Current perspective on infectious uveitis

Infectious uveitis is a significant cause of ocular morbidity and visual impairment worldwide, especially in developing regions, where it commonly leads to intraocular inflammation. However, in recent years, cases of infectious uveitis have been rising even in the developed world. Due to the considerable variation in the causes of infectious uveitis globally, this review concentrates on epidemiological aspects. Ophthalmologists should become familiar with the patterns of infectious uveitis in their area to enable early diagnosis and prevent blindness from these treatable conditions. The incidence of tuberculosis disease remains very high in low- and middle-income regions, including India. Although there is emerging consensus that tubercular uveitis (TBU) is a significant cause of uveitis in TB-endemic areas, the lack of microbiological evidence in most cases poses a major diagnostic challenge. Polymerase chain reaction (PCR) detection of the MTB genome in ocular fluids from several centers in India has shown low sensitivity and cannot definitively exclude TB infection. Conversely, nearly all intraocular viral infections can be diagnosed with high sensitivity and specificity using standard PCR techniques. The advent of mNGS as a diagnostic tool has shown great promise, with reports uncovering previously undetected pathogens. However, interpreting mNGS results remains complex. Serology continues to be a valuable method for diagnosing systemic viral infections that cause infectious uveitis, syphilis and parasitic infections. Effective antimicrobial treatments have been available for many years. Recurrences, especially in viral and toxoplasmosis-related uveitis, are common, necessitating a cautious approach to prophylactic therapy.