Uveal effusion: An anatomy-based and mechanism-based framework for diagnosis and management.

Abstract

Uveal effusion represents a heterogeneous clinical manifestation of disrupted uveal fluid homeostasis rather than a discrete disease entity. Despite long-standing recognition, its diagnosis and management remain challenging because the effusion reflects the interplay among vascular permeability, venous outflow resistance, scleral permeability, and intraocular pressure, rather than inflammation or retinal pathology alone. We integrate anatomical and physiological principles, clarifies terminology and classification, and proposes a mechanism-based framework for understanding uveal effusion. Advances in multimodal imaging, including ultrasound biomicroscopy, anterior segment optical coherence tomography (OCT), enhanced-depth imaging OCT, and ultrawide-field angiography, have transformed evaluation by enabling early detection, compartmental localization, and identification of dominant mechanistic drivers. Particular emphasis is placed on conditions in which uveal effusion is notably absent despite marked choroidal inflammation or hyperpermeability, highlighting the critical role of permissive factors such as hypotony, venous congestion, and impaired transscleral outflow. An imaging-driven, algorithmic clinical approach is presented to guide diagnosis and management, emphasizing targeted therapy aligned with the underlying mechanism. By reframing uveal effusion as a dynamic, mechanism-dependent process, this review seeks to reduce diagnostic ambiguity, avoid inappropriate empirical treatment, and promote individualized, physiology-based care. Emerging directions in quantitative imaging and mechanism-based research are also discussed.