Definition

Uveitis refers to inflammation within the uvea, the middle layer of the eye, encompassing the iris, choroid, and ciliary body. The uvea is situated between the sclera and the retina, and it plays a crucial role due to its extensive network of blood vessels that nourish various ocular structures. When inflammation occurs in this area, symptoms often include pronounced redness, pain, and impaired vision.

This condition predominantly affects individuals aged 20-50 years and can significantly impact visual acuity. Some cases of uveitis can be chronic and lead to complications such as cataracts, glaucoma, and even permanent blindness. Approximately 10% of blindness cases originate from uveitis.

Uveitis is classified based on the site of inflammation. They are anterior uveitis (iris inflammation), intermediate uveitis (inflammation in the area between iris and choroid), posterior uveitis (choroid inflammation), and panuveitis (inflammation of the entire uveal tract). Additionally, the condition is considered acute if symptoms resolve within three months or chronic if they persist beyond this period.

Causes

Approximately half of all uveitis cases arise without discernible causes, even in otherwise healthy individuals. However, a significant proportion is associated with immune system disorders, particularly autoimmune diseases. Autoimmune conditions linked to uveitis include:

• Psoriasis, which causes skin inflammation.
• Rheumatoid arthritis, leading to joint inflammation.
• Ankylosing spondylitis, affecting the spinal joints.
• Sarcoidosis, which causes inflammation in multiple body parts such as the lungs, lymph nodes, eyes, and skin.
• Kawasaki disease, is characterized by inflammation of blood vessel walls.
• Ulcerative colitis, is an autoimmune condition leading to colon inflammation.
• Crohn's disease, causing inflammation throughout the digestive tract.

Other than autoimmune diseases, infections can also precipitate uveitis, with potential pathogens including the varicella-zoster virus, herpes simplex virus, bacteria of tuberculosis and syphilis. Non-infectious causes, such as ocular trauma, prior eye surgery, intraocular malignancies, and exposure to toxins, can also contribute to uveitis development.

Risk Factor

Certain genetic predispositions can increase susceptibility to uveitis, as can the presence of autoimmune diseases and a history of ocular surgery. Despite this, the precise etiology of uveitis often remains unidentified.

Other risk factors include smoking and being over the age of 60, both of which can increase the risk of severe uveitis. Age, in particular, also influences the likelihood of experiencing complications from the condition.

Symptoms

Uveitis can appear suddenly or develop gradually. Symptoms that can arise include:

• Red eyes
• The eyes feel pain
• Escaped vision
• Sensitive to light
• Black spots appear or floaters in the eyes
• A sharp decline in vision

Diagnosis

Diagnosis of uveitis begins with a thorough review of medical history and symptoms, followed by a detailed ocular examination to confirm the diagnosis. Additional diagnostic tests may be conducted for more precise evaluation. In cases of acute uveitis with mild to moderate symptoms and no other accompanying diseases or systemic illnesses, such as Fuchs Uveitis Syndrome (FUS) or sarcoidosis, other diagnostic tests are generally unnecessary.

Diagnostic procedures may include:

• Assessment of visual acuity
• Intraocular pressure measurement using tonometry
• Examination of ocular structures using a slit lamp
• Fundoscopic examination to inspect the interior of the eye
• Blood tests
• Ocular imaging to assess thickness and detect inflammatory cells within the eye

CT scans or MRIs are reserved for cases where there are indications of underlying conditions contributing to uveitis.

Management

The primary objective of treating uveitis is to alleviate inflammation within the eye. Treatment typically involves pharmacological interventions or surgical procedures.

Pharmacological treatments for uveitis may include:

1. Corticosteroids: These medications effectively reduce inflammation.
2. Antibiotics or antivirals: Prescribed based on the specific infectious cause of uveitis, requiring regular consumption as directed by the doctor.
3. Immunosuppressive medicines: Administered if uveitis affects both eyes or does not respond adequately to corticosteroids. Close monitoring is essential to manage potential side effects, and usage is strictly according to medical guidance.

In cases where symptoms persist despite medication, surgical options may be recommended by the doctor. One such procedure is vitrectomy, which involves removing fluid from the interior of the eye (vitreous fluid). Another surgical intervention involves implanting a drug-delivery device designed to slowly release corticosteroids into the eye over 2-3 years. The choice and duration of treatment for uveitis depend on the severity and specific characteristics of the condition.

Complications

Untreated uveitis can lead to several complications, such as:

• Cataracts
• Glaucoma
• Retinal detachment, involving separation of the retina from its vascular layers that provide nutritions and oxygens to eyes
• Swelling of the retina
• Adhesion of the iris to the lens (synechiae) due to inflammation

Prevention

Preventing uveitis is challenging since most cases have unknown causes. However, early and appropriate detection and treatment can promptly mitigate potential complications, thereby reducing the risk of permanent vision loss.

When to see a doctor?

Individuals experiencing symptoms suggestive of uveitis should promptly consult an ophthalmologist, especially if they have underlying conditions such as autoimmune disorders that may precipitate uveitis.

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