Uveitis

By Peter Galvin, MD

The uvea makes up the middle part of the eye and includes the iris (eye color ring), ciliary body (eye focusing muscles), and the choroid (blood supply). Uveitis is inflammation of the uvea, and it is associated with up to 10% of visual impairment in the U.S. and Europe. Anterior uveitis, which accounts for about 60% of cases of uveitis, involves the iris and front part of the eye. Typical symptoms include eye pain, eye redness, and sensitivity to light. Intermediate uveitis involves the ciliary body and the vitreous humor (fluid that fills the eye) and typically causes painless blurry vision and floaters (spots/shapes in vision). Posterior uveitis involves the choroid and retina (tissue in the back of the eye) and can cause blurry or distorted vision or may cause no symptoms. Panuveitis, which accounts for about one-third of cases of uveitis, involves all parts of the uvea.

Uveitis typically occurs in people aged 20 to 50 years, although it can develop at any age. It can be associated with or caused by several inflammatory or autoimmune diseases, including Behcet disease, multiple sclerosis, sarcoidosis, juvenile idiopathic arthritis, psoriatic arthritis, and inflammatory bowel disease. It can also be caused by infections such as herpes, tuberculosis, HIV, syphilis, and toxoplasmosis. In addition, environmental factors such as pollution and cigarette smoking are associated with increased risk of uveitis. In the U.S. and Europe, approximately one-quarter to one-half of uveitis cases have no known cause.

Ophthalmologists diagnose uveitis using a slit lamp and a handheld lens to examine the eye. Anyone with symptoms such as eye pain, vision loss, or vision distortion should undergo urgent (same day) ophthalmologic evaluation. If infection is suspected, patients may have their eyes and blood tested for viral, fungal, and bacterial infections. Infectious uveitis is treated with antibiotics or antiviral medications. Initial treatment for noninfectious anterior uveitis is steroid eye drops. If these are ineffective or not well tolerated, steroid injections into the eye or implants that release steroids into the eye for several months may be prescribed. Oral steroids are recommended for severe noninfectious anterior uveitis that doesn’t respond to or worsens with steroid eye drops, injections, or implants.

First-line treatment for posterior uveitis is a disease-modifying antirheumatic drug (such as methotrexate). Biologic therapies (such as adalimumab) are second-line treatment for posterior uveitis. Patients with uveitis associated with an inflammatory or autoimmune condition should be evaluated by a specialist, usually a rheumatologist.

Untreated uveitis may cause vision-threatening complications such as cataracts, glaucoma, swelling of part of the retina (macular edema), optic nerve damage, retinal detachment, and vision loss. Therefore, patients with suspected uveitis should be promptly evaluated and treated. Unfortunately, prolonged use of oral steroids or steroid eye drops, injections, or implants increases the risk of glaucoma and cataracts.

For more information go to the website of the National Eye Institute at www.nei.nih.gov

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