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Uveitis is an inflammation of the uvea, the middle layer of the eye wall, which can manifest suddenly with symptoms such as eye redness, pain, and blurred vision. The inflammation can affect one or both eyes and is observable in individuals of all ages, including children. Although uveitis can result from infections, injuries, or autoimmune disorders, the cause often remains unidentified.
The anatomy of the eye leaves little room for swelling, making any inflammation potentially harmful as it can alter the eye’s shape and impair vision. This condition can be localized to specific areas of the eye or involve multiple regions, leading to varying degrees of pain and visual disruption.
Prompt diagnosis and treatment of uveitis are crucial to prevent serious outcomes, including permanent vision loss or blindness. Early medical intervention is essential to manage symptoms effectively and preserve eyesight.
Symptoms
Uveitis is an inflammatory condition affecting the uvea, the middle layer of the eye’s tissue, which includes the iris, the ciliary body, and the choroid. Below is a detailed breakdown of the symptoms, characteristics, and anatomy relevant to uveitis:
Symptoms of uveitis
- Eye redness: The eye may appear red and irritated.
- Eye pain: Discomfort can range from mild to severe.
- Light sensitivity: There is often increased sensitivity to light.
- Blurred vision: Vision may become blurry and unclear.
- Floaters: Dark, floating spots may appear in the field of vision.
- Decreased vision: There may be a noticeable reduction in visual acuity.
These symptoms can develop suddenly and worsen quickly, or they might emerge gradually. Uveitis can affect one or both eyes. In some cases, symptoms may not be noticeable, and uveitis is only detected during a routine eye exam.
Anatomy of the uvea
- Iris: The colored part of the eye, visible when looking in the mirror.
- Ciliary body: Located behind the iris, this structure controls the focusing shape of the eye’s lens.
- Choroid: A layer of blood vessels situated between the retina and the sclera that provides oxygen and nutrients to the eye.
The eye’s internal back is lined by the retina, akin to wallpaper, and filled with a gel–like substance called the vitreous. This anatomy plays a critical role in the symptoms and management of uveitis.
Classification of uveitis
Uveitis can be classified based on the specific area affected:
- Anterior uveitis: This most common form impacts the front inside part of the eye, specifically between the cornea and the iris, as well as the ciliary body. It is also referred to as iritis.
- Intermediate uveitis: This type targets the retina, blood vessels near the lens (pars plana), and the vitreous, the gel–like substance in the center of the eye.
- Posterior uveitis: This affects the inner layer at the back of the eye, involving either the retina or the choroid.
- Panuveitis: This severe form occurs when all layers of the uvea are inflamed, affecting the eye from front to back.
If you experience symptoms that suggest uveitis, consult your doctor promptly. They may refer you to an ophthalmologist. For severe eye pain or sudden vision issues, seek immediate medical attention.
Causes
In about half of all uveitis cases, the underlying cause remains unidentified, and the condition is often considered an autoimmune response that primarily affects the eyes. When a specific cause is identified, it could be one of several factors:
- Ankylosing spondylitis, a type of inflammatory disease that may cause bones in the spine to fuse together, leading to significant back pain. Uveitis is a common complication associated with this condition.
- Other autoimmune or inflammatory disorders that impact various parts of the body, including sarcoidosis, systemic lupus erythematosus, or Crohn’s disease.
- Infections such as tuberculosis, syphilis, herpes zoster, toxoplasmosis, or cat scratch disease.
- Side effects from certain medications.
- Eye injuries or surgical procedures.
- In very rare cases, an eye cancer such as lymphoma.
Risk factors
Individuals with alterations in specific genes may have an increased risk of developing uveitis. Additionally, cigarette smoking has been linked to more challenging–to–control uveitis.
Diagnosis
When you visit an eye specialist (ophthalmologist), they will likely perform a comprehensive eye examination and gather a detailed health history. The eye examination typically includes the following:
- Evaluation of your pupils’ reaction to light and your vision (if you typically wear glasses).
- Tonometry. Intraocular pressure, or intraocular pressure, is measured during a tonometry examination. For this examination, numbing eyedrops could be utilized.
- A slit–lamp analysis. A slit lamp is a type of microscope that produces a strong line of light that enlarges and illuminates the front of your eye. To detect minute inflammatory cells in the front of the eye, this examination is required.
- Ophthalmoscopy. This examination, also called a funduscopy, entails using eye drops to dilate the pupil and a strong light to inspect the back of the eye.
Additionally, your doctor might advise:
- Blood examination.
- Assessment of the eye aqueous or vitreous fluid
- Color photography. To check the retina inside the eyes.
- Optical coherence tomography (OCT) imaging. This test uses a mapping technique to identify edema in the retina and choroid.
- Fluorescein angiography or indocyanine green angiography. To administer a dye for these tests, an Intravenous (IV) catheter must be inserted into a vein in your arm. This dye will enter the blood vessels in the eyes, enabling images of enlarged blood vessels to be captured.
- Imaging tests. Radiology, computed tomography (CT) or magnetic resonance imaging (MRI).
If the ophthalmologist suspects an underlying condition as the culprit for your uveitis, you might need a referral to another doctor for a comprehensive medical examination and laboratory tests.
Finding a specific cause for uveitis can be challenging. However, even if a specific cause isn’t identified, successful treatment is still possible. In most cases, pinpointing the cause doesn’t result in a cure. Treatment is still necessary to manage the inflammation.
Treatment
If uveitis is linked to an underlying condition, treatment often focuses on addressing that specific cause. Generally, the treatment approach for uveitis is consistent, except when the cause is infectious. The primary goal is to reduce inflammation in the eye and other affected body parts. Depending on the severity and underlying causes, treatment may be necessary for several months or even years, with various options available to manage the condition.
Medications
- Drugs that reduce inflammation. Initially, your doctor might prescribe eye drops containing an anti–inflammatory medication, like a corticosteroid. However, eye drops may not be sufficient for treating inflammation beyond the front of the eye. In such cases, a corticosteroid injection in or around the eye, or corticosteroid tablets taken orally, may be required.
- Medication for spasm management. In order to manage iris and ciliary body spasms and alleviate eye pain, eye drops that dilate the pupil may be administered.
- Antiviral or antibacterial drugs. Your doctor may recommend antibiotics, antiviral drugs, or other treatments, with or without corticosteroids, to treat the infection if it is the cause of your uveitis.
- Substances that damage cells or interfere with the immunological system. If your uveitis affects both eyes, does not improve with corticosteroids, or gets bad enough to impair your vision, you could require immunosuppressive medication.
Some of these medications can cause serious eye–related side effects, such as glaucoma and cataracts. Oral medication or injections may also have side effects in other parts of the body beyond the eyes. Regular follow–up examinations and blood tests may be necessary, so you may need to visit your doctor frequently.
Surgery and other procedures
- Vitrectomy. It is uncommon to identify or treat the problem with surgery that involves partial vitreous removal from the eye.
- A medication–releasing implant. An implanted device may be a viable treatment option for those with persistent posterior uveitis that is difficult to manage. Depending on the implant being utilized, this device distributes corticosteroid into the eye gradually over several months or years.
This treatment typically causes cataracts to develop in those who have not had cataract surgery. Additionally, up to 30% of individuals will need glaucoma or high eye pressure to be monitored or treated.
The speed of recovery from uveitis can vary widely depending on the type and severity of the condition. Conditions like retinitis or choroiditis, which fall under posterior uveitis or panuveitis and affect deeper layers of the eye, generally take longer to heal compared to anterior uveitis or iritis, which impacts the front part of the eye. Severe inflammation typically requires more time to subside than milder forms.
There is also a possibility of recurrence with uveitis. Should your symptoms reappear or worsen, it is crucial to contact your doctor promptly to address the flare–up and adjust your treatment plan if necessary.
