Uveitis

Uveitis is inflammation of the uvea

What is uvea?

The term “uveitis” technically means inflammation of the uvea. However, uveitis is not limited to the uvea.

Inflammation of other structures of the eye

These diseases also affect the lens, retina, optic nerve, and vitreous, producing reduced vision or blindness.

Causes

Uveitis may be caused by problems or diseases occurring in the eye or it can be part of a systemic inflammatory disease affecting other parts of the body.

Demographics

It can happen at all ages and primarily affects people between 20-60 years old.

Trigeminal herpes uveitis and keratitis

Types

Uveitis can last for a short (acute) or a long (chronic) time.

The severest forms of uveitis reoccur many times.

• Anterior uveitis
• Intermediate uveitis
• Posterior uveitis
• Panuveitis uveitis

Pathophysiology

Inflammation is the body’s natural response to tissue damage, germs, or toxins. It produces swelling, redness, heat, and destroys tissues as certain white blood cells rush to the affected part of the body to contain or eliminate the insult.

Uveitis may be caused by:

• An attack from the body’s own immune system (autoimmunity)
• Infections or tumors occurring within the eye or in other parts of the body
• Bruises to the eye
• Toxins that may penetrate the eye
• The disease will cause symptoms, such as decreased vision, pain, light sensitivity, and increased floaters. In many cases the cause is unknown.

Diseases causing uveitis

Uveitis can be associated with many diseases including: Behçet disease, Crohn's disease, rheumatoid arthritis, Fuchs heterochromic iridocyclitis, Granulomatosis with polyangiitis, HLA-B27 related uveitis, Juvenile idiopathic arthritis, Sarcoidosis, Spondyloarthritis, Sympathetic ophthalmia, Tubulointerstitial nephritis and uveitis syndrome, brucellosis, herpesviruses, leptospirosis, Lyme disease, presumed ocular histoplasmosis syndrome, syphilis, toxocariasis, toxoplasmic chorioretinitis, tuberculosis, Zika fever, AIDS etc.

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Recurrent-anterior-uveitis-with-quiescent-disease

Symptoms

Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include:

• Blurred vision
• Dark, floating spots in the vision (floaters)
• Eye pain
• Redness of the eye
• Sensitivity to light (photophobia)

Diagnosis

Diagnosis of uveitis includes a thorough examination and the recording of the patient’s complete medical history.

Labs

Laboratory tests may be done to rule out an infection or an autoimmune disorder.

CNS exam

A central nervous system evaluation will often be performed on patients with a subgroup of intermediate uveitis, called pars planitis, to determine whether they have multiple sclerosis which is often associated with pars planitis.

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Photograph showed non-granulomatous anterior-uveitis with nuclear cataract and ciliary injection

The eye exams used include:

• An eye chart or visual acuity test.
• A funduscopic exam.
• Ocular pressure.
• A slit lamp exam.

Treatments

Uveitis treatments primarily try to eliminate inflammation, alleviate pain, prevent further tissue damage, and restore any loss of vision. Treatments depend on the type of uveitis a patient displays.

Steroids

• An eye care professional will usually prescribe steroidal anti-inflammatory medications.

• Long-term steroid use may produce side effects such as stomach ulcers, osteoporosis (bone thinning), diabetes, cataracts, glaucoma, cardiovascular disease, weight gain, fluid retention, and Cushing’s syndrome.
• Other immunosuppressive agents that are commonly used include medications such as methotrexate, mycophenolate, azathioprine, and cyclosporine.

Eye exam

• These treatments require regular blood tests to monitor for possible side effects.

Biologic response modifiers

Biologic response modifiers (BRM), or biologics, such as, adalimumab, infliximab, daclizumab, abatacept, and rituximab are used. These drugs target specific elements of the immune system. Some of these drugs may increase the risk of having cancer.

Anterior uveitis treatments

Anterior uveitis may be treated by:

• Taking eye drops that dilate the pupil to prevent muscle spasms in the iris and ciliary body (see diagram)
• Taking eye drops containing steroids, such as prednisone, to reduce inflammation
• Intermediate, posterior, and panuveitis treatments
• Intermediate, posterior, and panuveitis are often treated with injections around the eye, medications given by mouth, or, in some instances, time-release capsules that are surgically implanted inside the eye.
• Other immunosuppressive agents may be given. A doctor must make sure a patient is not fighting an infection before proceeding with these therapies.

Uveitis Resources
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