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Uvea and Ocular Inflammation

What is Uveitis?

Inflammation or swelling in any of the part of the uveal tract is called uveitis. Depending on the location of inflammation, it is called anterior uveitis (iris and ciliary body is involved), intermediate uveitis (ciliary body and the vitreous is involved), posterior uveitis (choroids and retina involved), panuveitis (all layers of the uveal tract are involved).

What is Uveitis?

Causes of Uveitis are many:

It may result from infection (bacteria like tuberculosis, viruses like herpes, parasites like toxoplasmosis)

It may also be related to an autoimmune disease (with or without the involvement of other parts of the body). This essentially is when our immune system recognizes a part of our own body as foreign and elicits a reaction in the form of uveitis. The uveitis may be the presenting manifestation of an underlying systemic disease.

It can occur as a result of injury to the eye.

It can occur due to causes within the eye like cataract and retinal detachment

Sometimes the cause is not known in the first instance. As we follow-up the patient over a period of time, we may be able to pick up new clues or signs suggestive of systemic disease. In such cases, they are labelled as idiopathic (cause not known) at the initial visit.

What are the Symptoms of Uveitis?

Depending on the structure involved, the symptoms can vary from

Pain

Redness

Inability to see light (photophobia)

Black spots moving in front of the eye

Blurring or reduction in vision

What are the possible risks?

Folks with certain gene combinations and those who smoke seem to be at greater risk.

Some diseases also increase chances, including:

AIDS

Ankylosing spondylitis

Behcet’s disease

CMV retinitis

Histoplasmosis

Kawasaki disease

Multiple sclerosis

Psoriasis

Reactive arthritis

Rheumatoid arthritis

Sarcoidosis

Syphilis

Toxoplasmosis

Ulcerative colitis

Vogt-Koyanagi-Harada disease

How is an Ophthalmic Evaluation Done in a Patient with Uveitis?

An initial examination of the eye will be done. This includes the recording of the visual acuity by reading a chart (to check if the vision has decreased), slit-lamp examination; (in which a narrow beam of light is shone into the eye so that a magnifying lens can closely examine the highlighted portion of the eye). Intraocular pressure recording (a painless test done by a tonometer); fundus examination (in which the pupil is widened so that the ophthalmologist can look into the eye and see structures in the back of the eye).

Because uveitis can be caused by so many different things (infections/autoimmune diseases) diagnosis may require detailed laboratory investigations and a referral to a uveitis specialist.

What Does a Uveitis Specialist Do?

A uveitis specialist is an ophthalmologist with a special, specific interest in uveitis and who has become proficient in the diagnosis and management of patients with uveitis. He or she has received adequate training in the field of uveitis.

A detailed medical history is elicited. As uveitis can occur due to infection or an underlying autoimmune disease, it is necessary to discover and treat these conditions as well. The results obtained in the routine laboratory tests and or imaging will be analyzed by the uveitis specialist. Many times a repeat in serologic testing may be needed. Specialized imaging of the eye and its structures may be required. Specialized blood tests related to the immune system may also be ordered to obtain a diagnosis. Depending on the type of uveitis, a sample of the fluid from the eye may also be sent to obtain a diagnosis by molecular diagnostic techniques. As uveitis may be related to a systemic disease, a cross consultation with a rheumatologist, a pulmonologist or a physician may also be done.

Why is Early Diagnosis of Uveitis Important?

Uveitis is the 3rd leading cause of blindness. Inflammation of the uvea can affect the cornea, retina, sclera and other vital parts of the body. Inflammation inside the eye is a medical emergency because untreated, it will lead to vision loss. Damage to the eye is preventable if detected early and treated adequately.

How is Uveitis Treated?

The treatment of uveitis aims to achieve the following:

Relief of pain and discomfort (when present)

To prevent sight loss due to the disease or its complications

To treat the cause of the disease where possible.

Medical treatment of uveitis must be aggressive to prevent glaucoma, to prevent scarring of the structures inside the eye and to prevent possible blindness.

Different medications are used to control the original cause of uveitis if known and to minimize the inflammation itself. Eye drops especially steroids (to reduce inflammation and pain) and pupil dilators (to widen the pupil and relax the muscles within the eye) are the main medications used to treat uveitis. For deeper inflammations, oral medicines eye injections or intravenous injections of steroids may be necessary. More severe cases of uveitis and those intolerant to steroids may require treatment with immunosuppressive agents. Complications such as glaucoma, cataract or new blood vessel formation (neovascularization) also may need treatment in the course of the disease. If complications are advanced, conventional surgery or laser surgery may be necessary.

What is the Expected Duration of Treatment?

The duration of treatment varies from person to person and also depends on the type and cause of uveitis. Simple forms of uveitis, for example, may respond to treatment within days and may not recur. Chronic (long term, recurring) forms of uveitis that threaten vision can be very difficult to cure and require persistence on the part of the treating physician(s) and patient. The length of time required to get the disease into a durable remission on steroids or immunosuppressants is difficult to quantify and is very individualistic but the minimum of 2 years is a reasonable estimate. With appropriate, targeted treatment, most people with uveitis will become well-controlled and progress to emission. Once in remission from uveitis, you should expect to have regular follow-up visits to our doctor to make sure that the disease remains in remission.

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