Non-Neoplastic Uveitis Masquerade Syndromes: Insights from a Case Series.

PURPOSE: To study the clinical characteristics and implications of non-neoplastic uveitis masquerade syndromes (NNUMS).

METHODS

A retrospective study of 1595 patients referred for evaluation of uveitis at a tertiary referral center in South India between July 2019 and July 2025. The clinical characteristics and outcomes of patients with NNUMS were evaluated.

RESULTS

Eighty eyes of 53 patients (40 males [75.5%], 13 females [24.5%] mean age 40.3 ± 15.7 years) were diagnosed with NNUMS. Forty-four (83%) patients had fundus lesions. Multimodal imaging was crucial in establishing the diagnosis in 46 (86.8%) patients. Retinal vascular diseases (22.6%), inherited retinal diseases (20.8%) and central serous chorioretinopathy (11.3%) were the most common etiological diagnoses. In 13 (24.5%) patients the diagnosis was delayed by more than 100 days. Twenty-seven (50.9%) patients were receiving anti-inflammatory therapy at presentation. The likelihood of unnecessary anti-inflammatory treatment was significantly higher (p < 0.001) in patients with a diagnostic delay >100 days than those without. Thirteen (24.5%) patients had underlying systemic disease, 92% of whom were previously undiagnosed until the ocular diagnosis was made. Retinal vascular involvement was significantly (p < 0.0001) associated with presence of underlying systemic condition.

CONCLUSIONS

NNUMS are a heterogenous group of clinical entities which mimic ocular inflammatory diseases often resulting in misdiagnosis and unnecessary anti-inflammatory treatment. Recognizing the clinical and imaging features of common clinical manifestations is key to accurate diagnosis and reducing visual morbidity.