Uveitis: Causes, Symptoms and Treatment
The term uveitis is used to designate inflammation of the uvea, which is the middle layer of those that make up the eyeball (made up of the iris, the ciliary body and the choroid).
What is uveitis?
Uveitis is generally considered any intraocular inflammation that occurs between the retina and the sclera (white part of the eye). The uvea is very important because it is made up of a wide variety of blood vessels that carry blood in and out of the eye, therefore, any inflammation in it can cause damage to vision.
The circulation of the anterior and posterior face maintains a relative individuality between the parts, which is why the division between anterior uveitis can be established, which will include iritis, cyclitis and mixed forms (irodocyclitis), and posterior uveitis that includes choroiditis. Only the inflammations of the anterior uvea produce a red eye.
How many types are there?
Anterior uveitis or iridocyclitis
It is the most common type of uveitis. It occurs suddenly and associated with autoimmune diseases in generally healthy and young patients. It can be unilateral (just one eye), and its symptoms can last up to two months. This type of anterior uveitis can be chronic or recurrent. Generally the prognosis of the anterior type of uveitis is good and patients usually recover without problems.
Intermediate uveitis or parsplanitis
It arises when the uvea is inflamed in the center of the eye, between the iris and the choroid. They can last from a couple of weeks to years. It is more common in young men and is not associated with any disease, although there is some relationship with Crohn’s disease and multiple sclerosis.
Posterior uveitis or choroiditis
This type of uveitis develops very slowly and can last for several years as it affects the entire back of the eye. If the condition reaches the retina, this uveitis is called chorioretinitis. In addition, a certain turbidity of the vitreous humor can be associated with this type of uveitis. The condition may be related to a systematic infection or immune-type diseases. The eye is usually not red and the patient notices blurred vision and floaters due to the turbidity of the vitreous humor. If the focus of the inflammation affects the macula, there is also a significant loss of vision.
Inflammations in the entire uveal tract are known as panuveitis (endophthalmitis).
Uveitis in pregnancy
If a pregnant woman becomes infected with toxoplasma, lesions can occur in the choroid and the retina, even destroying both layers. This occurs when the parasite settles in the nervous tissue of the retina where it can manifest as a cyst with an inflammatory reaction. As a consequence, scars may also appear on the retina.
Causes of uveitis
Uveitis is an ocular pathology that is usually related to other diseases or systematic conditions that affect our body such as:
– Rheumatic diseases: arthritis, Behcet’s disease or sarcoidosis.
– Infectious diseases: tuberculosis, syphilis, toxoplasmosis, the herpes zoster virus, etc.
– Ankylosing spondylitis.
– Because of the HIV virus.
– Kawasaki disease (affects the coronary arteries and occurs mainly in children under five years of age).
What are the symptoms?
For anterior uveitis, the symptoms are mainly:
– Pain: it is the dominant manifestation. It is acute and neuralgic in the eye, which is aggravated by exposure to light and palpation. It can also be associated with tearing.
– Decreased vision: it appears from the first moments and is due to corneal exudation, turbidity of the aqueous and pupillary or cyclitic membrane.
For posterior uveitis, they are mainly:
– There are no signs of pain, so it usually goes unnoticed by the patient unless the posterior pole in the area of the macular region is affected or the condition is very intense.
– Scotoma (area of blindness or black point): it is the main manifestation due to the involvement of the underlying retina with destruction of photoreceptors whose nutrition depends on the choroidal vessels.
– Turbidity of vision due to diffuse opacity of the vitreous that may be accompanied by myodesopsia due to vitreous detachment.
– Metamorphopsia (distorted vision): when the macular region is partially affected.
Diagnosis of uveitis
Diagnosis is often difficult. Furthermore, since it is related to other systemic diseases, not all possible research methods that could generate an unnecessary disorder to the patient can be applied. However, through an adequate eye examination and a correct anamnesis (collection of data in the medical history), causal agents can be found and the investigation focused. The eye examination will be performed with a slit lamp to determine the existence of ciliary injection, posterior synechiae, turbidity of the aqueous and opacity of the lens.
Treatment of uveitis
One of the main factors to consider in treating uveitis is trying to minimize the inflammatory reaction. For this, the specialist will carry out the following procedure:
– Pupillary dilation (mydriasis) and cycloplegia during the active phase of the process to keep the muscles that make up the eyeball at rest to relieve pain.
– Anti-inflammatory treatment: especially with corticosteroids applied topically in the anterior uveitis or systematically in the posterior.
– They can also be administered subconjunctivally, although this should always be done by a specialized ophthalmologist. The most commonly used topical corticosteroids are dexamethasone and prednisolone, preferably in eye drops. Other non-corticosteroid anti-inflammatory drugs are salicylates, phenylbutazone, or oxyphenbutazone.
– Antibiotic treatment: mainly indicated in purulent forms. It must be administered topically, subconjunctivally, systematically and, in some cases, by intraocular injection.
– Immunosuppressants: for those more serious cases when the previous treatment has failed. It must be controlled by a hematologist.
– Surgical intervention: in those cases in which a complication arises from intraocular inflammation such as cataract, glaucoma or retinal detachment.
Prevention of uveitis
The main prevention of uveitis is early detection with a consultation visit in which a specialist investigates the cause of the inflammation. Consult with your specialist ophthalmologist and obtain more information about this delicate ocular pathology.