Uveitis

Impact of Uveitis on Anatomy and Health

• Vision Impairment: Uveitis can lead to vision problems such as blurriness, floaters, sensitivity to light (photophobia), and decreased visual acuity. Severe cases can result in permanent vision loss.
• Eye Pain and Discomfort: Inflammation within the eye can cause pain, redness, and a sensation of pressure or discomfort.
• Complications: Uveitis can lead to various complications, including glaucoma (increased pressure within the eye), cataracts (clouding of the eye's lens), retinal detachment, and macular oedema (swelling of the central part of the retina).
• Secondary Effects: Uveitis can be associated with underlying systemic conditions such as autoimmune diseases (like rheumatoid arthritis, ankylosing spondylitis, or sarcoidosis) and infections (such as toxoplasmosis or herpes simplex). Treating the underlying cause is crucial to managing uveitis effectively.
• Chronicity: Uveitis can be acute (sudden onset) or chronic (lasting for an extended period). Chronic uveitis can require ongoing treatment and monitoring to prevent relapses and complications.

Risk Factors and Causes of Uveitis

• Age: While uveitis can occur at any age, it often affects people between 20 and 60.
• Genetics: Some genetic factors may increase the susceptibility to uveitis.
• Autoimmune Diseases: Individuals with autoimmune conditions such as rheumatoid arthritis, lupus, and ankylosing spondylitis have a higher risk of developing uveitis.
• Infections: Certain infections, such as toxoplasmosis, tuberculosis, and herpes simplex, can trigger uveitis.
• Injury or Trauma: Physical trauma to the eye can lead to uveitis.
• Family History: A family history of uveitis or other eye disorders might increase the risk.
• Gender: Some forms of uveitis appear more common in certain genders.
• Geographical Location: Uveitis rates might vary based on geographic location and environmental factors.
• Ethnicity: Certain ethnic groups might have a higher predisposition to uveitis.

What Are The Symptoms of Uveitis?

The symptoms of uveitis can vary depending on the specific part of the affected uvea and the underlying cause of the inflammation. Common symptoms include:

• Eye Redness: The affected eye may appear red or bloodshot.
• Eye Pain: Uveitis can cause varying degrees of eye discomfort or pain, described as aching, burning, or throbbing.
• Blurry Vision: Vision may become blurred or hazy.
• Sensitivity to Light (Photophobia): Bright lights can cause discomfort and increase sensitivity to light.
• Floaters: Floaters are dark spots or small specks that seem to "float" in the field of vision.
• Decreased Visual Acuity: Uveitis can lead to a decrease in central visual acuity.
• Increased Tearing: The eye might produce excessive tears.
• Small Pupil (Miosis): The pupil of the affected eye might become smaller.
• Changes in Iris Color: In some cases, uveitis can cause changes in the colour of the iris.
• Eye Discharge: There could be a discharge from the affected eye.
• Vision Loss: Severe or untreated uveitis can lead to permanent vision loss.

What are the Types of Uveitis? 

Uveitis is categorised based on the specific part of the uvea that's inflamed and the underlying cause of the inflammation. The main types of uveitis are:

• Anterior Uveitis: This type affects the front part of the eye and involves inflammation of the iris. It's the most common type of uveitis and often presents with symptoms like eye pain, redness, light sensitivity, and blurry vision.
• Intermediate Uveitis: Intermediate uveitis involves inflammation of the ciliary body, which is located in the middle of the eye. It might lead to floaters, blurry vision, and occasionally mild discomfort. This type is sometimes associated with conditions like multiple sclerosis.
• Posterior Uveitis: This type affects the back of the eye, specifically the choroid. It can cause symptoms like floaters, blurry or distorted vision, and visual field loss.
• Panuveitis: Panuveitis involves inflammation of all parts of the uvea—front, middle, and back of the eye. It's a more severe and less common form of uveitis that can have a greater impact on vision.
• Iridocyclitis refers to inflammation of the iris and the ciliary body, which often occurs together in anterior uveitis.
• Chorioretinitis: Chorioretinitis involves inflammation of both the choroid and the retina. It's usually a form of posterior uveitis, leading to blurred vision and visual disturbances.
• Focal vs. Diffuse Uveitis: Uveitis can also be classified based on the pattern of inflammation. Focal uveitis affects a specific part of the eye, while diffuse uveitis involves inflammation throughout a larger area.

How is Uveitis Diagnosed? 

Diagnosing uveitis involves a combination of a medical history review, thorough eye examination, and sometimes additional tests to determine the underlying cause and extent of the inflammation. Here's how uveitis is typically diagnosed:

• Medical History: Your doctor will inquire about your symptoms, their duration, any previous eye conditions, general health, and any systemic diseases you might have.
• Eye Examination: A comprehensive eye examination is essential. This includes assessing visual acuity, examining the front and back of the eye using a slit lamp microscope, and checking for signs of inflammation in the uvea and other eye structures.
• Pupil Dilation: Dilating the pupils allows the doctor to examine the peripheral parts of the retina and the vitreous humour (gel-like substance inside the eye) for signs of inflammation or damage.
• Additional Tests: Depending on the suspected cause and severity of uveitis, your doctor might order additional tests such as blood tests, imaging studies (like optical coherence tomography or fluorescein angiography), and sometimes a sample of the aqueous humour (the fluid in the front part of the eye) for laboratory analysis.

How Can Uveitis Be Treated?

The treatment of uveitis aims to reduce inflammation, manage symptoms, and prevent complications. The approach depends on the type, severity, and underlying cause of uveitis. Treatment options include:

• Topical Corticosteroids: These are eye drops or ointments that help reduce inflammation in the eye.
• Oral Corticosteroids: In more severe cases or when the inflammation affects other body parts, oral corticosteroids might be prescribed.
• Immunosuppressive Medications: These drugs help control the immune system and are often used in chronic or more severe uveitis cases.
• Biologic Agents: Biologic medications that target specific immune responses might be considered for certain types of uveitis linked to autoimmune diseases.
• Antibiotics or Antiviral Medications: If an infection is causing uveitis, appropriate antimicrobial treatment is essential.
• Intraocular Injections: Injections of corticosteroids or other medications directly into the eye might be used for certain cases.
• Surgery: Surgical intervention might be necessary in cases of complications like cataracts or glaucoma.

What if Uveitis is Untreated?

If left untreated, uveitis can lead to several complications that can severely impact vision and eye health, including:

• Vision Loss: Inflammation can damage the delicate structures of the eye, leading to irreversible vision loss.
• Glaucoma: Increased pressure within the eye due to inflammation can damage the optic nerve, causing glaucoma.
• Cataracts: Chronic inflammation can lead to the development of cataracts, clouding the eye's lens and affecting vision.
• Retinal Detachment: Inflammation might cause the retina to detach, leading to severe visual impairment.
• Macular Oedema: Swelling in the central part of the retina (macula) can lead to distorted or blurry central vision.
• Secondary Complications: Untreated uveitis can exacerbate underlying systemic conditions and lead to more systemic complications.

It's crucial to seek prompt medical attention if you suspect you have uveitis or experience any symptoms related to your eyes. Early diagnosis and appropriate treatment are key to preventing these complications and preserving your vision and overall eye health.