13th February 2025

Bacterial causes of uveitis

Tuberculosis

Infection with Mycobacterium tuberculosis predominantly affects the respiratory system but can also have extrapulmonary manifestations. Tuberculosis can cause a range of ocular pathology such as anterior uveitis, vitritis choroiditis and cystoid macular oedema. Posterior uveitis with choroiditis is the most common finding, though anterior uveitis with granulomatous findings can often be seen. Ocular symptoms may be present in the absence of systemic upset and may, therefore, prompt further investigations for suspected tuberculosis. Treatment of the systemic infection is necessary and should be referred to a respiratory specialist.

Syphilis

Anterior uveitis may be found in a small proportion of people infected with the spirochaete Treponema pallidum and may cause unilateral or bilateral disease. It is predominantly associated with secondary syphilis, and therefore, the patient may have a history of a painless genital or anal ulcer or a maculopapular rash. If suspected, the patient should be referred to a sexual health specialist for systemic assessment (HIV status should also be established) in addition to an ophthalmologist for management of uveitis.

Bacterial endophthalmitis

Bacterial endophthalmitis is a sight-threatening bacterial infection of the vitreous or aqueous humour of the eye and is an ophthalmic emergency. It is most commonly caused by exogenous contamination from surgery (most commonly Staphylococcus epidermidis when acute) or trauma to the eye. Spread from endogenous sources is less common and the risk factors are largely the same as fungal sources.

Symptoms may include pain, blurry vision and redness of the eye. Slit lamp examination may reveal a hazy cornea, chemosis, hypopyon and it may be difficult to visualise the fundus due to vitritis. Roth spots are retinal haemorrhages with white centres, and if present may indicate infective endocarditis as a potential source. Vitreous sampling for identification of the pathogen is helpful, and immediate intravitreal antibiotics are required in addition to treatment of systemic infection where present.