Uveitis

Overview

Uveitis (u-vee-I-tis) warning signs often come on suddenly and get worse quickly. They include eye redness, pain and blurred vision. The condition can affect one or both eyes. It primarily affects people ages 20 to 50, but it can develop at any age. Uveitis can be serious, leading to permanent vision loss. Early diagnosis and treatment are important to prevent the complications of uveitis.

Symptoms may occur suddenly and get worse quickly, though in some cases, they develop gradually. They may affect one or both eyes.

Left untreated, uveitis can cause complications, including glaucoma, cataracts, optic nerve damage, retinal detachment, and permanent vision loss.

Types of Uveitis

The uvea is the middle layer of tissue in the wall of the eye. It consists of the iris, the ciliary body and the choroid. The choroid is sandwiched between the retina and the sclera. The retina is located at the inside wall of the eye and the sclera is the outer white part of the eye wall. The uvea provides blood flow to the deep layers of the retina. The type of uveitis you have depends on which part or parts of the eye are inflamed:

• Iritis (anterior uveitis) affects the front of your eye and is the most common type.
• Cyclitis (intermediate uveitis) affects the ciliary body.
• Choroiditis and retinitis (posterior uveitis) affect the back of your eye.
• Diffuse uveitis (panuveitis) occurs when all layers of the uvea are inflamed.

In any of these conditions, the jelly-like material in the center of your eye (vitreous) can become inflamed and infiltrated with inflammatory cells.

Potential Causes and Risk Factors

In about half of all cases, the specific cause of uveitis isn't clear.

Possible causes of uveitis are infection, injury, or an autoimmune or inflammatory disease. Many times a cause can't be identified.

Inflammation in the eye may result from many different disease processes, including infections, viruses, fungi, parasites, bacteria, and other infectious agents. Uveitis may be a manifestation of various systemic disorders, including sarcoidosis, some arthritic syndromes, and chronic intestinal diseases. It can also result from trauma to the eye.

Eye injury or surgery An autoimmune disorder, such as sarcoidosis or ankylosing spondylitis An inflammatory disorder, such as Crohn's disease or ulcerative colitis An infection, such as cat-scratch disease, herpes zoster, syphilis, toxoplasmosis, tuberculosis, Lyme disease or West Nile virus A cancer that affects the eye, such as lymphoma

People with changes in certain genes may be more likely to develop uveitis. In addition, a recent study shows a significant association between uveitis and cigarette smoking.

Diagnosis

When you visit an eye specialist (ophthalmologist), he or she will likely conduct a complete eye exam and gather a thorough health history. You may also need these tests:

• Blood tests
• Analysis of fluid from the eye
• Photography to evaluate the retinal blood flow (angiography)
• Photography to measure the thickness of the retinal tissue and to determine the presence or absence of fluid in or under the retina.

If the ophthalmologist thinks an underlying condition may 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 is caused by an infection or another condition.

Treatment

If uveitis is caused by an underlying condition, treatment will focus on that specific condition. The goal of treatment is to reduce the inflammation in your eye. Several treatment options are available.

The speed of your recovery depends in part on the type of uveitis you have and the severity of your symptoms. Uveitis that affects the back of your eye (choroiditis) tends to heal more slowly than uveitis in the front of the eye (iritis). Severe inflammation takes longer to clear up than mild inflammation does.

Medications

Your doctor may first prescribe eyedrops with an anti-inflammatory medication, such as a corticosteroid. If those don't help, a corticosteroid pill or injection may be the next step.

If uveitis is caused by an infection, your doctor may prescribe antibiotics, antiviral medications or other medicines, with or without corticosteroids, to bring the infection under control.

You may need immunosuppressive or cytotoxic drugs if your uveitis affects both eyes, doesn't respond well to corticosteroids or becomes severe enough to threaten your vision.

Surgical and Other Procedures

Surgery to remove some of the vitreous in your eye (known as a vitrectomy) may alleviate symptoms.

Surgery that implants a device into the eye to provide a slow and sustained release of a medication. For people with difficult-to-treat posterior uveitis, a device that's implanted in the eye may be an option. This device slowly releases corticosteroid medication into the eye for two to three years. Possible side effects of this treatment include cataracts and glaucoma.