Intermediate uveitis

Intermediate uveitis is a chronic inflammatory eye disease characterized by inflammation primarily affecting the vitreous cavity (the gel-filled space inside the eye) and the peripheral retina. It is also known as pars planitis when it occurs in its idiopathic form with characteristic snowbank or snowball opacities. The condition falls within the broader category of uveitis, which refers to inflammation of the uveal tract of the eye. Intermediate uveitis accounts for approximately 10-20% of all uveitis cases and predominantly affects younger adults and children. Key symptoms include floaters (spots or strands in the visual field), blurred vision, and, less commonly, mild eye pain or redness. Many patients experience a gradual, painless decrease in visual acuity. The disease can be bilateral in a significant proportion of cases. Complications may include cystoid macular edema (swelling of the central retina), cataracts, vitreous opacities, epiretinal membrane formation, and, in severe cases, retinal detachment, all of which can lead to significant vision loss if untreated. Intermediate uveitis can be idiopathic or associated with systemic conditions such as multiple sclerosis, sarcoidosis, or certain infectious diseases including tuberculosis and Lyme disease. A thorough systemic workup is often recommended to identify any underlying cause. The condition is thought to involve immune-mediated mechanisms, though the precise pathogenesis remains incompletely understood. Treatment depends on severity and typically follows a stepwise approach. Mild cases may be observed without treatment. For visually significant disease, corticosteroids (periocular injections or systemic) are the first-line therapy. Steroid-sparing immunosuppressive agents such as methotrexate, mycophenolate mofetil, or azathioprine are used for chronic or refractory cases. Biologic agents, including anti-TNF therapies such as adalimumab, have shown efficacy in refractory intermediate uveitis. Intravitreal sustained-release corticosteroid implants (such as fluocinolone acetonide or dexamethasone implants) are also used. Pars plana vitrectomy may be considered in cases with persistent vitreous opacities or complications. With appropriate management, many patients can achieve good long-term visual outcomes, though the disease often follows a chronic relapsing course requiring prolonged treatment.

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