Uveitis: Ocular Inflammation
What is uveitis?
Uveitis (u-vee-ey-tis) is inflammation or swelling of the uvea. The uvea is the middle layer of the eye, which is comprised of the iris, ciliary body, and choroid. Inflammation can occur in any of these layers.
This type of uveitis occurs in the front part of the eye, which affects the iris. The iris is responsible for controlling the amount of light that enters the eye by changing the size of the pupil. This is the most common form of uveitis.
The middle portion, or ciliary body, of the uvea is inflamed in intermediate uveitis. The ciliary body controls the focusing system of the eyes by altering the shape of the crystalline lens based on the amount of focus needed.
The back of the eye, or choroid, is affected in posterior uveitis. Blood vessels that supply the retina travel through the choroid, which is located underneath the retina.
All three layers of the uvea (iris, ciliary body, and choroid) show inflammation in panuveitis.
What causes uveitis?
There are many different causes of uveitis, and in some cases, a particular cause is not always determined. Uveitis can occur in one or both eyes in people of all ages, although it is more common in adulthood. When both eyes are affected, it is usually an indication that the source of the problem is a systemic or body-wide issue. The most common causes of uveitis include:
- Trauma or injury to the eye
- Recent eye surgery
- Autoimmune and inflammatory diseases
- Infections: herpes zoster (shingles), Lyme disease, syphilis
Certain autoimmune diseases, such as psoriatic arthritis, sarcoidosis, lupus, and inflammatory bowel disease, can lead to chronically occurring uveitis. Complications of reoccurring uveitis involve cataracts, glaucoma, and retinal detachment.
What are the symptoms of uveitis?
The main symptoms of uveitis include:
- Photophobia (light sensitivity)
- Eye pain
- Decreased or hazy vision
Most individuals also experience redness of the eyes. While this condition could be confused for “pink eye” or conjunctivitis, it is typically not contagious since an underlying infection is usually systemic.
How is uveitis diagnosed?
Taking a thorough history of both the current condition and overall health can help diagnose uveitis. It is important for an eye doctor to examine the eyes to confirm the diagnosis because there are several other problems that could mimic uveitis.
First, vision should be measured to ensure there is not a decrease in one eye versus the other. Then, eye pressure is checked, in addition to a slit lamp examination. Using a highly magnified light source, the doctor is able to visualize individual inflammatory cells in the front part of the eye when the room is dark. Inflammatory cellular deposits can adhere to the back of the cornea, which are also visible during examination. If new floaters are a primary symptom, a dilated exam is necessary to view the entire retina for inflammation.
What is the treatment for uveitis?
Uveitis treatment varies based on the type and source of uveitis. Most commonly, steroid eye drops are used for their anti-inflammatory properties. Pupil-dilating drops are also used for pain. When the pupil is exposed to different light conditions, it naturally constricts and dilates. Pain can occur when the swollen and sticky iris is constantly changing its shape. The dilating drops temporarily lock the iris into a stationary position to decrease iris movement. An antibiotic or antiviral medication may also be needed if the source of the uveitis is from an infection.
If an individual has experienced multiple episodes of uveitis, it is important to get bloodwork to rule out systemic conditions that could be causing the chronic problem. If an underlying condition is identified, it is necessary to treat the source. This can include medications for decreasing inflammation and suppressing the immune system, if related to an autoimmune condition. A rheumatologist is the specialist who typically manages the systemic disease aspect of uveitis.