Uveitis

Uveitis

Definition:

Uveitis (u-ve-I-tis) is inflammation of the uvea, the middle layer of the eye. The uvea consists of the iris, choroid and ciliary body. The choroid is sandwiched between the retina and the white of the eye (sclera), and it provides blood flow to the deep layers of the retina. The most common type of uveitis is an inflammation of the iris called iritis (anterior uveitis).

Infections, injury and autoimmune disorders may be associated with the development of uveitis, though the exact cause is often unknown.

Uveitis can be serious, leading to permanent vision loss. Early diagnosis and treatment are important to prevent the complications of uveitis.

Symptoms:

The signs, symptoms and characteristics of uveitis include:

• Eye redness
• Eye pain
• Light sensitivity
• Blurred vision
• Dark, floating spots in your field of vision (floaters)
• Decreased vision
• Whitish area (hypopyon) inside the eye in front of the lower part of the colored area of the eye (iris)

The site of uveitis varies and is described by where in the eye it occurs.

• Anterior uveitis affects the front of your eye (also called iritis).
• Posterior uveitis affects the back of your eye (also called choroiditis).
• Intermediary uveitis affects the ciliary body (also called cyclitis).
• 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 also become inflamed and infiltrated with inflammatory cells.
Symptoms may occur suddenly and get worse quickly, though in some cases, symptoms develop gradually. Symptoms may be noticeable in one or both eyes.

When to see a doctor
Contact your doctor if you think you may have symptoms of uveitis. Your doctor may refer you to an eye specialist (ophthalmologist). If you're having significant eye pain and new vision problems, seek prompt medical attention.


Causes:

Sometimes, the specific cause of uveitis isn't clear. However, in some people, uveitis is associated with:

• Autoimmune disorders, such as Behcet's disease, sarcoidosis or ankylosing spondylitis
• Inflammatory disorders, such as Crohn's disease or ulcerative colitis
• Infections such as cat-scratch disease, herpes, syphilis, toxoplasmosis, tuberculosis or West Nile virus
• Eye injury
• Certain cancers, such as lymphoma, that can directly or indirectly affect the eye

Complications:

Left untreated, uveitis can cause the following complications:

• Abnormally high pressure inside the eye (glaucoma)
• Damage to the optic nerve
• Clouding of the lens (cataract) or cornea
• Retinal problems, such as fluid within the retina or retinal detachment
• Vision loss

Treatments and drugs:

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.
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's implanted in your eye may be an option. This device slowly releases corticosteroid medication into your eye for about 2 1/2 years.
  
• 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.