Uveitis: What you need to know

Uveitis generally refers to a range of conditions that cause inflammation of the middle layer of the eye, the uvea, and tissues around it. It can be painful, the eye or eyes may be red, and there may be cloudy vision.

An eye injury, a viral or bacterial infection and certain underlying diseases can cause uveitis. It can cause eye tissues to swell and cause damage. Untreated, may result in loss of vision. It has the potential to affect one or both eyes.

The term uveitis is used not only to refer to a uvea inflammation but to any portion of the eye’s inside. It’s not just a single illness and it has different causes.

It is the fifth leading cause of vision loss in the United States, and thus has severe social and economic implications.

It affects mainly people aged 20 to 60 years.

Types

Red eye can be a sign of uveitis.
Red eye can be a sign of uveitis.

The uvea collectively consists of the iris, the eye choroid and the ciliary body. The most common type of uveitis is inflammation of the iris, or iritis.

The uvea is also known as the uveal layer, uveal coat, uveal tract, or vascular tunic.

The uvea consists of:

  • The iris, the colored part of the eye that surrounds the pupil
  • The pars plana, one of the layers of the eye
  • The choroid, a thin, vascular middle layer between the white of the eye, or the sclera, and the retina, the light-sensing part at the back of the eye
  • The ciliary body, a ring of muscle behind the iris; this body of tissue connects the iris with the choroid

There are different types of uveitis.

Also known as iritis is anterior uveitis which affects the colored part of the eye, the iris. Iridocyclitis is similar but it does involve ciliary body inflammation.

Intermediate uveitis can be vitritis or pars planitis. Vitritis is an inflammation of the vitreous cavity, which is the jelly-like part of the eye. An inflammation of the plana pars is called planitis pars.

Posterior uveitis is retina and choroidal inflammation. Subsequent refers to the back of the eye.

Pan-uveitis is an inflammation that occurs in all uvea strata.

Symptoms

Signs and symptoms of uveitis may include:

  • General vision problems, including blurred or cloudy vision
  • Floaters, spots in the eye that look like tiny rods or chains of transparent bubbles floating around in the field of vision
  • Eye pain and redness
  • Photophobia, an abnormal sensitivity to light
  • Headaches
  • A small pupil
  • Alteration of the color of the iris

Symptoms can appear on gradually or rapidly.

Causes

The exact cause of uveitis is always uncertain but certain factors make it more likely to happen.

These include:

  • Juvenile arthritispsoriasis and other autoimmune disorders, such as rheumatoid arthritis
  • Inflammatory disorders, such as Crohn’s disease, ulcerative colitis
  • AIDS/HIV and other diseases that weaken the immune system

HIV, brucellosis, herpes simplex, herpes zoster, leptospirosis, Lyme disease, syphilis, toxocariasis, toxoplasmosis, and tuberculosis ( TB) include infections that increase the risk of uveitis.

Uveitis can occur inside the eye as a normal immune response to fight an infection.

Research indicates that the black tattoo ink may be related to uveitis. In some people, skin tattoeing is thought to trigger an immune response that affects both the eyes and the skin.

Diagnosigs

An eye specialist or an ophthalmologist will ask about signs, symptoms and general medical history.

A doctor will look at symptoms and check for underlying conditions.
A doctor will look at symptoms and check for underlying conditions.

Whether the uveitis is due to an infectious process or underlying condition is important to learn.

If the uveitis appears to be underpinned by another disease, the ophthalmologist may refer the patient to a specialist to ensure the disease receives proper treatment.

The ophthalmologist will take a special slit lamp to the eye. When the light hits the inside of the eye, the doctor will be able to determine if that area is clear or foggy.

If the iris involves inflammation, patients can experience some discomfort when the pupil contracts, which is when light hits.

White blood cells and protein in the eye fluid can be seen by microscope if uveitis is present.

The doctor may also order blood tests and x-rays.

Treatment

Usually a patient with uveitis will recover, receiving prompt and appropriate treatment. There’s a risk of cataracts, glaucoma, band keratopathy, retinal edema and permanent loss of vision without treatment.

Antibiotics or antiviral medication will be used if there is an infection.

Corticosteroid medications are often often given as eye drops (prednisolone acetate), pills, or as an injection into the hand. Steroids perform well in the treatment of inflammation. It is important to rule out corneal ulcers before administering corticosteroids by using a florescence dye test.

Immunosuppressants if symptoms are very severe and there is a risk of loss of vision, or if the patient has not responded well to other therapies, may be recommended.

Mydriatic eye drops: like atropine or cyclopentolate, dilate the pupil and help the skin recover. It also helps with pain in the eye and prevents the pupil from sticking to the lens.

Complications

The chances of complications are reduced significantly with prompt and proper treatment and close monitoring. Blurred vision and unusual sensitivity to light, called photophobia, may occur.

If they do occur, they may include:

  • Glaucoma
  • Cataracts
  • Macular edema
  • Scar tissue
  • Retinal detachment, or detached retina
  • Vision loss

Research is underway to determine who is most likely to develop uveitis, the possible causes, and new approaches to treat it.Research is ongoing to find out who is most likely to develop uveitis, the possible causes, and new ways of treating it.

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