Intraocular Inflammation / Uveitis

What is uveitis?

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The eye can be divided into different layers. The outside of the eye is called the sclera and it is covered by a transparent tissue called the conjunctiva. The sclera is the white part of the eye that you can see. The middle part of the eye is called the uvea. The uvea is made up of the iris (the colored part of the eye that you can see), ciliary body, and choroid layer of blood vessels. The inner layer of the eye is the retina. The retina can only be seen by your doctor after your eye is dilated. Technically, uveitis is inflammation of the uvea, the middle part of the eye. However uveitis is used as a general term to describe inflammation occurring in any part of the eye including in the vitreous, optic nerve, and retina.

What are the symptoms of uveitis?

Depending on the severity and type of the uveitis the patient may experience varying degrees of some or all of the following symptoms:

  • Eye pain
  • Redness of the white part of the eye
  • Blurry vision
  • Floaters or spots in the vision
  • Light sensitivity

What are the different types of uveitis?

Uveitis is generally divided into three types: anterior (front of the eye), intermediate (middle part of the eye), and posterior (back part of the eye). There is also a type called pan-uveitis which affects the entire eye and is typically a very severe form of uveitis.

  • Anterior Uveitis is the most common type of uveitis and results from inflammation of the iris and/or ciliary body. Most patients with this type of uveitis experience the classic symptoms of eye discomfort, eye redness, and light sensitivity.

  • Intermediate Uveitis results from inflammation of the vitreous. This type of uveitis is generally painless and the eye does not always look red on exam. The most common symptom is floaters.

  • Posterior Uveitis results from inflammation of the retina and choroid. It is the least common type of uveitis but generally the most severe. Symptoms vary but vision loss is common.

What causes uveitis?

There are several causes of uveitis including inflammatory/autoimmune conditions, infections, trauma, and even cancer. The location of the uveitis, whether it affects one or both eyes, and how long it has been present can all be clues as to what may cause it. However in some cases, especially in anterior uveitis, we may not be able to determine the cause of the inflammation. The following lists a few conditions that may be associated with uveitis.

  • Idiopathic (unknown cause)
  • Ankylosing spondylitis
  • Acute retinal necrosis
  • Birdshot Chorioretinopathy
  • Candidiasis
  • Cytomegalovirus
  • Endophthalmitis
  • Herpes Simplex/Zoster
  • Inflammatory bowel disease
  • Intermediate Uveitis/Pars Planitis
  • Leukemia
  • Lyme disease
  • Lymphoma
  • Multiple Sclerosis
  • Reactive arthritis
  • Sarcoidosis
  • Syphilis
  • Toxocariasis
  • Toxoplasmosis
  • Tuberculosis
  • Vogt-Koyanagi Harada Syndrome

How is uveitis diagnosed?

Your doctor will take a detailed history and do a complete dilated eye exam. Additional testing, such as OCT and fluorescein angiography may also be done. Depending on what your doctor finds on examination, laboratory testing may also be ordered to help determine the cause of the uveitis.

How is uveitis treated?

Any underlying conditions associated with the uveitis should be evaluated and treated appropriately. The inflammation from the uveitis may cause a wide range of complications including eye pain, scar tissue formation, high eye pressure (glaucoma), and swelling in the retina (macular edema). Treatments are aimed at reducing or eliminating these complications. Steroids, usually in the form of eye drops or injections in or around the eye, are commonly used to combat inflammation. In some cases steroids may need to be surgically implanted in the eye or given orally. Eye drops that dilate the eye may also be used to alleviate pain and reduce scarring in the front of the eye. In advanced or refractory cases, such as posterior uveitis, patients may also need to begin long-term treatment with immunosuppressive medications. In these instances your doctor will work closely with a rheumatologist to determine the best treatment while minimizing any side effects from the medication.