What is Uveitis?

Uveitis

Introduction 

The inflammation of any component of the uveal tract is called uveitis. Under most circumstances, it is due to idiopathic causes. Anterior uveitis cases often present acutely. Posterior uveitis cases may be associated with preventable blindness.

The incidence of uveitis in the USA is 25-52 cases per 1,000,000 population. It affects both males and females equally. Early diagnosis and management lend to a good prognosis. Delayed treatment may result in blindness.

Types of uveitis 1

The anatomical division of uveitis is as follows:

• Anterior uveitis 

• IritiIt is the most common type

• Generally occurs in healthy people

• It can affect one or both eyes

• Usually less severe

• Intermediate uveitis 

• Includes vitritis, hyalitis and pars planitis

• Posterior uveitis 

• Includes choroiditis, chorioretinitis, and retinitis

• It is the least common type 

• Posterior uveitis is generally a more serious form

• Usually occurs in the setting of underlying autoimmune disease 

• Panuveitis 

• Inflammation of all chambers of the uveal tract

Uveitis can be divided further by the following:

• Onset

• Sudden vs progressive 

• Duration

• Limited vs persistent 

• Clinical course 

• Acute vs recurrent vs chronic

• Involvement 

• Unilateral vs bilateral 

What are the causes of uveitis? 1,2

In healthy individuals, causes are usually unknown. In other cases, uveitis may occur in the setting of trauma, autoimmune diseases or infections. 

• Infectious Causes

• AIDS

• Herpes virus

• Cytomegalovirus

• Syphilis

• Toxoplasmosis 

• Systemic autoimmune diseases 

• Sarcoidosis

• Lupus

• Behcet disease

• Crohn's disease

• Ulcerative colitis

• Rheumatoid arthritis 

• Trauma

• Trauma is thought to be a combination of bacterial and inflammatory components. Accumulation of necrotic debris due to trauma leads to inflammation. 

What are the signs and symptoms of uveitis?

The presentation of uveitis may differ from patient to patient and depends in part on the duration of the disease. Chronic cases may present with mild redness and subtle symptoms only. The following signs and symptoms may be present: 

• Eye pain

• Blurry vision

• Eye redness

• Sensitivity to light 

• Floaters

• Tearing

• May be asymptomatic 

How is Uveitis diagnosed? 3

As described earlier most cases are idiopathic, and a thorough history to rule out the systemic causes is necessary.  An ophthalmologist will go through the following steps before reaching a certain diagnosis:

• History

• Examination

• Lids and external examination 

• Visual acuity 

• Intraocular pressure 

• Extraocular movement

• Pupillary examination 

• Slit-lamp examination 

• Anterior chamber and dilated examination 

• An ophthalmologist may advise the following laboratory workup depending on the findings:

• Complete blood count 

• Erythrocyte sedimentation rate

• ANA

• VDRL

• HLA testing

• Urinalysis 

• Viral markers

What is the treatment of uveitis? 3

There is no standard treatment for uveitis, rather each patient is treated individually based on their presentation. A systematic approach is adopted to manage the disease. If the underlying cause is an autoimmune disease then immunosuppressive agents are prescribed, often by a rheumatologist. The target of medical therapy is to control pain and inflammation, especially in the acute phase. The following medications may be prescribed:

• Cycloplegics 

• To reduce pain and sensitivity to light 

• Anti Inflammatory drugs

• NSAIDs

• Corticosteroids 

• Topical steroid drops have been standard for uveitis for decades. 

• The only drug approved by the FDA for uveitis. 

Acute cases are usually monitored with a slit lamp for examination and intraocular pressure readings for the first two weeks. If the condition is stable then drugs are tapered and the patient is called for follow-up every 1 to 6 months.

There are also sustained release devices/implants which are available for chronic/persistent cases and should be managed by an ophthalmologist.

What are the possible complications of Uveitis?

• Retinal detachment 

• Glaucoma 

• Cataracts formation

• Blindness 

If you have signs or symptoms of uveitis, or a history of uveitis or autoimmune disease, contact Eye Surgeons Associates to set up a visit. 

References 

1. What Is Uveitis? (2021, November 22). American Academy of Ophthalmology. Retrieved July 9, 2022, from https://www.aao.org/eye-health/diseases/what-is-uveitis

2. Cafasso, J. (2018, September 17). Uveitis. Healthline. Retrieved July 9, 2022, from https://www.healthline.com/health/uveitis

3. Muchatuta, M. N., MD. (2021, December 16). Iritis and Uveitis: Practice Essentials, Background, Pathophysiology. Medscape. Retrieved July 9, 2022, from https://emedicine.medscape.com/article/798323-overview

Author

Eye Surgeons Associates Drs. Zuhair H. Peracha, Manal H. Peracha-Riyaz, Eric Zuckerman, Matthew Pieters, and Leila Siblani are dedicated to excellence in eye care and service. We utilize the latest treatment methods and procedures, including routine eye care, cataract surgery, glaucoma treatment, retinal disease management, diabetic eye treatment, and eyelid surgery.