Uveitis

Uveitis is an umbrella term for a group of eye conditions that cause inflammation. This inflammation typically affects the uvea, the middle layer of your eye, but it can involve other parts too. If left untreated, uveitis can lead to permanent vision loss.

Anyone can get this eye condition, but it’s more common in women and people between 40 and 60. There’s no single known cause for most cases, but some potential triggers include infections, injuries, and autoimmune diseases.

Can uveitis affect both eyes?

Uveitis can strike one or both eyes. It can involve different parts of the eye, including:

• Retina: The light-sensitive layer at the back of the eye that transmits images to the brain.
• Uvea: The middle layer, consisting of the iris (colored part), choroid (blood vessel layer), and ciliary body (nutrient supplier).
• Sclera: The tough, white outer layer of the eye.

How common is uveitis?

Uveitis is a serious condition, that causes thousands to lose vision annually.

Who is at risk for uveitis?

Uveitis can affect anyone, including children. Women and people between 40 and 60 are slightly more susceptible.

Causes of Uveitis

Around one in three cases of this eye condition have unidentified causes. Smoking raises the likelihood of uveitis. Additionally, eye inflammation can arise from:

• Injuries to the eye
• Infections such as herpes, chickenpox, tuberculosis, or syphilis.
• Inflammatory disorders like lupus, inflammatory bowel disease (IBD), or rheumatoid arthritis
• Autoimmune diseases (where your body attacks itself)
• Certain medications

Types of uveitis

Doctors classify this eye condition based on the inflamed area of the eye. The main types are:

• Anterior uveitis: the most common type, affecting the front of the eye. Symptoms may appear suddenly and sometimes resolve on their own, if mild. Chronic cases exist where inflammation recurs after treatment. People with certain conditions, like arthritis, autoimmune diseases, or infections, are more susceptible to this type of infection.
• Intermediate uveitis: This type primarily affects young adults and inflames the middle part of the eye, including the vitreous (jelly-like center). Symptoms may fluctuate, improving and worsening over time. Individuals with multiple sclerosis or sarcoidosis are more at risk.
• Posterior uveitis: The least common but potentially most severe form targets the back of the eye, including the retina, optic nerve, and choroid. It can cause recurring symptoms lasting months or years. Potential causes include infections, autoimmune diseases, and syphilis.
• Panuveitis: This rare form involves inflammation throughout all three layers of the eye. It’s more serious and increases the risk of permanent vision loss. Causes can be similar to posterior uveitis.

Symptoms of Uveitis

• Blurred vision
• Floating dark shapes in your vision
• Eye pain or pressure
• Sensitivity to light
• Red eyes
• Vision loss

Risk Factors of Uveitis

Certain factors can increase your risk of getting this eye condition, including:

• Smoking
• Certain genes
• Autoimmune diseases
• Infections
• Tumors

Diagnosis

Eye specialists conduct various tests during an eye examination, including:

• A visual acuity test is used to assess vision.
• Ocular pressure tests are used to measure intraocular pressure.
• Slit-lamp examination for internal eye inspection.
• Dilated eye examination for enhanced internal eye examination. Additional tests may include:
• Blood tests to rule out infections or autoimmune diseases.
• Imaging scans of the chest or brain to identify systemic inflammatory causes.
• Fluorescein angiography for imaging of ocular blood vessels.
• Gonioscopy for examining the eye’s front region.
• Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) for detailed eye imaging.
• A visual field test is used to evaluate optic nerve damage and peripheral vision.

Treatments

The treatment depends on the cause and severity. Here’s a breakdown of common treatments:

• Eye drops: Usually containing corticosteroids to reduce inflammation.
• Dilating eye drops: Help prevent scarring and relax eye muscles to ease discomfort.
• Antibiotics or antivirals: If the cause is an infection.
• Oral medications or injections: For severe cases or when eye drops don’t work.
• Immunosuppressants are medications that dampen your immune system, typically used with corticosteroids.
• Implantable device: Slowly releases medication for long-term management.
• Vitrectomy: A surgical procedure to remove some of the gel-like substance inside your eye (vitreous) in some cases.

How Can Uveitis Be Prevented?

1. Maintain Good Overall Eye Health:
   • Regularly visit an eye care professional for comprehensive eye examinations.
   • Practice good eye hygiene, such as washing hands before touching eyes and avoiding eye trauma.
2. Seek Treatment for Associated Diseases or Infections:
   • Promptly address any underlying health conditions known to be associated with uveitis, such as autoimmune diseases or infections.
   • Adhere to prescribed treatment plans for these conditions to minimize the risk of uveitis development.
3. Quit Smoking:
   • Smoking cessation can reduce the likelihood of developing uveitis, as smokers are at a higher risk.
   • Seek support and resources to quit smoking, such as counseling, nicotine replacement therapy, or medication.

By implementing these preventive measures, individuals can take proactive steps to lower their risk of this eye condition and promote overall eye health.

What Complications Might Arise?

Approximately one in five uveitis patients develop ocular hypertension, escalating the risk of glaucoma and vision loss. Other potential complications include posterior synechiae, cataracts, cystoid macular edema, vitreous gel damage, retinal detachment, and vision loss.

What Is the Prognosis for Uveitis Patients?

Prompt treatment typically results in minimal long-term vision issues, with treatments halting disease progression and restoring lost vision. Severe cases may necessitate prolonged treatment, with a higher likelihood of vision loss or blindness. Regular eye exams are crucial for individuals at risk of the eye condition.

When to Seek Medical Attention?

Consult a healthcare provider if you are experiencing eye floaters, flashes, pain, redness, swelling, pressure, light sensitivity, or vision loss. Regular communication with eye care professionals is advised for those with predisposing factors or uveitis-related symptoms.

Sources:

• Mayo Clinic: “Uveitis.”
• The Ocular Immunology and Uveitis Foundation.
• University of Michigan Kellogg Eye Center: “Uveitis.”
• Psoriasis, “Psoriasis and uveitis: links and risks