WHAT IS UVEITIS ?
The eye can be divided into different layers:
- The outside of the eye is called the sclera, and it is covered by a transparent tissue called the conjunctiva. The sclera is the white part of the eye that you can see.
- The middle part of the eye is called the uvea. The uvea is made up of the iris (the colored part of the eye that you can see), ciliary body, and choroid layer of blood vessels.
- The inner layer of the eye is the retina. The retina can only be seen by your doctor after your eye is dilated.
Technically, uveitis is inflammation of the uvea, the middle part of the eye. However, uveitis is used as a general term to describe inflammation occurring in any part of the eye, including in the vitreous (the clear, jelly-like substance that fills the middle of the eye between the lens and the retina), optic nerve, and retina.
SYMPTOMS OF UVEITIS
Depending on the severity and type of uveitis, the patient may experience varying degrees of some or all of the following symptoms:
- Eye pain
- Redness of the white part of the eye
- Blurry vision
- Floaters or spots in the vision
- Light sensitivity
TYPES OF UVEITIS
Uveitis is generally divided into three types:
- Anterior uveitis (front of the eye): This is the most common type of uveitis and results from inflammation of the iris and/or ciliary body. Most patients with this type of uveitis experience the classic symptoms of eye discomfort, eye redness, and light sensitivity.
- Intermediate uveitis (middle part of the eye): This type of uveitis results from inflammation of the vitreous. It is generally painless, and the eye does not always look red on exam. The most common symptom is floaters.
- Posterior uveitis (back part of the eye): This results from inflammation of the retina and choroid. It is the least common type of uveitis but generally the most severe. Symptoms vary, but vision loss is common.
There is also a type called pan-uveitis which affects the entire eye and is typically a very severe form of uveitis.
CAUSES OF UVEITIS
There are several causes of uveitis, including inflammatory/autoimmune conditions, infections, trauma, and even cancer. The location of the uveitis, whether it affects one or both eyes, and how long it has been present can all be clues as to what may cause it. However, in some cases, especially in anterior uveitis, we may not be able to determine the cause of the inflammation.
The following lists a few conditions that may be associated with uveitis:
- Idiopathic (unknown cause)
- Ankylosing Spondylitis
- Acute Retinal Necrosis
- Birdshot Chorioretinopathy
- Candidiasis
- Cytomegalovirus
- Endophthalmitis
- Herpes Simplex/Zoster
- Inflammatory Bowel Disease
- Intermediate Uveitis/Pars Planitis
- Leukemia
- Lupus
- Lyme Disease
- Lymphoma
- Multiple Sclerosis
- Reactive arthritis
- Rheumatoid Arthritis
- Sarcoidosis
- Syphilis
- Toxocariasis
- Toxoplasmosis
- Tuberculosis
- Vogt-Koyanagi Harada Syndrome
DIAGNOSIS
Dr Pritam Dedhia will take a detailed history and perform a complete dilated eye exam. Additional testing, such as OCT and fluorescein angiography may also be done. Depending on what your doctor finds on examination, laboratory testing may also be ordered to help determine the cause of the uveitis.
TREATMENT AND PROGNOSIS
Any underlying conditions associated with the uveitis should be evaluated and treated appropriately. The inflammation from the uveitis may cause a wide range of complications, including eye pain, scar tissue formation, high eye pressure (glaucoma), and swelling in the retina (macular edema). Treatments are aimed at reducing or eliminating these complications.
Steroids, usually in the form of eye drops or injections in or around the eye, are commonly used to combat inflammation. In some cases, steroids may need to be surgically implanted in the eye or given orally. Eye drops that dilate the eye may also be used to alleviate pain and reduce scarring in the front of the eye. In advanced or refractory cases, such as posterior uveitis, patients may also need to begin long-term treatment with immunosuppressive medications. In these instances, your retina specialist will work closely with a rheumatologist to determine the best treatment while minimizing any side effects from the medication.
