Non-Neoplastic Uveitis Masquerade Syndromes: Insights from a Case Series

To study the clinical characteristics and implications of non-neoplastic uveitis masquerade syndromes (NNUMS).

A retrospective study of 1595 patients referred for evaluation of uveitis at a tertiary referral center in South India between July 2019 and July 2025. The clinical characteristics and outcomes of patients with NNUMS were evaluated.

Eighty eyes of 53 patients (40 males [75.5%], 13 females [24.5%] mean age 40.3 ± 15.7 years) were diagnosed with NNUMS. Forty-four (83%) patients had fundus lesions. Multimodal imaging was crucial in establishing the diagnosis in 46 (86.8%) patients. Retinal vascular diseases (22.6%), inherited retinal diseases (20.8%) and central serous chorioretinopathy (11.3%) were the most common etiological diagnoses. In 13 (24.5%) patients the diagnosis was delayed by more than 100 days. Twenty-seven (50.9%) patients were receiving anti-inflammatory therapy at presentation. The likelihood of unnecessary anti-inflammatory treatment was significantly higher (p < 0.001) in patients with a diagnostic delay >100 days than those without. Thirteen (24.5%) patients had underlying systemic disease, 92% of whom were previously undiagnosed until the ocular diagnosis was made. Retinal vascular involvement was significantly (p < 0.0001) associated with presence of underlying systemic condition.

NNUMS are a heterogenous group of clinical entities which mimic ocular inflammatory diseases often resulting in misdiagnosis and unnecessary anti-inflammatory treatment. Recognizing the clinical and imaging features of common clinical manifestations is key to accurate diagnosis and reducing visual morbidity.