Non-Neoplastic Disorders Mimicking Posterior Segment Inflammation

Masquerade syndromes encompass a heterogeneous group of ocular conditions that mimic intraocular inflammation but are caused by non-inflammatory processes. Accurate distinction from true uveitis is critical, as misdiagnosis can lead to inappropriate immunosuppression, delayed definitive therapy, and irreversible visual loss. This review focuses on non-neoplastic disorders presenting as posterior segment inflammation, highlighting their epidemiology, clinical hallmarks, multimodal imaging features, and diagnostic pitfalls. We discuss inherited retinal degenerations such as retinitis pigmentosa, chronic endophthalmitis, retinal detachment syndromes, intraocular foreign bodies, idiopathic uveal effusion, central serous chorioretinopathy, amyloidosis, and vascular anomalies including Coats disease. Developmental anomalies like persistent fetal vasculature and rare entities such as X-linked retinoschisis are also examined. For each disorder, we outline distinguishing characteristics from uveitis and propose a systematic diagnostic approach integrating history, examination, targeted laboratory testing, and imaging modalities including OCT, FAF, FA, ICGA, and ultrasonography. Early recognition of these mimickers is essential to guide appropriate management, prevent unnecessary exposure to corticosteroids or immunomodulators, and optimize visual prognosis.