Uveitis

What is Uveitis ?

Uveitis is swelling of the middle layer of the eye, which is called the uvea. The uvea supplies blood to the retina. The retina is the light-sensitive part of the eye that focuses the images you see and sends them to the brain. It is normally red due to its blood supply from the uvea.


What Causes Uveitis ?

In many cases, particularly in healthy individuals, the cause is unknown. Some types of uveitis may be caused by an underlying autoimmune or inflammatory disorder. An autoimmune disease occurs when your own immune system attacks a part of your body. These conditions include:


  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Behcet’s syndrome
  • Psoriasis
  • Arthritis
  • Ulcerative colitis
  • Kawasaki disease
  • Crohn’s disease
  • Sarcoidosis
  • Masquerade syndrome is  immune-mediated uveitis  due to certain lymphomas, leukemias and malignant melanoma

Infections are another cause of uveitis, including:

  • AIDS (viral infection)
  • Herpes (viral infection)
  • CMV retinitis (viral infection of the eye)
  • Syphilis (sexually transmitted bacterial infection)
  • Toxoplasmosis (parasitic infection)
  • Tuberculosis (bacterial infection)
  • Histoplasmosis (fungal infection)
  • West Nile (viral infection

Other potential causes of uveitis include exposure to a toxin that penetrates the eye or bruising, injury, or trauma to the eye

Types of Uveitis

There are many types of uveitis. Each type is classified by where the inflammation occurs in the eye. They include:


  • Anterior Uveitis (Front of the Eye)
  • Anterior uveitis is often referred to as “iritis” because it affects the iris. The iris is the colored part of the eye near the front. Iritis is the most common type of uveitis and generally occurs in healthy people. It can affect one eye, or it may affect both eyes at once. Iritis is usually the least serious type of uveitis

  • Intermediate Uveitis (Middle of the Eye)
  • Intermediate uveitis involves the middle part of the eye and is also called iridocyclitis. The word intermediate in the name refers to the location of the inflammation and not the severity of the inflammation. The middle part of the eye includes the pars plana, the part of the eye between the iris and the choroid.

  • Posterior Uveitis (Back of the Eye)
  • Posterior uveitis may also be referred to as choroiditis because it affects the choroid. The tissue and blood vessels of the choroid are important because they deliver blood to the back of the eye. This type of uveitis usually occurs in people with an infection from a virus, parasite, or fungus, or who have an autoimmune disease. Posterior uveitis tends to be more serious than anterior uveitis because it can cause scarring in the retina. The retina is a layer of cells in the back of the eye. However, posterior uveitis is the least common form of uveitis.

  • Pan-Uveitis (All Parts of the Eye)

When the inflammation affects all major parts of the eye, it is called pan-uveitis. It often involves a combination of features and symptoms from all three types of uveitis.

What are the  Signs and Symptoms of Uveitis ?

The following symptoms may occur in one or both eyes:

  • redness in the eye
  • eye pain
  • floaters (dark floating spots in your vision)
  • sensitivity to light
  • blurred vision
  • whitish area (hypopyon) inside the eye in front of the lower part of the colored area of the eye (iris)


How is Uveitis Diagnosed ?

When you visit an eye specialist (ophthalmologist), your doctor will likely conduct a complete eye exam and gather a thorough health history.
If an ophthalmologist suspects an underlying condition to be the cause of your uveitis, you may be referred to another doctor for a general medical examination and laboratory tests.
 Sometimes, it's difficult to find a specific cause for uveitis. However, your doctor will try to determine whether your uveitis has an infectious cause or results from some other disease.

How is Uveitis Treated ?

Treatment for uveitis depends on the cause and the type of uveitis. The goal of treatment is to reduce the inflammation in the eye.
Treatment of uveitis may include:


  • Anti-inflammatory medication. Your doctor may prescribe anti-inflammatory medication, such as a corticosteroid, to treat your uveitis. This medication may be given as eyedrops. Or, you may be given corticosteroid pills or an injection into the eye. For people with difficult-to-treat posterior uveitis, a device that is implanted in your eye may be an option. This device slowly releases corticosteroid medication into your eye for about 6 months.
  • Antibiotic or antiviral medication. If uveitis is caused by an infection, antibiotics, antiviral medications or other medicines may be given with or without corticosteroids to bring the infection under control.
  • Immunosuppressive or cell-destroying (cytotoxic) medication.Immunosuppressive or cytotoxic agents may be necessary if your uveitis doesn't respond well to corticosteroids or becomes severe enough to threaten your vision.
  • Surgery. Vitrectomy — surgery to remove some of the jelly-like material in your eye (vitreous) — may be necessary both for diagnosis and management of your uveitis. A small sample of the vitreous can help identify a specific cause of eye inflammation, such as a virus, bacterium or lymphoma. The procedure may also be used to remove developing scar tissue in the vitreous. The part of your eye affected by uveitis — either the front (anterior) or back (posterior) of the uvea — may determine how quickly your eye heals. Uveitis affecting the back of your eye tends to heal more slowly than uveitis in the front of the eye. Severe inflammation takes longer to clear up than mild inflammation does.

Uveitis can come back. Make an appointment with your doctor if any of your symptoms reappear after successful treatment.

Post-Treatment Recovery and Outlook

Uveitis will typically go away within a few days with treatment. Uveitis that affects the back of the eye (posterior uveitis) typically heals more slowly than uveitis that affects the front of the eye. Relapses are common.
Posterior uveitis due to another condition may persist for months and can cause permanent vision damage.

Potential Complications from Uveitis

Untreated uveitis can lead to serious complications, including:

  • Cataracts (clouding of the lens or cornea)
  • Fluid in the retina
  • Glaucoma (high pressure in the eye)
  • Retinal detachment
  • Loss of vision