifocal chorioretinitis or choroiditis

-disseminated chorioretinitis or choroiditis

What are the posterior segment inflammatory disorders that often lead to posterior uveitis?

Syphilus

______ is always a differential for any ocular manifestation

Yes -- if severe

Can retinal vasculitis lead to vascular occlusions?

The walls of BVs which become outlines with inflammatory cells & can cause a blockage eventually.

What is affected by retinal vasculitis?

Retinal Vasculitis (Pic)

Retinal Vasculitis (Pic)

Retinal Vasculitis -- WBCs following the path of the BVs (Pic)

Retinal Vasculitis -- WBCs following the path of the BVs (Pic)

vascular sheathing

What can be present post-vasculitis in the retina?

Vascular Sheathing Post Vasculitis (Pic)

Vascular Sheathing Post Vasculitis (Pic)

Chorioretinal Inflammation -- Unifocal Choroiditis (Pic)

Chorioretinal Inflammation -- Unifocal Choroiditis (Pic)

toxoplasmosis

What is the #1 cause of unifocal inflammation in the retina?

Chorioretinal Scar -- Post Chorioretinal Inflammation Appearance (Pic)

Chorioretinal Scar -- Post Chorioretinal Inflammation Appearance (Pic)

Multifocal Choroiditis (Pic)

Multifocal Choroiditis (Pic)

Histoplasmosis and TB

What patients are likely to have multifocal chorioditis manifestations?

Atrophic Scars -- Post-Disseminated Choroiditis (Pic)

Atrophic Scars -- Post-Disseminated Choroiditis (Pic)

1) Immune mediated causes (inflammatory)

2) Primary ocular issues -- pars planitis

3) Infectious disease

What are the top 3 causes of posterior uveitis?

-Sarcoidosis

-Systemic Lupus Erythematosus

-Multiple Sclerosis

-Behcet's Disease

-Giant cell arteritis

-Granulomatous with polyangiitis

-Susac's Syndrome

-VKH

-Polyarteritis nodosa

-COVID-19

What are the immune mediated SYSTEMIC causes of posterior uveitis (not a comprehensive list)?

**not on the final

multisystem granulomatous inflammation of unknown etiology

What is sarcoidosis?

20-50

What is the typical age of dx of sarcoidosis?

African Americans

______ are more commonly affected by Sarcoidosis?

women

Is there a slight predilection of sarcoidosis for women or men?

Yes

Does sarcoidosis have a multi-system involvement?

-95% of cases have pulmonary involvement

-lymph nodes commonly involved

-muscle, renal, bone and joint, spleen, liver, bone marrow, neurological, cardiac

What are the body systems that are involved in sarcoidosis?

-may be non-specific complaints

-fatigue and depression

-"asthma" symptoms

-arthritis and muscle pain or weakness

-skin granulomas/rash like

What are the signs and symptoms of sarcoidosis?

**not on the final

Sarcoidosis -- Granulomas on the Skin (Pic)

Sarcoidosis -- Granulomas on the Skin (Pic)

**hard wall around the lesion

25-50

Ocular involvement present in ___% of cases of sarcoidosis

anterior uveitis and conj nodules

EXAM QUESTION: What is the MOST COMMON ocular manifestations of sarcoidosis?

May be acute iridocyclitis or chronic granulomatous uveitis

Describe the anterior uveitis that can present as a result of sarcoidosis...

Yes -- intermediate uveitis (vitritis), retinal vasculitis (candle wax drippings), & chorioretinitis

Are intermediate and posterior uveitis possible complications of sarcoidosis?

1) Sarcoidosis

2) TB

3) syphilis

What are the ocular differentials for granulomatous uveitis?

1) Conj nodules (40%)

2) Granulomatous uveitis (30-70%)

REVIEW: What are the most common eye findings of sarcoidosis?

Sarcoidosis Retinal Vasculitis -- Candle-Wax Drippings (Pic)

Sarcoidosis Retinal Vasculitis -- Candle-Wax Drippings (Pic)

Sarcoidosis Choroiditis (Pic)

Sarcoidosis Choroiditis (Pic)

-biopsy (bronchoscopy)

-presence of non-caseating epitheliod cell granulomas

-bilateral hilar adenopathy on chest xray

What is the only way to definitively diagnose sarcoidosis?

-corticosteroids (systemic and ocular)

-cytotoxic agents (methotrexate)

What is the management of sarcoidosis?

Disseminated chorioretinitis

What do white dot syndromes often lead to?

exclusion

White dot syndromes are a dx of ________

Yes

Can white dot syndromes be infectious or inflammatory?

White Dot Syndrome -- Multifocal (Pic)

White Dot Syndrome -- Multifocal (Pic)

toxoplsma gondii -- protozoan parasite

What is the organism that will lead to toxoplasmosis?

toxoplasmosis

What is the MOST COMMON CAUSE of POSTERIOR UVEITIS in NON-IMMUNOCOMPROMISED individuals?

yes

Is toxoplasmosis a common opportunistic infection in patients with HIV/AIDS?

-ingestion of undercooked/raw meat, unwashed vegetables, raw eggs, waterborne

-ingestion directly (cat litter, dirt)

-congenital -- mainly when a mother becomes infected during pregnancy or within 6 months or so of pregnancy

What is the common modes of infection of toxoplasmosis?

later in pregnancy

When does the risk of transmission of toxoplasmosis to fetus increase?

Yes -- can result in convulsions, paralysis, and hydrocephalus

Can toxoplasmosis be dangerous to a fetus congenitally?

Yes

Are most forms of congenital toxoplasmosis subclinical?

toxoplasmosis retinal scars

What is possible in babies that were exposed to toxoplasmosis congenitally but subclinical symptoms?

-subclinical signs and symptoms usually

-lymphadenopathy

-meningoencephalitis

What are the signs/symptoms of acquired toxoplasmosis?

-mainly based on clinical appearance

-serological tests of IgM and IgG may support the dx

-anti-toxoplasma titers

How to diagnose toxoplasmosis?

-retinochorioditis (recurrent in 2/3 of cases) -- typically unifocal but can be disseminated

-macula involved in a majority of cases

-mild to moderate anterior segment inflammation may or may not be -present when active

-vitreous inflammation is almost always present

-retinal vasculitis possible

What are the ocular manifestations of acquired toxoplasmosis?

No

Is toxoplasmosis in the retina usually hemorrhagic?

Toxoplasmosis -- Active (Pic)

Toxoplasmosis -- Active (Pic)

Toxoplasmosis -- Chorioretinal Scar (Pic)

Toxoplasmosis -- Chorioretinal Scar (Pic)

-pyrimethamine

-sulfadiazine

-oral prednisone

-clindamyacin

**Recently, intravitreal injections of clindamycin and dexamethasone

What is the classic triple therapy of toxoplasmosis?

Sexually transmitted disease caused by the spirochete Treponema pallidum

What is syphilis?

Penicillin or doxy

What is syphilis commonly treated with?

Chancre (round, painless) presents 21 days after infection; generalized lymphadenopathy

Primary syphilis signs/symptoms

skin rash, HA, lymphadenopathy, pharyngitis, genital lesion, cranial nerve abnormalities, renal problems, GI issues

Secondary syphilis signs/symptoms

Neurosyphilis -- worst effects; personality changes, tremor, wasting, general paresis

Tertiary syphilis signs/symptoms

Syphilis Primary Sore (Pic)

Syphilis Primary Sore (Pic)

No -- it is the great masquerader

EXAM QUESTION: Are there any pathognomonic ocular signs of syphilis?

secondary and tertiary

Ocular findings are rare earlier than 6 months after the primary chancre and are most common in _____ and ____ syphilis

-interstitial keratitis

-anterior uveitis is common (can be granulomatous)

-chorioretinitis (unifocal or disseminated) and retinal vasculitis are possible

-Argyll-Robertson pupil

Common clinical signs of syphilis?

-small pupil,

-light-near disassociation-dorsal midbrain

-poor response to light

What is Argyll-Robertson pupil?

Syphilis -- Interstitial Keratitis (Pic)

Syphilis -- Interstitial Keratitis (Pic)

Syphilis -- Chorioretinitis (Pic)

Syphilis -- Chorioretinitis (Pic)

Syphilis -- Retinal Vasculitis (Pic)

Syphilis -- Retinal Vasculitis (Pic)

Fungal disease endemic to the Ohio-Mississippi River valley

What is histoplasmosis?

Carried by birds/in bird droppings, esp chickens. Also carried by bats. Grows well in wet, nitrogenous soil

What is the etiology of histoplasmosis?

aerosolized

What is the MODE OF INFECTION of histoplasmosis?

1) Benign (more the 90% of the time)

2) Primary acute histoplasmosis (resp infection similar to influenza)

3) Disseminated histoplasmosis (pulmonary infection, inflammation lymph nodes, spleen, adrenal gland insufficiency, anemia, ulcerations of tongue and mouth)

4) Chronic pulmonary histoplasmosis (infection of lung tissue that has already been compromised; weight loss, fever chronic cough & chest pain)

What are the systemic manifestations of Histoplasmosis?

Definitive diagnosis from culture (blood or sputum)

How to diagnose histoplasmosis?

Very slow -- 5 days to 6 weeks to get results

Is the culture for histo fast or slow growing?

-peripapillary changes (70%)

-peripheral atrophic "histo" spots secondary to disseminated chorioditis (active inflammation)

-macular inflammation with the potential for choroidal neovascularization (5%)

What is the Clinical Triad for Presumed Ocular Histoplasmosis Syndrome (POHD)?

Histoplasma capsulatum -- inhaled early in life; macular lesions reactive 10-30 years later in life within the choriocapillaris & grow through prior breaks in Bruch's membrane

Can Histo reactivate?

Amsler grid

Every patient with suspected Histo needs a _____

Presumed Ocular Histoplasmosis Syndrome (POHS) -- Histo Spots (Pic)

Presumed Ocular Histoplasmosis Syndrome (POHS) -- Histo Spots (Pic)

Presumed Ocular Histoplasmosis Syndrome (POHS) (Pic)

Presumed Ocular Histoplasmosis Syndrome (POHS) (Pic)

Yes -- see Pic

Can Fuch's spot present in POHS?

-systemic antifungal drugs

-systemic corticosteroids

-Amsler grid to every patient!

-ocular corticosteroids

-Anti-VEGF meds w/ laser photocoagulation for choroidal neovasc

What is the management of histoplasmosis?

-Parasite toxocara canis (roundworm in dogs)

-toxocara cati (in cats)

What is the etiology of toxocariasis?

mostly children

EXAM QUESTION: What population gets toxocariasis?

-most common infections in children who eat dirt contaminated with parasite eggs from dog or cat excrement

-ingesting food from infected soil

What are the modes of transmission of toxocariasis?

No

Do systemic and ocular infections of toxocariasis typically occur together?

-usually by age 2

-numerous organs potentially affected but often benign or subclinical

What is the systemic infection of toxocariasis?

-usually by 7.5yo

-unilateral, focal granuloma, peripheral inflammatory mass, endophthalmitis

What is the ocular infection of toxocariasis?

-clinical signs and hx of exposure to dogs

-ELISA

What is the diagnosis process of toxocariasis?

Toxocariasis -- Unifocal Granuloma (Pic)

Toxocariasis -- Unifocal Granuloma (Pic)

toxoplasmosis

What is the #1 differential of this picture?

Mycobacterium tuberculosis

What is the etiology of Tuberclulosis?

inhalation (aerosolized)

How to acquire Tuberclulosis?

Yes

Is lung involvement common with Tuberclulosis?

-prolonged coughing (>3w)

-hemotpysis (coughing up blood)

-chest pain

-fever

-night sweats

-body aches

-weight loss

-lymphadenopathy

What are the signs and symptoms of Tuberclulosis?

culture (body fluids or biopsy)

How to definitively dx Tuberclulosis?

-chorioditis (disseminated or unifocal)

-retinal vasculitis

-granulomatous uveitis possible

What are the most common ocular manifestations of Tuberclulosis?

Granulomatous Anterior Uveitis (Pic)

Granulomatous Anterior Uveitis (Pic)

Choroiditis -- Tuberculosis (Pic)

Choroiditis -- Tuberculosis (Pic)

spirochete, Borellia burgdoferi

What is the etiology of Lyme Disease?

tick of the genus Ixodes (deer tick)

How is Lyme Disease transmitted?

-PCR

-ELISA

Diagnosis of Lyme Disease aided by what tests?

-expanding skin lesion (bullseye rash)

-lymphadenopathy and other constitutional symptoms (fever, malaise, sweating, fatigue)

What are the early systemic manifestations of Lyme Disease?