Uveitis

Description

Uveitis is a form of inflammation of the eyes. It affects the middle layer of tissue in the eye wall (uvea).

Uveitis (u-v-I-tis) warning signs often come on suddenly and get worse quickly. They include redness, pain and blurred vision. The condition can affect one or both eyes, and can affect people of all ages, even children.

Possible causes of uveitis are infection, injury, or an autoimmune or inflammatory disease. Many times a cause can't be identified.

Uveitis can be serious, leading to permanent loss of vision. The early diagnosis and treatment are important to prevent complications and preserve your vision.

Symptoms

The signs, symptoms, and characteristics of uveitis may include:

  • Redness of the eyes.
  • Pain in the eyes.
  • Sensitivity to light.
  • Blurred vision.
  • Dark, floating spots in your field of vision (floaters).
  • Decreased vision.

The symptoms can occur suddenly and get worse quickly, although in some cases, develop gradually. It can affect one or both eyes. Sometimes there are no symptoms and signs of uveitis are seen in a routine eye exam.

The uvea is the middle layer of tissue in the wall of the eye. It consists of the iris, the ciliary body and the choroid. When you look at your eye in the mirror, you will see the white part of the eye (sclera) and the colored part of the eye (iris).

The iris is located on the inside of the front part of the eye. The ciliary body is a structure behind the iris. The choroid is a layer of blood vessels between the retina and the sclera. The retina lines the inside of the back of the eye, such as the wallpaper. The inside of the back of the eye is filled with a liquid gel called vitreous humor.

The type of uveitis you have depends on which part or parts of the eye are inflamed:

  • Anterior uveitis affects the inside of the front part of the eye (between the cornea and the iris and the ciliary body. It is also called iritis and is the most common type of uveitis.
  • Uveitis intermediate affects the retina and the blood vessels behind the lens (pars plana), as well as the gel in the center of the eye (vitreous humor).
  • Posterior uveitis affects a layer on the inside of the back of the eye, the retina and the choroid.
  • Panuveitis occurs when all layers of the uvea is inflamed, from the front to the back of the eye.

When to seek medical advice

Contact your doctor if you think you have the warning signs of uveitis. He or she may refer you to an eye specialist (ophthalmologist). If you are having significant pain of the eyes, and the unexpected vision issues, seek medical attention immediately.

Causes

In approximately half of all cases, the specific cause of uveitis is not clear, and the disorder can be considered as an autoimmune disease affecting only the eye or eyes. If a cause can be determined, it may be one of the following:

  • An autoimmune or inflammatory disease affecting other parts of the body, such as sarcoidosis, lupus erythematosus, or Crohn's disease.
  • Ankylosing spondylitis, a type of inflammatory disease that can cause some of the bones in the spine to fuse, leading to back pain. Uveitis is one of the most common complications of ankylosing spondylitis.
  • An infection, such as cat-scratch disease, herpes zoster, syphilis, toxoplasmosis, and tuberculosis.
  • A side effect of the drug.
  • Eye injury or surgery.
  • Very rarely, a cancer that affects the eyes, such as lymphoma.

Risk factors

People with the changes in certain genes may be more likely to develop uveitis. Cigarette smoking has been associated with more difficult to control the uveitis.

Complications

Left untreated, uveitis can cause complications, including:

  • Inflammation of the retina (macular edema).
  • The fibrosis of the retina.
  • Glaucoma.
  • The falls.
  • Damage to the optic nerve.
  • The detachment of the retina.
  • Permanent loss of vision.

Uveitis

Diagnosis

When you visit an eye specialist (ophthalmologist), it is likely to perform a complete eye exam and gather a comprehensive history of the health. The eye exam usually consists of the following:

  • Evaluation of the vision (with glasses if you normally wear) and the response of the pupils to light.
  • Tonometry. A tonometry test measures the pressure inside the eye (intraocular pressure). Numbing eye drops may be used for this test.
  • A slit-lamp examination. A slit lamp is a microscope that enlarges and illuminates the front of the eye with an intense line of light. This assessment is necessary to identify microscopic inflammatory cells in the front part of the eye.
  • Ophthalmoscopy. Also known as the fundus of the eye, this test involves the widening (dilating) the pupils with eye drops and the glare of a bright light into the eye to examine the back of the eye.

Your doctor may also recommend:

  • The Color photo of the inner part of the eye (retina).
  • The optical coherence tomography (OCT) imaging. This test maps of the retina and the choroid to reveal inflammation of the layers.
  • Fluorescein angiography or indocyanine green angiography. These tests require the placement of an intravenous (IV) catheter into a vein in your arm to give a contrast dye. This dye is going to get to the blood vessels in the eyes and allow the photographs of the swollen blood vessels in the interior of the eye.
  • Analysis of aqueous humor or vitreous fluid of the eye.
  • Blood tests.
  • Imaging tests, x-ray, computed tomography (CT) or Magnetic resonance imaging (MRI).

If your ophthalmologist thinks of an underlying condition may be the cause of the uveitis, you may be referred to another doctor for a general medical examination and laboratory tests.

Sometimes, it is difficult to find a specific cause of uveitis. Even if a specific cause is not identified, the uveitis can still be treated successfully. In most cases, the identification of the cause of the uveitis does not lead to a cure. It is still necessary to use some form of treatment to control the inflammation.

Treatment

If the uveitis is caused by an underlying disease, treatment may focus on the specific condition. In general, the treatment of uveitis is the same regardless of the cause, always and when the cause is not infectious. The goal of treatment is to reduce inflammation in the eye, as well as in other parts of the body, if present. In some cases, treatment may be needed for months to years. There are several treatment options.

Drugs

  • Medications that reduce inflammation. Your doctor may prescribe eye drops with anti-inflammatory medication, such as a corticosteroid. Eye drops are not usually sufficient to treat the inflammation beyond the front of the eye, so that an injection of corticosteroids in or around the eyes or steroids (taken by mouth) may be necessary.
  • Drugs that control the spasms. Eye drops that dilate (widen) the pupil may be prescribed to control the spasms in the iris and the ciliary body, which can help to relieve the pain in the eyes.
  • The medications that fight the bacteria or virus. If the uveitis is caused by an infection, the doctor may prescribe antibiotics, antiviral drugs or other medications, with or without corticosteroids, to bring the infection under control.
  • Drugs that affect the immune system or destroy the cells. You may need immunosuppressive drugs, if your uveitis affects both eyes, does not respond well to treatment with corticosteroids or becomes severe enough to threaten the vision.

Some of these medicines can have serious eye-related side effects, such as glaucoma and cataracts. Medicine by mouth or injection can cause side effects in other parts of the body away from the eyes. You must visit your doctor regularly for follow-up exams and blood tests.

Surgical or other procedures

  • The vitrectomy. Surgery to remove part of the vitreous in the eye, is rarely used to diagnose or treat the disease.
  • A drug-releasing implants.For people with difficulty for the treatment of posterior uveitis, a device that is implanted in the eye may be an option. This device slowly releases corticosteroid in the eye for months or years, depending on the implant used. If the people have not had cataract surgery, this treatment usually cause cataracts to develop. In addition, up to 30% of patients require treatment or monitoring for the elevation of eye pressure or glaucoma.

A drug-releasing implants. For people with difficulty for the treatment of posterior uveitis, a device that is implanted in the eye may be an option. This device slowly releases corticosteroid in the eye for months or years, depending on the implant used.

If the people have not had cataract surgery, this treatment usually cause cataracts to develop. In addition, up to 30% of patients require treatment or monitoring for the elevation of eye pressure or glaucoma.

The speed of your recovery depends in part on the type of uveitis you have and the severity of the symptoms. Uveitis affecting the posterior part of the eye (uveitis posterior, or panuveitis, including retinitis or choroiditis) tends to heal more slowly than the uveitis in the front part of the eye (anterior uveitis or iritis). Severe inflammation takes longer to clear up than mild inflammation causes.

Uveitis can go back to. Make an appointment with your doctor if your symptoms come back or get worse.

Preparing for your appointment

Your symptoms may ask you to make an appointment with your primary care physician. You may be referred to a doctor who specializes in disorders of the eyes, called an ophthalmologist.

Here's some information to help you prepare for your appointment and know what to expect from your doctor.

What you can do

  • List of symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • The list of personal information, including any major diseases, trauma or recent life changes.
  • Bring a list of all medications, vitamins or supplements you are taking.
  • Ask a family member or friend to come with you. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot. In addition, someone who comes with you can lead to the appointment, particularly if your symptoms make it difficult to see properly.
  • List of questions to ask your doctor.

Prepare a list of questions can help you cover all the points that are important to you. For uveitis, some basic questions to ask include:

  • What is the most likely cause of my problems in the eyes?
  • What else could be the cause of my symptoms?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • Is it temporary or long-term?
  • I'm going to lose my sight?
  • What treatments are available, and which do you recommend?
  • What types of side effects can I expect from treatment?
  • Is there anything I can do to prevent it from happening again?
  • I have other health conditions. How can I best manage these conditions?
  • Do you have any brochures or other material that could take me home with me?
  • What sites do you recommend?

What to expect from your doctor

Your doctor may ask you a series of questions, such as:

  • When did you first begin experiencing symptoms?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms? Have gotten worse?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Have you ever had uveitis before?
  • Do you have any other medical problems?
  • Do you have arthritis?
  • Do you have back problems?
  • Have you had any recent eruptions on the skin?
  • Have you had any ulcerated sores in the mouth or on the genitals?
  • Has had a recent upper respiratory infection or cold symptoms?
Symptoms and treatment of Uveitis