A 28-year-old woman with a history of sarcoidosis presents with chronic posterior uveitis. Which of the following is NOT a typical finding in posterior uveitis?

Explanation

## Posterior Uveitis: Clinical and Pathological Features **Key Point:** Posterior uveitis involves the choroid, retina, and vitreous. The inflammation is located behind the lens-iris diaphragm, resulting in a distinct clinical picture from anterior uveitis. ### Typical Findings in Posterior Uveitis | Finding | Presence in Posterior Uveitis | Explanation | |---------|-------------------------------|-------------| | **Vitritis** | Yes (prominent) | Snowball opacities, snowbanking, haze | | **Floaters** | Yes (common) | Due to vitreous inflammation and cellular infiltration | | **Photopsia** | Yes (common) | Retinal irritation and inflammation | | **Keratic precipitates** | Minimal/absent | Inflammation is posterior; corneal endothelium not involved | | **Ciliary injection** | Minimal/absent | Ciliary body not primarily inflamed | | **Photophobia** | Absent or minimal | Iris and ciliary body not primarily affected | | **Retinal vasculitis** | Yes (variable) | Cotton-wool spots, hemorrhages, vascular sheathing | | **Choroidal inflammation** | Yes | Focal or diffuse choroiditis | **High-Yield:** Keratic precipitates are a **signature finding of anterior uveitis**, not posterior uveitis. Their presence in a patient with suspected posterior uveitis should prompt investigation for concurrent anterior involvement (panuveitis) or misdiagnosis. ### Clinical Presentation of Posterior Uveitis 1. **Floaters and photopsia** — Patient's primary complaint; due to vitreous inflammation and retinal irritation. 2. **Minimal eye redness** — Unlike anterior uveitis, the anterior segment appears relatively quiet. 3. **Visual field defects** — May occur with retinal or choroidal involvement. 4. **Snowball opacities and snowbanking** — Pathognomonic vitreous findings, especially in pars planitis. 5. **Retinal vasculitis** — Sheathing of vessels, cotton-wool spots, retinal hemorrhages, and exudates. **Clinical Pearl:** In posterior uveitis, the fundus examination is more informative than anterior segment examination. Look for vitritis haze, snowball opacities, choroidal infiltrates, and retinal vasculitis. The anterior segment may appear completely normal. **Mnemonic: FLOPPY** — **F**loaters, **L**ess eye redness, **O**paque vitreous (snowball), **P**hotopsia, **P**osterior findings (retinitis, choroiditis), **Y**ellow spots (exudates). **Warning:** Do not mistake keratic precipitates in the setting of posterior uveitis as a typical finding — their presence suggests panuveitis or anterior involvement.