What is uveitis?
Uveitis is a term for swelling of the eye. It occurs in one or both eyes and affects the lining of the eye called the uvea. It is associated with inflammation of other parts of the eye and can last for a short (severe) or long (chronic) period. It can be severed and lead to permanent vision loss.
The uvea is the fibrous and vascular membrane that protects the eye and is crucial for the exchange of nutrients and gases. This consists of three parts, the iris, the ciliary body, and the choroid. If any part of the uvea grows inflamed, it is called uveitis. There are several types of chorioretinitis, each of which affects different parts of the chorioretinitis.
Who can treat uveitis?
Only an ophthalmologist (medical eye doctor) is qualified to treat chorioretinitis. Since chorioretinitis can cause inflammation within the eye and damage to vision, prompt treatment, and proper diagnosis are required. A simple case of “red eyes” can actually be a serious chorioretinitis problem. An ophthalmologist should examine and treat “red eyes” that do not go away right away.
An ophthalmologist is a physician (MD or osteoporosis) who is educated, trained, and licensed to provide comprehensive eye care. General eye care includes conducting comprehensive medical ophthalmic examinations, prescribing corrective lenses, diagnosing eye injuries and disorders, and using the medical and surgical procedures necessary to treat them.
Types of uveitis
There are four types of uveitis:
Anterior uveitis: The most common form of uveitis, affecting the iris and surrounding tissues, is located both in front of the eye and on the ciliary body. It is sometimes called erythema because the iris is often part of the inflamed uvea.
Intermediate uveitis: occurs most often in children, adolescents, and young adults when the area behind the ciliary body and the retina is inflamed. It has been linked to people with sarcoidosis and multiple sclerosis.
Posterior uveitis: it is the lowest of the various forms of the disease, which in most cases affects the back of the eye, as its name implies. This swelling affects both the retina and the choroid of the eye and can be caused by various infectious and non-infectious diseases.
Panuveitis: The term panuveitis is used when three main parts of the eye are affected by inflammation. Behets disease is one of the best-known forms of panuveitis and can seriously damage the retina.
Intermediate, posterior, and panuveitis are the most severe and recurrent forms of uveitis. If left untreated, they can often cause blindness.
Possible risk factors include:
- Genetic predisposition. People with mutations in certain genes are more likely to develop them.
- You have an infection. Many infections such as toxoplasmosis, cat scratch fever, tuberculosis, herpes, syphilis, and West Nile virus increase the risk.
- You have an autoimmune or inflammatory disorder. Conditions that increase the risk of chorioretinitis include Behits disease, ankylosing spondylitis, sarcoidosis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis.
- History of eye injury. An injury to the eye can cause chorioretinitis. Chorioretinitis may also develop in a healthy eye.
Causes of uveitis
Uveitis is caused by inflammatory responses within the eye.
Inflammation is the body’s normal response to tissue injury, germs, or toxins. It produces inflammation, redness, heat, and destruction of tissues because some white blood cells rush to eliminate or eliminate the aggression to the affected part of the body.
Uveitis can be caused by:
- Attack of the body’s own immune system (autoimmunity)
- Infections or tumors can occur within the eye or in other parts of the body.
- Eye injuries
- Toxins that penetrate the eye
The disease causes symptoms such as decreased vision, pain, sensitivity to light, and increased floaters. In most cases the cause is unknown.
Symptoms of uveitis
Uveitis can appear suddenly with redness and pain, or it can be initially slow with slight pain or redness, but gradually the vision becomes blurred. Symptoms of chorioretinitis can include:
- Eye pain: Pain that is usually dull in or around the eye, maybe worse when focused
- The eye is red
- Sensitivity to light (photophobia)
- Hazy or cloudy vision
- Small shapes that move in your field of vision (floaters)
- Loss of ability to see objects into your field of vision (peripheral vision)
Symptoms can appear suddenly or gradually over several days. One or both eyes can become infected with chorioretinitis.
Diagnosis of uveitis
Uveitis can affect any age from childhood, however, the average age of patients with this condition is 40 years. The diagnosis of uveitis requires a complete examination by an ophthalmologist, which includes a detailed examination of your current and past medical history.
- The first step in diagnosing uveitis is a complete history of the disease and a review of the system. The importance of this cannot be overstated and is sadly sometimes overlooked.
- The slit lamp test reveals the type of chorioretinitis. Clinical tests can help identify symptoms or complications of uveitis, such as vasculitis, macular edema, and glaucoma.
- Blood tests are almost always done for well-known reasons for the type of uveitis offered. External remissions, imaging, and biopsy may be required to diagnose comorbid systemic disease.
- Finally, response to treatment can sometimes help the doctor determine which type of chorioretinitis is most common.
Systemic diseases that can present with uveitis
- Ankylosing spondylitis
- Reactive arthritis
- Rheumatoid arthritis
- Psoriatic arthritis
- Juvenile idiopathic arthritis
- Systemic lupus erythematosus
- Inflammatory bowel disease
- Multiple sclerosis
Infectious causes can include:
- Herpes simplex
- Varicella-zoster (chickenpox or shingles)
- Epstein-Barr virus, or cytomegalovirus
- Lyme disease
- Fungal infections
- Cat scratch disease
Treatment for uveitis
Uveitis treatment focuses on reducing inflammation and pain. If you have an infection, your doctor may prescribe antibiotics or antiviral medications for a bacterial infection. For non-infectious chorioretinitis, treatment usually includes prescription eye drops or ointments that contain corticosteroids to reduce inflammation. If chorioretinitis affects the iris, eye drops that separate the pupil, causing pain without moving the iris, may also be indicated. Your doctor may recommend sunglasses because bright light can cause discomfort.
For more severe cases, your ophthalmologist may prescribe corticosteroid injections, oral forms of corticosteroids, or additional immunosuppressive medications for the eye. Parts of immunosuppressive therapies done in the treatment of chorioretinitis are methotrexate, cyclosporine, tacrolimus, azathioprine, and mycophenolate mofetil. Recently, options available to treat people with severe chorioretinitis who do not respond to other therapies include adalimumab (injected under the skin) or surgically inserted into ocular steroid implants.
Intermediate, posterior, and panuveitis treatments begin with steroid eye drops but may also include extended-release capsules with oral injections, oral medications, or surgery to treat chronic inflammation of the eye. If you are diagnosed with an autoimmune disease, you can take special immunosuppressant medications that can reduce your chorioretinitis symptoms.
In rare cases, surgery may be necessary to treat chorioretinitis. However, it is generally only used if you have recurrent or severe uveitis affecting the back of the eye.
An operation called a vitrectomy may be used to remove the vitreous (jelly that fills the eye).
Complications associated with uveitis include:
- Glaucoma – This is a malignant structure of fluid within the eyeball. The liquid that nourishes the iris is aqueous humor. It is inside a small chamber behind the cornea. Glaucoma occurs when aqueous humor does not flow properly. This can damage the optic nerve and lead to narrowing of vision or gaps in the visual field.
- Cataract: the lens behind the iris becomes cloudy. Treatment includes surgery to replace the lens
- Macular edema: swelling of the central retina and filling with water, resulting in blurred vision.
Depending on the type of uveitis, its severity, and duration, it responds immediately to treatment and if there is a related disease. When diagnosed and treated promptly, the prognosis is generally good and patients are expected to recover eventually. If left untreated, complications from chorioretinitis can be serious and can include glaucoma, cataracts, or permanent vision loss.
Departments to consult for this condition
- Department of Ophthalmology