Uveitis: Causes, Symptoms, and Treatment

Uveitis is a form of eye inflammation. It affects the middle layer of tissue of the wall of the eye (UVA).
The warning signs of uveitis often come on suddenly and get worse quickly. These include redness of the eyes, pain and blurred vision. The condition can occur in one or both eyes and can affect people of all ages, including children.
Possible causes of uveitis are: an infection, injury, or autoimmune or inflammatory disease. Sometimes the cause cannot be identified.
Uveitis can be serious and lead to permanent vision loss. Early diagnosis and treatment are important to prevent complications and preserve vision.

symptoms

Signs, symptoms, and features of uveitis may include:
eye redness
eye pain
light sensitivity
blurred vision
floaters in the field of vision
low vision
Symptoms can come on suddenly or get worse quickly, although in some cases they come on gradually. They can affect one eye or both. Sometimes there are no symptoms and signs of uveitis are seen on a routine eye exam.
The uvea is the middle tissue layer of the wall of the eye. It is made up of iris, ciliary body and choroid. When you look at your eye in a mirror, you will see the white part of the eye (the sclera) and the colored part of the eye (the iris).
The iris is located inside the front part of the eye. The ciliary body is a structure behind the iris. The choroid is a layer of blood vessels between the retina and the sclera. Like wallpaper, the retina lines the inside of the back of the eye. The back of the eye is filled with a jelly-like fluid called the vitreous humour.
The type of uveitis you have will depend on which parts of the eye are inflamed:
Anterior uveitis affects the front of the eye (between the cornea and the iris) and the ciliary body. It is also called iritis and is the most common type of uveitis.
Intermediate uveitis affects the retina and the blood vessels lining the lens (pars plana) as well as the gel in the center of the eye (vitreous humor).
Posterior uveitis affects the back layer of the eye, either the retina or the choroid.
Panuveitis occurs when all layers of the uva become inflamed, from the front to the back of the eye.

When to seek medical advice

Contact your doctor if you think you have warning signs of uveitis. Your doctor may refer you to an eye specialist (ophthalmologist). Seek immediate medical attention if you experience severe eye pain or unexpected vision problems.

risk

People with changes in certain genes may be more likely to develop uveitis. Cigarette smoking is associated with more difficult to control uveitis.

diagnosis

When you see an eye specialist (ophthalmologist), they will likely do a comprehensive eye exam and take your full medical history. Eye exams usually include the following:
Vision assessment (with your glasses if you normally wear them) and your pupils’ response to light.
Tonometry. Tonometry measures the pressure of the fluid inside the eye (intraocular pressure). Numbing eye drops may be used for this test.
slit lamp test. A slit lamp is a microscope that magnifies and illuminates the front of the eye with an intense beam of light. This evaluation is necessary to identify microscopic inflammatory cells in the front of the eye.
Ophthalmoscopy. This test, also known as fundoscopy, involves dilating (dilating) the pupils with eye drops and shining a bright light into the eye to examine the back of the eye.
Your doctor may also recommend the following:
Color picture of the inside of the eye (retina).
optical coherence tomography. This test measures the thickness of the retina and choroid to reveal inflammation in these layers.
Fluorescein angiography or indocyanine green angiography. These tests require the insertion of an intravenous catheter into a vein in the arm to deliver the contrast dye. The dye will travel to the blood vessels in the eye, allowing a picture of the swelling of the blood vessels inside the eye to be taken.
Analysis of the aqueous or vitreous fluid of the eye.
blood test.
Imaging test, X-ray, CT scan or MRI.
If your ophthalmologist believes that an undiagnosed condition may be causing your uveitis, you may be referred to another doctor for a general physical exam and laboratory tests.
Sometimes it is difficult to find a specific cause for uveitis. Even if a specific cause is not identified, uveitis can be successfully treated. In most cases, identifying the cause of uveitis does not lead to treatment. It is still necessary to use some sort of treatment to control the inflammation.

treatment

If the uveitis is caused by an underlying condition, treatment may focus on that condition. In general, the treatment of uveitis is the same regardless of the underlying cause, as long as it is not infectious. The goal of treatment is to reduce swelling in the eye and other parts of the body, if present. In some cases, treatment may be necessary for months or years. There are many treatment options.

medicines

Medicines that reduce inflammation Your doctor may first prescribe eye drops with an anti-inflammatory medicine such as a corticosteroid. Eye drops are not usually sufficient to treat inflammation beyond the front of the eye, so corticosteroid injections in or around the eye, or corticosteroid tablets (taken by mouth) may be needed.
Medicines that control spasms. Eye drops that dilate (dilate) the pupil may be prescribed to control spasms in the iris and ciliary body, which may help relieve eye pain.
Drugs that fight bacteria or viruses. If uveitis is caused by infection, your doctor may prescribe antibiotics, antivirals, or other medications with or without corticosteroids to control the infection.
Medicines that affect the immune system or kill cells. If uveitis affects both eyes, doesn’t respond well to corticosteroids, or becomes severe enough to threaten your vision, you may need immunosuppressive drugs.
Some of these drugs can have serious side effects related to the eyes, such as glaucoma and cataracts. Medicines taken by mouth or injected can have side effects on other parts of the body outside the eyes. You may need to visit your doctor every one to three months for follow-up exams and blood tests.

surgical intervention or other procedures

Vitrectomy. Surgery to remove part of the vitreous from the eye is rarely used to diagnose or manage the condition.
A drug-eluting implant. For people whose posterior uveitis is difficult to treat, a treatment option may be to implant a device in the eye. Up to 30% of patients with high eye pressure will also need treatment to prevent the development of glaucoma.
How quickly you recover will depend on the type of uveitis you have and how severe your symptoms are. Uveitis that affects the back of the eye (posterior uveitis or panuveitis, which also includes retinitis or choroiditis) heals more slowly than uveitis at the front of the eye (anterior uveitis or iritis). Severe inflammation takes longer to resolve than mild inflammation.
Uveitis may return. If any of your symptoms return or worsen, contact your doctor.

With information from Mayo Clinic

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