Posterior Uveal Effusion

globe anatomy
anatomy of the eye (click on image to enlarge)

What is posterior uveal effusion syndrome (PUES)?

PUES is an abnormal leakage of clear fluid under the retina, which causes symptoms of blurred vision, sometimes with distortion of straight lines. It is also call the peripapillary pachychoroid syndrome. This condition frequently presents as central serous retinopathy. The retina is a thin layer of delicate tissue in the back of your eye, which lines the inside wall like the film in a camera. The retina “takes the picture” of objects you look at and sends the message to the brain.

What causes PUES?

PUES appears to be due to an abnormal leakage of serum (clear fluid) from blood vessels in the choroid. The choroid is a layer of tissue with many blood vessels lying under the retina. When the choroid is thick, it may abnormally leak fluid into the retina (Figure A-D) causing visual symptoms. Thick choroid is seen more commonly in far-sighted eyes than near-sighted eyes.

PUES
Thickened choroid leads to leakage of fluid into the retina

What is the treatment of PUES?

If the leakage is mild, observation may be all that is needed. If symptoms of blurred vision become significant, treatment may include eye drops or pills taken by mouth (Figure E-F). In rare cases, laser treatment or surgery in the operating room may be required to control the leakage. An attempt is made to eliminate aggravating factors such as ocular inflammation and, rarely, medications.

What will happen to my vision?

With prompt treatment the vision usually remains stable. In some cases, there may be a degree of permanent damage to the retina affecting the vision from past leakage that cannot heal. Treatment needs to be continued as a return of leakage may occur is medications is stopped (Figure G-H).

For more information see: Isolated Posterior Uveal Effusion: expanding the spectrum of the uveal effusion syndrome.

By Scott E. Pautler, MD

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