What are Uveitis and its Causes

2021-08-23

If you have been experiencing eye pain, redness, blurry vision, floaters (dark, floating spots in the vision), and sensitivity to light ‎(photophobia)‎, it could be uveitis.

Uveitis is an inflammatory disease that can affect the uvea, lens, retina, optic nerve, and vitreous; they are different parts of your eyes, and uveitis is named after the uvea. These parts mentioned above are susceptible to inflammation and damage.

When and where does it occur?

Uveitis can present itself in one or both eyes. It can be part of an inflammatory disease affecting other parts of the body‎. It usually happens in the form of a short (acute) or long (chronic) disease, with severe forms consisting of relapses of variable intensity.‎

Anyone can suffer from it, but it is more common in the 20-60 age range.

What causes uveitis?

Inflammatory responses inside the eye cause uveitis‎, and its origin is often unknown. Eyecare professionals usually differentiate between infectious and non-infectious uveitis, meaning that the disease either stems from toxins that penetrated the eye or an attack from your own body’s immune system (called autoimmunity) ‎. Other causes are bruises to the eye and tumors within the eye or elsewhere in the body.

Some of the diseases associated with uveitis are:

  • Histoplasmosis
  • Kawasaki disease
  • Behcet’s syndrome
  • CMV retinitis
  • Herpes zoster infection
  • Reactive arthritis
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Psoriasis
  • AIDS
  • Ulcerative colitis
  • Vogt Koyanagi Harada’s disease
  • Syphilis
  • Toxoplasmosis
  • Ankylosing spondylitis
  • Sarcoidosis
  • Tuberculosis

 

How many kinds of uveitis are there?

Ophthalmologists classify uveitis into four groups depending on the parts of the eye involved in the inflammatory process:

  • Anterior uveitis
  • Posterior uveitis
  • Intermediate uveitis
  • Panuveitis

Anterior uveitis: Anterior uveitis is the most common form of uveitis and occurs in the front part of the eye. It is often of infectious origin, or it can represent the first stage of the disease.

Intermediate uveitis:‎ Intermediate uveitis is commonly found in young adults and is linked to ‎ sarcoidosis and multiple ‎sclerosis.‎ The vitreous ‎ is often the center of the ‎inflammation. This type of uveitis is characterized by blurred vision and floaters but not pain.

Posterior uveitis: ‎Posterior uveitis is the rarest form of uveitis and can result in vision loss. It occurs mainly in the ‎back of the eye and often involves both the retina and the choroid. It is also called ‎choroiditis or chorioretinitis.

Its causes are numerous, both infectious and non-infectious. It can only be ‎identified through an eye examination.‎

Panuveitis: When all three major parts of the eye are inflamed, ophthalmologists speak of Panuveitis‎. It can cause severe damage to the retina and is usually linked to Behcet’s disease.

What to expect at a doctor’s appointment?

Your ophthalmologist will proceed to check your eyes for the typical signs of uveitis and confirm whether it is anterior, intermediate, and posterior, or panuveitis.

The eye specialist may request laboratory tests to rule out an infection ‎or an autoimmune disorder apart from examining your complete medical history.‎

Moving on to the actual eye exam, you will probably face:

  • An Eye Chart or Visual Acuity Test; to measure how well you can see
  • A Funduscopic Exam; the doctor will dilate (widen) your pupil with eye drops and use a light to inspect the back inside the eye. This is a non-invasive and painless procedure
  • An Ocular Pressure Measurement is performed with a tonometer or tonopen that measures the pressure inside your eye. It could be necessary to use drops that numb the eye. Or an Air-Puff Tonometry, a non-contact measurement that uses a rapid air pulse. Although there is some controversy about its accuracy, modern devices are considered quite reliable. This step is completely painless
  • A Slit Lamp Exam; to non-invasively inspect the rest of your eye. Some lamps include a tonometer to measure eye pressure.

How is uveitis treated?

The treatments for uveitis aim to eliminate inflammation, reduce pain, and stop tissue damage. This leads to vision restoration and a better quality of life overall. Depending on the type of uveitis, treatments can include medicine or surgery.

Two of the most effective remedies are corticosteroid eye drops and injections around or inside the eye. They target the eye exclusively, while immunosuppressive agents taken by mouth may be preferred when the disease occurs in both eyes or the back (posterior or panuveitis).

Steroidal anti-inflammatory medication ‎may take the form of eye drops, pills, injections around or into the eye, blood infusions, or surgically implanted capsules inside the eye.

 Long-term steroid use may result in the following side effects;

Anterior uveitis may be treated with eye drops that dilate the pupil and eye drops containing steroids to treat the four types of uveitis. While intermediate, posterior, and panuveitis are usually treated with injections ‎around the eye, pills, or ‎surgically implanted capsules.‎

Methotrexate, mycophenolate, azathioprine, and cyclosporine are commonly used immunosuppressive agents in such cases. Biologic response modifiers (BRM) or biologics like adalimumab, ‎infliximab, daclizumab, abatacept, and rituximab are valid alternatives to the initial immunosuppressive agents mentioned.

However, these treatments is not a prescription, visit your doctor for that and  these treamenet can produce side effects and require regular blood tests.

 

Written By: Silvia Romano