What is it?
Uveitis (‘you-vee-eye-tiss’) generally refers to ocular inflammation. The Uvea is one of the three major layers of the eye comprising the coloured part of the eye and blood vessels which generates inflammation within the eye, when accidentally told to. Therefore, it is the layer in which the immune system is most involved in ocular health. Other names include iritis, vitritis, choroiditis and retinitis depending on the parts of the eye that are involved.
Inflammation is generally a normal bodily response to an injury, but when it occurs within the eye it is always abnormal. Uveitis can also be divided into anterior, intermediate, posterior or pan-uveitis, depending on the particular compartments of the eye involved. This then may give the eye doctor clues for the cause and direct treatment for it.
The outermost layer of the eye can also be involved which can be termed episcleritis or scleritis.
It is an uncommon spectrum of disorders, and whilst it is most common in young and middle aged adults, certain subtypes can affect children and the elderly.
What are the symptoms and complications?
Symptoms of uveitis can include;
- Red eye
- Sensitivity to light (photophobia)
- Blurred or loss of vision and
The key to diagnosis is through both adequate history taking and also observation at the slit lamp microscope visualising the inflammation within the eye.
Prolonged untreated inflammation can result in:
- Vision loss, through many mechanisms including the inflammation itself or macular oedema (swelling in the central retina)
- Cataract formation (lens clouding within the eye)
- Glaucoma development (raised pressure inside the eye leading to optic nerve damage)
- Potentially delayed diagnosis of associated systemic conditions (ie. if the eye trouble is the first indication of a wider spread bodily condition)
Investigation & Treatment
The cause of the inflammation guides the treatment. In general, the major causes of uveitis are:
- Non-infectious inflammatory
- Infectious agents
- Obscure or ‘masquerade’ conditions (ie certain medications) or
- No cause yet identified, undifferentiated or non-specific which is termed ‘idiopathic’
A thorough assessment is crucial which includes a complete history of other bodily systems to try and obtain a clue to the underlying cause. These may include questions about the skin, lungs, joints and other body parts. A complete eye examination, including dilating eye drops is almost always undertaken to ensure the eye is adequately treated. OCT scans are detailed pictures of the eye using harmless light rays to examine the back of the eye in great detail and are often used. Further medical tests such as blood tests, xrays and other radiological imaging (ie MRI) may be required.
Typically treatment is targeted at the underlying cause. Treatment is centered around anti-inflammatory medications (aka Corticosteroids) to limit the effect of inflammation and bring the process under control. If an infection is the cause, then medications to treat that infection are used in conjunction with anti-inflammatories. Anti-inflammatory treatment can include drops, injections or tablets. The decision for which is made on various factors including the site of inflammation involved, the patient’s individual medical considerations and potential side effects of medications. These are all discussed in detail prior to commencement and treatment individualised to the patients needs.
Generally Uveitis requires treatment for several weeks, months or even years and can become a longstanding chronic condition or recurrent in nature with ‘flare ups’. Sometimes the need for high dose or prolonged anti-inflammatory medication can result in the need for substitution with other immune therapies, which are typically introduced by a specialist with deep knowledge in those medications (aka Rheumatologist or Immunologist).
- Uveitis generally refers to ocular inflammation in the middle or the surface layer of the eye
- Its diagnosis may be delayed, such as red eye or blurred vision not responding to other treatment (ie conjunctivitis, dry eye etc)
- A key symptom is sensitivity to light, or eye pain which can be extreme
- Significant vision loss and other complications can occur if untreated
- It can be a sign of disease elsewhere in the body
- Causes are numerous but can include infectious, non infectious inflammatory, masquerade (medications or other medical conditions) but is commonly unproven or unknown
- Treatment centres around underlying related medical conditions, along with anti-inflammatory medication in the form of drops, tablets or injections
- Frequent visits are required to ensure there is response to treatment and side effects monitored, minimised and treated where present
- Examination visits often include dilating drops to allow a complete ocular examination and OCT scans, which are detailed pictures of the back of the eye monitoring for complications
- Treatment is often for months to years, and the condition may recur or ‘flare up’