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Key Features

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  • The terms choroiditis, retinitis, and retinochoroiditis denote the tissue layers primarily involved in posterior uveitis

  • Infectious agents are the most common cause of posterior uveitis in the pediatric population

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Clinical Findings

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  • Children with posterior uveitis often present with systemic manifestations of a congenital infection

  • Congenital rubella presents with deafness, developmental delay, cataracts, "salt and pepper" retinopathy, and hearing and cardiac disorders

  • Active toxoplasmosis

    • Produces a white lesion appearing as a "headlight in the fog" owing to the overlying vitreitis

    • Inactive lesions have a hyperpigmented border

    • Contiguous white satellite lesions suggest reactivation of disease

  • Ocular candidiasis/endogenous endophthalmitis typically occurs in an immune compromised host or a premature infant in the intensive care nursery receiving hyperalimentation

  • Candidal chorioretinitis appears as multifocal, whitish yellow, fluffy retinal lesions that may spread into the vitreous and produce a so-called cotton or fungus ball vitritis

  • Acute retinal necrosis syndrome

    • Caused most often by varicella-zoster virus and occasionally by HSV

    • May present with vision loss and a red and painful eye

  • CMV infection is the most common cause of retinitis in immunocompromised children, especially those with hematopoietic stem cell transplantation or HIV infection

    • CMV retinitis appears as a white retinal lesion, typically but not always associated with hemorrhage, or as a granular, indolent-appearing lesion with hemorrhage and a white periphery

    • Cotton-wool spots (nerve fiber layer infarcts) also commonly occur in HIV-positive patients

  • In toddlers and young children, Toxocara canis or Toxocara cati infections (ocular larva migrans) occur from ingesting soil contaminated with parasite eggs

    • Disease is usually unilateral

    • Red injected eye, leukocoria, and decreased vision are common

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Diagnosis

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  • Serologic analysis and retinal examination by an ophthalmologist are used to identify the cause of posterior uveitis

  • Acute retinal necrosis syndrome

    • Ophthalmoscopy may show

      • Unilateral or bilateral patchy white areas of retina

      • Arterial sheathing

      • Vitreous haze

      • Atrophic retinal scars

      • Retinal detachment

      • Optic nerve involvement

  • In toddlers and young children, Toxocara canis or Toxocara cati infections

    • Funduscopic examination may show endophthalmitis (vitreous abscess) or localized granuloma

    • Diagnosis is based on the appearance of the lesion and serologic testing using ELISA for T canis and T cati

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Treatment

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  • Congenital toxoplasmosis infections must be treated with systemic antimicrobials

  • Other infectious agents such as Candida, varicella, and CMV require systemic and/or intraocular injections of antimicrobial agents and may require retinal surgery

  • Treatment of toxocariasis includes periocular corticosteroid injections and vitrectomy

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