Uveitis (patient information)
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What is uveitis?
Uveitis specifically refers to inflammation of the uvea. The uvea consists of the iris, ciliary body, and choroid, and it provides most of the blood supply to the retina. Uveitis may occur in either eye or both eyes.
Uveitis may be classified into the following forms, depending on which part of the uvea is primarily affected by the inflammation:
- Anterior uveitis involves inflammation in the front part of the eye. It is the most common form of uveitis, making up 40-70% of all uveitis cases[1]. It is often called iritis because it is usually only effects the iris.
- Intermediate uveitis (also known as cyclitis, pars planitis or vitritis) involves inflammation of the ciliary body, the vitreous humor, and the front end of the retina. This is the least common form of uveitis, constituting 7-15% of cases[2].
- Posterior uveitis (also known as choroiditis if just the choroid is involved, or chorioretinitis if the retina is also involved) affects the back part of the uvea and involves primarily the choroid, a layer of blood vessels and connective tissue in the middle part of the eye. It can also involve inflammation of the retina and optic nerve. It makes up 15-22% of all uveitis cases[3].
What are the symptoms of uveitis?
Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include:
- Blurred vision
- Dark, floating spots in the vision
- Eye pain
- Redness of the eye
- Sensitivity to light (photophobia)
Additionally, the symptoms may vary depending on the form of uveitis:[4]
- Anterior uveitis causes pain, redness, and light sensitivity.
- Intermediate uveitis causes floaters and blurry vision, and it generally leads to chronic inflammation (uveitis that lasts for at least six weeks).
- Posterior uveitis typically causes chronic inflammation that can recur and can last from a few weeks to years.
- Panuveitis causes floaters, blurry vision, and it is more likely to cause vision loss than the other forms.
What are the causes of uveitis?
Uveitis can have many causes, including injury to the eye and exposure to toxic substances such as acid. Uveitis can also be caused by inflammatory diseases, autoimmune disorders such as rheumatoid arthritis or ankylosing spondylitis, or infection. However, in many cases the cause is unknown.
Uveitis can be associated with any of the following:
- AIDS
- Ankylosing spondylitis
- Behcet syndrome
- CMV retinitis
- Herpes zoster infection
- Histoplasmosis
- Injury
- Kawasaki disease
- Psoriasis
- Reactive arthritis
- Rheumatoid arthritis
- Sarcoidosis
- Syphilis
- Toxoplasmosis
- Tuberculosis
- Ulcerative colitis
Additionally, the causes may vary depending on the form of uveitis:
- Anterior uveitis may be associated with autoimmune diseases, but most cases occur in healthy people for unapparent reasons. The disorder may affect only one eye. It is most common in young and middle-aged people.
- Intermediate uveitis usually occurs in young men and is generally not associated with any other disease. In most cases, the cause is unknown[5]. However, some evidence suggests it may be linked to Crohn's disease and possibly multiple sclerosis [6].
- Posterior uveitis may develop in people who have an autoimmune disease or who have had a systemic (body-wide) infection. The most common cause of posterior uveitis is infections resulting from toxoplasmosis [7]
Who is at risk for uveitis?
How to know you have uveitis?
A complete medical history and eye examination should be performed. Laboratory tests may be done to rule out infection or an autoimmune disorder.
Persons over age 25 with pars planitis should have an MRI of their brain and spine to rule out multiple sclerosis.
When to seek urgent medical care
Call for an appointment with your health care provider if you have symptoms of uveitis (e.g. eye pain or reduced vision). Uveitis requires an urgent referral and thorough examination by an optometrist or ophthalmologist along with urgent treatment to control the inflammation.
Treatment options
Generally speaking, uveitis is typically treated with glucocorticoid steroids, either as topical eye drops (prednisolone acetate) or oral therapy with corticosteroids. In addition to corticosteroids, topical cycloplegics, such as atropine or homatropine, may be used. In some cases an injection of PSTTA can also be given to reduce the swelling of the eye. [8].
If the uveitis is caused by a body-wide infection, treatment may involve antibiotics and powerful anti-inflammatory medicines called corticosteroids.
Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatment with Infliximab or other anti-TNFs' infusions may prove helpful.
More specifically, the treatment regimen differs among the various forms of uveitis:
- Iritis is usually mild. Treatment may involve: dark glasses, eye drops that dilate the pupil to relieve pain, and steroid eye drops or ointment
- Pars planitis is often treated with steroid eye drops. Other medicines, including steroids taken by mouth, may be prescribed to help suppress the immune system.
- Choroiditis treatment depends on the underlying cause. Additional specialists in infectious disease or autoimmunity may be needed for such diseases as syphilis, tuberculosis, AIDS, sarcoidosis, or Behcet's syndrome.
Diseases with similar symptoms
Where to find medical care for uveitis
Directions to Hospitals Treating uveitis
Prevention of uveitis
Treatment of an underlying disorder may help to prevent uveitis in persons with a body-wide (systemic) infection or disease.
What to expect (Outlook/Prognosis)
Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States.[9]
However, with proper treatment, most attacks of anterior uveitis go away in a few days to weeks. However, relapses are common.
Inflammation related to posterior uveitis may last from months to years and may cause permanent vision damage, even with treatment.
Possible complications of uveitis include:
- Cataracts
- Fluid within the retina
- Glaucoma
- Retinal detachment
- Vision loss
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/001005.htm
- ↑ http://www.preventblindness.org/uveitis/what/types.html
- ↑ http://www.preventblindness.org/uveitis/what/types.html
- ↑ http://www.preventblindness.org/uveitis/what/types.html
- ↑ http://www.preventblindness.org/uveitis/what/types.html
- ↑ http://www.preventblindness.org/uveitis/what/types.html
- ↑ http://www.nlm.nih.gov/medlineplus/ency/article/001005.htm
- ↑ http://www.preventblindness.org/uveitis/what/types.html
- ↑ BNF 45 March 2003
- ↑ Sergio Schwartzman. Inflammatory eye disease: an expert interview with Sergio Schwartzman,MD Medscape Rheumatology 2007.