Uveitis refers to inflammation of the uvea, which is the middle layer of the eye comprising the choroid, ciliary body and iris. Other areas of the eye, such as the vitreous, retina and optic nerve may also be involved.
It is an uncommon condition, estimated to affect 2 to 5 people in 10,000 every year. Adults between the age of 20 and 59 are most likely to be affected, particularly those that suffer from other inflammatory or immune conditions.
A patient presenting with symptoms of uveitis requires urgent examination and treatment in order to prevent long-term complications such as blindness from occurring.
There are four different types of uveitis, depending on the area of the uvea that is affected. This include:
- Anterior uveitis in the front of the eye. This is the most common type that affects people of all ages including young and otherwise healthy people.
- Intermediate uveitis usually presents in the vitreous of the eye and commonly affects young adults.
- Posterior uveitis affects the back area of the eye, usually the retina and choroid. It is the rarest form of uveitis and may sometimes be referred to as choroiditis or chorioretinitis.
- Pan-uveitis is a broad term that is used to describe inflammation that affects all three major areas of the eye. A clinical example of this type if Behcet’s disease, which can cause significant damage to the retina.
Uveitis is caused by an inflammatory response in the eye, which naturally occurs following tissue damage or the presence of germs or toxins. Possible causes for the inflammation include:
- Autoimmune response where the body’s immune system attacks its own natural cells.
- Mechanical damage to the eye that causes bruising
- Bacteria or toxins that penetrate the eye
- Tumors within the eye or other related parts of the body
In some cases, however, the specific cause in unknown.
Uveitis may be associated with inflammation of one eye or both, depending on the cause and specific conditions of the inflammation.
Patients may notice symptoms such as:
- Blurred vision
- Floaters or dark spots in vision
- Pain in the eyes
- Redness of the eyes
If significant eye pain, light sensitivity or vision changes are noted, the patient should be referred to an ophthalmologist for an eye examination as soon as possible.
The primary aim of treatment is to eliminate inflammation, which will help to relieve pain, prevent further tissue damage and restore any vision abnormalities or loss.
The specific treatment plan depends on which type of uveitis is evident and the severity of symptoms. Anterior uveitis, for example, is associated with less severe complication and can usually be managed adequately with eye drops, whereas other types may require more aggressive treatment.
Non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended for administration into the eye via drops or an injection, or orally. Steroid medications may also be recommended in some instances, although long-term use of these medications is associated with adverse effects such as stomach ulcers, osteoporosis and Cushing’s syndrome.
In more severe cases, immunosuppressive agents such as methotrexate, mycophenolate, azathioprine and cyclosporine may be recommended, although they require regular blood tests to monitor the effect. Biologic response modifiers can be used when other treatments have failed, as they target specific elements of the immune system but may increase risk of cancer.