Uveitis

What is Uveitis?

Uveitis occurs when the middle layer of the eyeball gets inflamed (red and swollen). This layer, called the uvea, has many blood vessels that nourish the eye. Uveitis can damage vital eye tissue, leading to permanent vision loss.

 

Three types of uveitis

There are 3 types of uveitis. They are based on which part of the uvea is affected.

  • Swelling of the uvea near the front of the eye is called anterior uveitis. It starts suddenly and symptoms can last up to 8 weeks. Some forms of anterior uveitis are ongoing, while others go away but keep coming back.
  • Swelling of the uvea in the middle of the eye is called intermediate uveitis. Symptoms can last for a few weeks to many years. This form can go through cycles of getting better, then getting worse.
  • Swelling of the uvea toward the back of the eye is called posterior uveitis. Symptoms can develop gradually and last for many years.

In severe cases, all layers may be involved.

Many cases of uveitis are chronic, and they can produce numerous possible complications, including clouding of the cornea, cataracts, elevated eye pressure (IOP), glaucoma, swelling of the retina or retinal detachment. These complications can result in permanent vision loss.

Statistics on the prevalence of uveitis vary in different regions of the world. However, researchers who reviewed 522 international articles concerning the causes and patterns of uveitis and 22 major epidemiology reviews concluded it affects 52.4 per 100,000 people.

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What causes uveitis?

Uveitis has dozens of causes, including viral, fungal and bacterial infections. But, in many cases, the cause is unknown.

Eye doctors often can identify the cause of uveitis if there has been trauma to the eye or you have an infectious or immunological systemic disorder.

Some of the many disorders that can cause uveitis include:

  • ankylosing spondylitis
  • herpes simplex
  • herpes zoster
  • inflammatory bowel disease
  • juvenile rheumatoid arthritis
  • leptospirosis
  • lupus
  • Lyme disease
  • multiple sclerosis
  • psoriatic arthritis
  • sarcoidosis
  • syphilis
  • toxocariasis
  • toxoplasmosis
  • tuberculosis

Also, smoking has been identified as a risk factor for uveitis.

Symptoms of anterior uveitis include:
  • light sensitivity
  • decreased visual acuity
  • eye pain
  • red eyes Intermediate and posterior uveitis usually are painless. Symptoms of these types of uveitis include blurred vision and floaters, typically in both eyes. Most people who develop intermediate uveitis are in their teens, 20s or 30s.

Diffuse uveitis has a combination of symptoms of all types of uveitis.

HOW IS UVEITIS TREATED?

If your eye doctor determines you have uveitis, he or she will likely prescribe a steroid to reduce the inflammation in your eye.

Whether the steroid is administered as an eye drop, pill or injection depends on the type of uveitis you have. Because iritis affects the front of the eye, it’s usually treated with eye drops.

Posterior uveitis usually requires tablets or injections. Depending on your symptoms, any of these treatments might be used for intermediate uveitis.

Steroids and other immune suppressants can produce many serious side effects, such as kidney damage, high blood sugar, high blood pressure, osteoporosis and glaucoma.

This is especially true of steroids in pill form because the dose must be relatively high in order for enough of the drug to find its way to the back of the eye. So, it is important to follow your doctor’s dosage instructions carefully and to keep visiting him or her regularly to monitor the progress of the treatment.

Retisert (Bausch + Lomb) is a surgical implant used to treat chronic, non-infectious posterior uveitis.

The device is a tiny drug reservoir that is implanted in the back of the eye and delivers sustained amounts of an anti-inflammatory corticosteroid medication called fluocinolone acetonide to the uvea for about 30 months.

Clinical trials have shown that implantation of the Retisert device significantly reduced the recurrence of uveitis. The most common side effects noted were cataract progression, increased intraocular pressure, procedural complications and eye pain.

In a later study, researchers found that surgical implantation of the Retisert device was equally effective as systemic corticosteroid medications for the treatment of non-infectious intermediate, posterior and diffuse uveitis over a period of 24 months.

Ozurdex (Allergan) is another long-acting corticosteroid drug implant used to treat non-infectious uveitis affecting the back of the eye. Ozurdex implants contain the steroid medication dexamethasone and are biodegradable.

If you have anterior uveitis, your doctor likely will prescribe, in addition to steroids, pupil-dilating eye drops to reduce pain. You also may need eye drops to lower your intraocular pressure if you develop high eye pressure due to uveitis.

If you have a known systemic condition that may be contributing your uveitis, your doctor will treat that as well.

If you suffer from sensitivity to light (photophobia) from chronic iritis or uveitis, ask your eye doctor about photochromic lenses. These eyeglass lenses darken automatically in sunlight to reduce photophobia-related discomfort when going outdoors.