Uveitis

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

Uveitis warning signs often come on suddenly and get worse quickly. They include eye redness, pain and blurred vision. The condition can affect one or both eyes. It primarily affects people ages 20 to 50, but it may also affect 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 vision loss. Early diagnosis and treatment are important to prevent the complications of uveitis.

Symptoms

The signs, symptoms and characteristics of uveitis include:

• Eye redness
• Eye pain
• Light sensitivity
• Blurred vision
• Dark, floating spots in your field of vision (floaters)
• Decreased vision

Symptoms may occur suddenly and get worse quickly, though in some cases, they develop gradually. They may affect one or both eyes.

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. The choroid is sandwiched between the retina and the sclera. The retina is located at the inside wall of the eye and the sclera is the outer white part of the eye wall. The uvea provides blood flow to the deep layers of the retina. The type of uveitis you have depends on which part or parts of the eye are inflamed:

• Iritis (anterior uveitis) affects the front of your eye and is the most common type.
• Cyclitis (intermediate uveitis) affects the ciliary body.
• Choroiditis and retinitis (posterior uveitis) affect the back of your eye.
• Diffuse uveitis (panuveitis) occurs when all layers of the uvea are inflamed.

In any of these conditions, the jelly-like material in the centre of your eye (vitreous) can become inflamed and infiltrated with inflammatory cells.

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’re having significant eye pain and unexpected vision problems, seek immediate medical attention.

Causes

In about half of all cases, the specific cause of uveitis isn’t clear. If a cause can be determined, it may be one of the following:

• Eye injury or surgery
• An autoimmune disorder, such as sarcoidosis or ankylosing spondylitis
• An inflammatory disorder, such as Crohn’s disease or ulcerative colitis
• An infection, such as cat-scratch disease, herpes zoster, syphilis, toxoplasmosis, tuberculosis, Lyme disease or West Nile virus
• A cancer that affects the eye, such as lymphoma

Risk factors

People with changes in certain genes may be more likely to develop uveitis. In addition, a recent study shows a significant association between uveitis and cigarette smoking.

Complications

Left untreated, uveitis can cause complications, including:

• Glaucoma
• Cataracts
• Optic nerve damage
• Retinal detachment
• Permanent vision loss

Diagnosis

When you visit an eye specialist (ophthalmologist), he or she will likely conduct a complete eye exam and gather a thorough health history. You may also need these tests:

• Blood tests
• Analysis of fluid from the eye
• Photography to evaluate the retinal blood flow (angiography)
• Photography to measure the thickness of the retinal tissue and to determine the presence or absence of fluid in or under the retina.

If the ophthalmologist thinks an underlying condition may be the cause of your uveitis, you may be referred to another doctor for a general medical examination and laboratory tests. Sometimes, it’s difficult to find a specific cause for uveitis. However, your doctor will try to determine whether your uveitis is caused by an infection or another condition.

Treatment

If uveitis is caused by an underlying condition, treatment will focus on that specific condition. The goal of treatment is to reduce the inflammation in your eye. Several treatment options are available.

Medications

• Drugs that reduce inflammation. Your doctor may first prescribe eyedrops with an anti-inflammatory medication, such as a corticosteroid. If those don’t help, a corticosteroid pill or injection may be the next step.
• Drugs that fight bacteria or viruses. If uveitis is caused by an infection, your doctor may prescribe antibiotics, antiviral medications or other medicines, with or without corticosteroids, to bring the infection under control.
• Drugs that affect the immune system or destroy cells. You may need immunosuppressive or cytotoxic drugs if your uveitis affects both eyes, doesn’t respond well to corticosteroids or becomes severe enough to threaten your vision.

Some of these medications can have serious side effects, such as glaucoma and cataracts. You may need to visit your doctor for follow-up examinations and blood tests every 1 to 3 months.

Surgical and other procedures

• Vitrectomy. Surgery to remove some of the vitreous in your eye (vitrectomy) may be necessary to manage the condition.
• Surgery that implants a device into the eye to provide a slow and sustained release of a medication. For people with difficult-to-treat posterior uveitis, a device that’s implanted in the eye may be an option. This device slowly releases corticosteroid medication into the eye for two to three years. Possible side effects of this treatment include cataracts and glaucoma.

The speed of your recovery depends in part on the type of uveitis you have and the severity of your symptoms. Uveitis that affects the back of your eye (choroiditis) tends to heal more slowly than uveitis in the front of the eye (iritis). Severe inflammation takes longer to clear up than mild inflammation does.

Uveitis can come back. Make an appointment with your doctor if any of your symptoms reappear after successful treatment.

Alternative medicine

Some alternative medicine treatments have anti-inflammatory properties, but they haven’t been well-studied for the treatment of uveitis. Let your doctor know if you plan on using any alternative supplements or treatments, because some may interact with treatments you’re receiving or cause adverse reactions.