Choroidopathy a is noninflammatory degeneration of the choroid. The choroid is the dark blue vascular layer of the eye, and it is part of the uveal tract.

Uveitis is an inflammation of any component of the uveal tract of the eye, which consists of the iris, ciliary body, and choroid. Uveitis is classified anatomically as anterior, intermediate, posterior, or diffuse.

Iritis is an inflammation of the iris which is a part of the uveal tract. The iris refers to the colored, annular membrane which is immediately in front of the lens and suspended behind the cornea. Anterior uveitis includes the condition of iritis.

Cyclitis refers to an inflamed ciliary body of the eye. The alternate term for this condition is intermediate uveitis or pars planitis.

Choroiditis is an inflammation of the choroid, and is also known as posterior uveitis.

The following causes relate to the anatomical classifications of uveitis:

• Anterior uveitis which has several causes including: ankylosing spondylitis; toxoplasmosis (combined with posterior uveitis); herpes zoster and herpes simplex; syphilis (see diagnostic code: 6310 syphilis); sarcoidosis; or penetrating trauma.

• Intermediate uveitis (also called pars planitis) which may have an idiopathic cause, or be related to ingestion of Toxocara canis larva; syphilis; sarcoidosis; or penetrating trauma.

• Posterior uveitis which may be due to toxoplasmosis; cytomegalovirus; histoplasmosis; syphilis; sarcoidosis; or penetrating trauma.

• Diffuse uveitis which may be caused by Toxocara canis; syphilis; or infection.

The following causes relate to the anatomical classifications of iritis:

• The cause of iritis is unknown. There may be a connection with hypersensitivity in non-granulomatous iritis. In addition, autoimmune disorders, certain infections, trauma, and some malignancies are causes of anterior uveitis (iritis).

The following causes relate to the anatomical classifications of cyclitis:

• The cause may be unknown or it may be secondary to some systemic diseases such as, syphilis (see diagnostic code: 6310 syphilis), sarcoidosis or toxocariasis.

The following causes relate to the anatomical classifications of choroiditis:

• Posterior uveitis may be due to toxoplasmosis, cytomegalovirus, histoplasmosis, syphilis, sarcoidosis, or penetrating trauma.

The following listings of signs and symptoms relate to the anatomical classification of uveitis:

• Anterior uveitis typically presents with pain, redness, photophobia, and limited vision. The iris is the area involved in anterior uveitis. Men are more affected than women if the condition is anterior uveitis caused by ankylosing spondylitis.

• Intermediate uveitis usually presents with floaters, decreased vision, and lack of pain. The ciliary body and pars planitis are the areas involved in the condition.

• Posterior uveitis presents the symptoms of intermediate uveitis, including floaters and decreased vision. The choroid is the area involved in the condition. Additionally, lesions in the retina, retinal detachment, and optic nerve edema are possible signs that may occur.

• Diffuse uveitis may present with any or all of the aforementioned signs and symptoms.

The following listings of signs and symptoms relate to the anatomical classification of iritis:

• There may be complaints of pain and photophobia. In addition, there may be blurring of vision; a red eye; a small, irregular pupil; and usually no purulent discharge. There are two types of inflammation; granulomatous and non-granulomatous. The iris is usually involved in the non-granulomatous type.

The following listings of signs and symptoms relate to the anatomical classification of cyclitis:

• Signs and symptoms include: reduced vision, pain, photophobia and floaters.

The following listings of signs and symptoms relate to the anatomical classification of choroiditis:

• Posterior uveitis may result in floaters and decreased vision, lesions in the retina, retinal detachment, and optic nerve edema.

Laboratory tests for any common, underlying systemic disease are performed. In addition, vitreous biopsy and cultures; skin testing and chest x-ray for histoplasmosis (see diagnostic code: 6834 histoplasmosis); and blood testing for syphilis (VDRL) (see diagnostic code: 6310 syphilis) may be done depending on the underlying etiology.

Anterior uveitis (iritis) does not usually require extensive laboratory investigations. Follow-up testing related to underlying diseases may be needed (see diagnostic code: 6000 choroidopathy, including uveitis, iritis, cyclitis, and choroiditis).

Laboratory testing may be performed for underlying systemic diseases. Ocular infections may be cultured for organisms.

Depending on the underlying etiology, the following laboratory tests may be done: vitreous biopsy and cultures; skin testing and chest x-ray for histoplasmosis (see diagnostic code: 6834 histoplasmosis); and blood testing for syphilis (VDRL) (see diagnostic code: 6310 syphilis).

Treatment varies, and is based on the underlying cause. However, local and systemic corticosteroids; cycloplegics; cryotherapy; vitrectomy; antiviral therapy; specific syphilis (see diagnostic code: 6310 syphilis) treatments; and broad spectrum systemic antibiotics for severe infections may be used.

Symptomatic relief with analgesics for pain and dark glasses for photophobia are helpful. The pupil needs to be kept dilated with cycloplegic drops. Local steroid eye drops help reduce the inflammation.

Treatment usually involves administration of a mydriatic to keep the pupil dilated as well as other medications. Systemic treatment will be aimed at the underlying disease as well as relieving any pain with analgesics. If intermediate uveitis, is severe or chronic, cryotherapy or vitrectomy may be required.

Treatment varies, and is based on the underlying cause. However, local and systemic corticosteroids; cycloplegics; cryotherapy; vitrectomy; antiviral therapy; specific syphilitic (see diagnostic code: 6310 syphilis) treatments; and broad spectrum systemic antibiotics for severe infections may be used.

The complications from uveitis may result in profound and irreversible loss of vision. Early and appropriate treatment is essential. The frequent complications include: cataract, retinal detachment, macular edema, and glaucoma.

Often, glaucoma is a common complication, as well as cataract formation. A non-granulomatous uveitis (iritis) attack lasts from days to a few weeks, and recurrences are common.

Complications include: glaucoma; iritis (see diagnostic code: 6000 choroidopathy, including uveitis, iritis, cyclitis, and choroiditis), and scleritis (see diagnostic code: 6002 scleritis).

The complications from posterior uveitis may cause profound and irreversible loss of vision. Early and appropriate treatment is essential. The frequent complications include: cataract, retinal detachment, macular or optic nerve edema, and glaucoma.

• Consider entitlement to Auto and auto adaptive equipment under 38 CFR 3.308 if there is permanent impairment of vision in both eyes consisting of central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20° in the better eye.

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• Review for potential entitlement to special monthly compensation under 38 CFR 3.350 when there is loss/loss of use of one or both eyes, light perception only; visual acuity 5/200 or less; the vision field is reduced to 5 degree concentric contraction in both eyes; or blindness with no light perception in one or both eyes.

• Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation.

• For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.

• Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions.

• For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75, 38 CFR 4.76, 38 CFR 4.77, 38 CFR 4.78,  and  38 CFR 4.79, diagnostic codes 6061-6091.