Uveitis (Inflammation of the Eye)
In common usage, uveitis refers to inflammation anywhere in the eye, from the anterior segment, or the front of the eye, to the back of the eye including the vitreous gel, the retina, and the choroid. A more strict definition of uveitis involves all inflammatory processes of the middle layers of the eye, also called the uveal tract or uvea.
The uvea includes the iris (colored part of the eye), choroid (a thin membrane containing many blood vessels) and ciliary body (the part of the eye that joins these together).
The uvea is very important because its many veins and arteries transport blood, elements, and inflammatory cells to the parts of the eye that are critical for vision.
What Are the Symptoms of Uveitis?
Symptoms of uveitis may include:
- Eye redness and irritation.
- Blurred vision.
- Eye pain or soreness.
- Increased sensitivity to light.
- Floating spots before the eyes.
- Flashing lights.
Uveitis may develop rapidly over a long period of time. Left untreated, uveitis may permanently damage occular structures critical to your vision.
What Causes Uveitis?
Uveitis has many potential causes, including infection with a virus, fungus, bacteria or parasite, inflammatory disease affecting the eye only or as a manifestation of a systematic disease involving other parts of the body, injury to the eye, or, rarely, due to malignancy.
There are three types of uveitis:
- Anterior Uveitis is the most common form of uveitis. It affects the iris and ciliary body and may be associated with autoimmune disorders such as various types of arthritis. Iritis may develop suddenly and may last up to eight weeks, even with treatment, or may have a chronic course, requiring prolonged treatment.
- Intermediate uveitis is an inflammation of the middle portion of the eye, the vitreous gel, and retina. This may develop suddenly and last several months, or have a chronic, indolent course.
- Posterior uveitis affects the back of the eye and involves the retina, choroid, or both. It may be rapidly progressive, making it difficult to treat. Retinitis may be caused by viruses such as shingles or herpes simplex virus and bacterial infections such as syphilis or toxoplasmosis. Choroiditis is an inflammation of the layer beneath the retina. It may also be caused by an infection such as tuberculosis. Retinitis and choroiditis can also be caused by an autoimmune disease. In a large number of cases, the cause of uveitis is not known.
How is Uveitis Diagnosed?
After performing a careful medical and ocular history, review of systems and an examination of your eyes, laboratory tests, including blood work or X rays, may be ordered to confirm the diagnosis or exclude important infections or neoplastic processes. Sometimes, surgery to obtain an intraocular biopsy or sample of ocular fluid is necessary to establish the diagnosis.
Uveitis may have an underlying cause elsewhere in your body, and your ophthalmologist may want to talk with your primary care doctor or another medical specialist to evaluate your overall medical health.
How Is Uveitis Treated?
Because uveitis is potentially vision threatening, treatment needs to begin right away if inflammation is active. For uveitis not caused by an infection, steroids are the first line of treatment. Steroids may be administered topically (drops), injected around or into the eye, or delivered systematically (pills) depending on the severity and location of the inflammation. Non-steroidal anti-inflammatory drugs, or immunomodulating agents, are administered as first line therapy for certain diseases that are vision or life threatening, and as a part of a steroid sparing strategy for patients who do not respond or tolerate systematic steroids, develop unacceptable side effects, or in whom extended inflammatory therapy is anticipated. Antibiotics are used in patients with infectious uveitis. Dark glasses and cycloplegic drops (dilating) will help with light sensitivity.
Complications of uveitis may include glaucoma, cataracts, abnormal growth of blood vessels in the eyes that interfere with vision, fluid within the retina (edema), retinal detachment, membrane formation anywhere in the eye, low pressure, all of which may result in vision loss.