UVEITIS

Uveitis: An Overview

Uveitis refers to inflammation of the uvea, the middle layer of the eye, which consists of the iris, ciliary body, and choroid. It can also involve the retina and vitreous humor. Uveitis is a significant cause of vision impairment worldwide and may occur as a result of infections, autoimmune diseases, trauma, or systemic inflammatory conditions. Prompt diagnosis and treatment are essential to prevent complications, including vision loss.

Types of Uveitis

Uveitis can be classified based on the anatomical location of the inflammation:
    1.     Anterior Uveitis (Iritis):
      •     Location: Inflammation is primarily in the iris and the ciliary body.
      •     Symptoms: Eye redness, pain, photophobia (sensitivity to light), and blurred vision.
      •     Common Causes: Autoimmune conditions like ankylosing spondylitis, reactive arthritis, and juvenile idiopathic arthritis, as well as infections like herpes simplex virus and tuberculosis.
    2.     Intermediate Uveitis (Vitreitis):
      •     Location: Inflammation occurs in the vitreous body, the gel-like substance that fills the eye.
      •     Symptoms: Floaters (small spots or lines seen in vision), blurred vision, and discomfort.
      •     Common Causes: Sarcoidosis, multiple sclerosis, and certain viral infections like cytomegalovirus (CMV).
    3.     Posterior Uveitis (Choroiditis or Retinitis):
      •     Location: The choroid, retina, and vitreous are involved.
      •     Symptoms: Blurred vision, blind spots, and, in some cases, floaters.
      •     Common Causes: Systemic infections like toxoplasmosis, syphilis, or tuberculosis, as well as autoimmune conditions such as Behçet’s disease.
    4.     Panuveitis:
      •     Location: Inflammation affects all parts of the uvea, including the iris, ciliary body, and choroid.
      •     Symptoms: A combination of the symptoms seen in anterior, intermediate, and posterior uveitis.
      •     Common Causes: Behçet’s disease, systemic lupus erythematosus (SLE), and other autoimmune diseases.

Causes of Uveitis

Uveitis can be triggered by a variety of factors:
•         Infections: Bacterial, viral, fungal, and parasitic infections can cause uveitis. Examples include herpes simplex virus (HSV), tuberculosis, toxoplasmosis, and CMV.
•         Autoimmune and Systemic Diseases: Conditions like rheumatoid arthritis, sarcoidosis, multiple sclerosis, and systemic lupus erythematosus (SLE) may lead to uveitis.
•         Trauma: Injury to the eye, either penetrating or blunt, can cause inflammation.
•         Medications: Certain drugs, such as bisphosphonates and rifabutin, may induce uveitis as a side effect.
•         Idiopathic: In many cases, the exact cause of uveitis is unknown.

Symptoms of Uveitis

Symptoms vary depending on the type and severity of uveitis but may include:
•         Red, painful, or swollen eye
•         Sensitivity to light (photophobia)
•         Blurred vision or visual disturbances
•         Floaters or spots in the field of vision
•         Tearing or watery eyes

Diagnosis

The diagnosis of uveitis involves a comprehensive eye examination, including:
•         Slit-lamp examination: A detailed evaluation of the eye’s structures, especially the anterior segment, vitreous body, and retina.
•         Fundus examination: To check for inflammation in the retina and choroid.
•         Blood tests: To identify underlying systemic conditions or infections.
•         Imaging: In some cases, optical coherence tomography (OCT) or fluorescein angiography may be used to assess the extent of retinal involvement.

Treatment

Treatment of uveitis aims to reduce inflammation, alleviate symptoms, and address any underlying cause:
•         Corticosteroids: Topical, oral, or intravitreal injections of corticosteroids are commonly used to reduce inflammation.
•         Immunosuppressive Drugs: In cases of autoimmune-related uveitis, immunosuppressive agents such as methotrexate, azathioprine, or biologic agents may be prescribed.
•         Antibiotics/Antivirals: If the uveitis is caused by an infection, appropriate antimicrobial treatment will be necessary.
•         Cycloplegics: Medications to relieve pain and prevent the eye muscles from spasming.
•         Surgical Interventions: In some cases, surgery may be needed to treat complications, such as cataracts or retinal issues, resulting from chronic uveitis.

Prognosis and Complications

The prognosis of uveitis depends on its cause, severity, and the effectiveness of treatment. Chronic uveitis or delays in treatment can lead to complications such as:
•         Cataracts: A common complication due to long-term steroid use.
•         Glaucoma: Increased intraocular pressure can result from both the inflammation itself and the use of steroids.
•         Macular edema: Swelling of the retina that can lead to vision loss.
•         Retinal damage or detachment: Severe cases of uveitis can lead to long-term damage to the retina.
•         Vision loss: In untreated or poorly managed cases, uveitis can cause irreversible damage to vision.

Prevention

While it is not always possible to prevent uveitis, early detection and treatment can significantly reduce the risk of complications. Regular eye exams, especially for individuals with systemic autoimmune or infectious diseases, are crucial in managing the condition. Additionally, protecting the eyes from trauma and avoiding known triggers may reduce the incidence of uveitis.

Conclusion

Uveitis is a serious eye condition that requires prompt medical attention. With appropriate management, most cases of uveitis can be controlled, and vision can be preserved. However, if left untreated, it can lead to permanent vision loss. If you experience symptoms of uveitis, it’s important to seek care from an ophthalmologist to determine the cause and initiate appropriate treatment.