Intermediate Uveitis and Pars Planitis

Last updated: November 2026

Intermediate uveitis is inflammation centred on the vitreous and peripheral retina. It affects children and young adults, often both eyes, and threatens vision mainly through cystoid macular oedema.

Features

Floaters and blurred vision in a white, quiet eye; few anterior chamber cells.
Vitreous cells and snowballs (inflammatory aggregates) inferiorly; snowbanking (white exudate over the inferior pars plana) defines pars planitis.
Peripheral periphlebitis; cystoid macular oedema (the main cause of visual loss); cataract, glaucoma, vitreous haemorrhage and retinal detachment.

Associations and work-up

Association	Tests
Multiple sclerosis (HLA-DR15)	MRI brain if neurological symptoms or before anti-TNF drugs
Sarcoidosis	ACE, lysozyme, chest X-ray or CT
Tuberculosis	IGRA or Mantoux, chest imaging (important in India)
Syphilis	Serology in every case
Lyme, toxocara, lymphoma (older patients)	As indicated

Pars planitis is the name used when no systemic cause is found.

Treatment

Step	Treatment
Observation	Mild floaters with good vision and no macular oedema
Local steroids	Posterior sub-Tenon triamcinolone, intravitreal dexamethasone implant (or fluocinolone in chronic disease) for unilateral disease or CMO
Systemic	Oral steroids, then steroid-sparing immunosuppressants (methotrexate, mycophenolate) or adalimumab for bilateral or resistant disease
Laser or cryotherapy	To peripheral neovascularisation or snowbanks in selected cases
Vitrectomy	Non-clearing haemorrhage, dense opacities, retinal detachment, diagnostic uncertainty

Where residents slip

Missing macular oedema: get an OCT at every visit.
Starting anti-TNF therapy without excluding demyelination and TB.
Forgetting syphilis serology.

Test yourself: flip cards

Key sources

Standardization of Uveitis Nomenclature (SUN) Working Group. Classification criteria for pars planitis. Am J Ophthalmol. 2021;228:268-274
Babu BM, Rathinam SR. Intermediate uveitis. Indian J Ophthalmol. 2010;58:21-27

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Written by Dr. Dhaval Patel, MD (Ophthalmology, AIIMS New Delhi)

Consultant, Cataract & Refractive Surgery — among a small number of AIIMS-trained ophthalmologists practicing in Gujarat. Read full credentials & experience or view his 28 publications on ResearchGate.

📚 Also the author of OKAT Decoded and other high-yield ophthalmology exam-prep books used by residents and PG aspirants.

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