Disease: Uveitis

    What is uveitis?

    Uveitis is inflammation of the 'uvea' of the eye. The uvea is made up of three parts. The first part is the iris, which is the colored ring of tissue you can see in the mirror. The dark hole in the middle of the iris is the pupil. The second and third parts, which you cannot see directly when looking in a mirror, are the ciliary body and the choroid. They are located behind the iris. An ophthalmologist can visualize them using special examination equipment.

    Inflammation of the iris is called iritis. Inflammation of the ciliary body is called intermediate uveitis or cyclitis. Inflammation of the choroid is called choroiditis. Inflammation of all three is called panuveitis.

    What causes uveitis?

    There are several causes of uveitis, including autoimmune disorders (such as sarcoidosis, rheumatoid arthritis, systemic lupus erythematosus, Behcet's disease, and ankylosing spondylitis), infections (such as syphilis and toxoplasmosis), and trauma. Additionally, some are “idiopathic,” meaning the cause is unknown.

    What are symptoms of uveitis?

    Symptoms of uveitis can include some or all of the following:

    • Aching, painful eye(s)
    • Red, bloodshot eye(s)
    • Sensitivity to light (increased pain when eyes are exposed to light, called photophobia)
    • Blurred, cloudy vision
    • Floaters (random spots in the visual field)

    What are the signs of uveitis?

    Aside from the redness of the eye(s), the only other visible signs of uveitis are microscopic and can be seen by an ophthalmologist using a slit lamp microscope. Inflammatory white blood cells can be visualized in and around the uvea portion of the eye and in the front portion of the eye under the cornea (the anterior chamber).

    What are the different types of uveitis?

    The different types of uveitis are classified based on which parts of the uvea are affected: iritis (iris), cyclitis or intermediate uveitis (ciliary body), choroiditis (choroid), or panuveitis (all three parts of the uvea).

    Different types are then further classified by cause: autoimmune (when associated with an autoimmune disease in the body), infectious (when caused by a bacteria, virus, fungus, or parasite), traumatic (after trauma to either eye), or idiopathic (no identifiable cause).

    What other medical conditions are associated with uveitis?

    Several autoimmune diseases can be associated with uveitis: sarcoidosis, lupus, rheumatoid arthritis, and multiple sclerosis, to name a few. Several infections in the body can also be associated: tuberculosis, Lyme disease, syphilis, herpes zoster (shingles), and others.

    How is uveitis diagnosed?

    An ophthalmologist will ask several questions about the symptoms, both in the eye(s) and the rest of the body (for example, about painful joints, weight changes, skin rashes, etc). The doctor will also need a detailed history of any existing medical conditions and family history of medical disorders.

    The vision and eye pressures will be measured, and the examination will involve careful observation of all parts of the eyes.

    Though there are several types of uveitis, they all have one thing in common: invasion of white blood cells (immune cells of inflammation found in the bloodstream) from inside the blood vessels of the uvea to outside the blood vessels. These white cells permeate the uveal tissue and also leak out of the uvea into other parts of the eye. This presence of white blood cells is what an ophthalmologist looks for when making the diagnosis. Using a slit lamp, an ophthalmologist can detect white blood cells accumulating in different parts of the eye.

    Iritis can present as 'subclinical' with no white blood cells visible, or as subtle microscopic white blood cells floating in the aqueous, the liquid in front of the iris. Sometimes uveitis is not so subtle with large numbers of cells visible and accumulations on the back of the cornea (the clear “dome-shaped” front cover of the eye). These clusters of cells are referred to as 'mutton fat deposits.' In extreme cases, the cells can also form a large pool in the space between the iris and the cornea. This is referred to as a 'hypopyon.'

    Cyclitis (intermediate uveitis) presents as white blood cells floating in the clear material just behind the iris (the vitreous) and collections of cells on the surface of uveal tissues behind the iris. Similarly, choroiditis presents as cells in the vitreous and uveal tissue, but further posterior (towards the back of the eye). An ophthalmologist will likely need to dilate the patient's eyes and use special examination techniques to visualize this.

    If an associated medical disease is suspected, additional tests or consultation with other specialists may be necessary to identify the condition. These tests might include laboratory evaluation of a small sample of aqueous or vitreous liquid from the eye, blood tests, and/or X-rays. These tests take time. Therefore, usually a treatment plan is initiated based on a clinical judgment before the cause can be definitively identified.

    What is the treatment for uveitis?

    Because uveitis is an inflammatory condition, the urgent treatment centers on control of the inflammation. This can be achieved with steroids given as eye drops, injection in or around the eye, orally (by mouth), or intravenously, depending on the extent and severity of the inflammation.

    In certain situations, alternatives to steroids (such as indomethacin, methotrexate, and others) may be used.

    The duration of the treatment may be as short as a week or several months or even years, depending on the cause.

    If the cause is infectious, an anti-infective medication will also be used (for example antibiotic, antiviral, or antifungal) to combat the underlying infectious agent.

    What is the prognosis for uveitis?

    The prognosis varies tremendously: some types are mild and occur only once, never to recur again. Others recur repeatedly over the years, coming and going at seemingly random and unpredictable intervals. Still other types never completely subside and linger for years, requiring chronic treatment to prevent flare-ups.

    What are the complications of uveitis?

    Uveitis has many potentially serious complications that can lead to permanent, irreversible vision loss. For this reason, it is imperative that uveitis be treated rapidly and to the best extent possible.

    If the inflammation continues unchecked, complications may include sudden or chronic rises in eye pressure that can lead to permanent damage of the optic nerves, resulting in irreversible vision loss (glaucoma). The inflammation can also damage delicate cells on the cornea and retina, causing fluid buildup that blurs and damages the vision, sometimes irreversibly.

    For these reasons, uveitis should ideally be treated as aggressively as possible. The medications used to treat uveitis have side effects of their own, some of them serious. The ophthalmologist, often together with the patient's other doctor(s), balances the risks and benefits of the drug(s) against the potential damage that can result from undertreated uveitis.

    What are symptoms of uveitis?

    Symptoms of uveitis can include some or all of the following:

    • Aching, painful eye(s)
    • Red, bloodshot eye(s)
    • Sensitivity to light (increased pain when eyes are exposed to light, called photophobia)
    • Blurred, cloudy vision
    • Floaters (random spots in the visual field)

    What are the signs of uveitis?

    Aside from the redness of the eye(s), the only other visible signs of uveitis are microscopic and can be seen by an ophthalmologist using a slit lamp microscope. Inflammatory white blood cells can be visualized in and around the uvea portion of the eye and in the front portion of the eye under the cornea (the anterior chamber).

    What are the different types of uveitis?

    The different types of uveitis are classified based on which parts of the uvea are affected: iritis (iris), cyclitis or intermediate uveitis (ciliary body), choroiditis (choroid), or panuveitis (all three parts of the uvea).

    Different types are then further classified by cause: autoimmune (when associated with an autoimmune disease in the body), infectious (when caused by a bacteria, virus, fungus, or parasite), traumatic (after trauma to either eye), or idiopathic (no identifiable cause).

    What other medical conditions are associated with uveitis?

    Several autoimmune diseases can be associated with uveitis: sarcoidosis, lupus, rheumatoid arthritis, and multiple sclerosis, to name a few. Several infections in the body can also be associated: tuberculosis, Lyme disease, syphilis, herpes zoster (shingles), and others.

    How is uveitis diagnosed?

    An ophthalmologist will ask several questions about the symptoms, both in the eye(s) and the rest of the body (for example, about painful joints, weight changes, skin rashes, etc). The doctor will also need a detailed history of any existing medical conditions and family history of medical disorders.

    The vision and eye pressures will be measured, and the examination will involve careful observation of all parts of the eyes.

    Though there are several types of uveitis, they all have one thing in common: invasion of white blood cells (immune cells of inflammation found in the bloodstream) from inside the blood vessels of the uvea to outside the blood vessels. These white cells permeate the uveal tissue and also leak out of the uvea into other parts of the eye. This presence of white blood cells is what an ophthalmologist looks for when making the diagnosis. Using a slit lamp, an ophthalmologist can detect white blood cells accumulating in different parts of the eye.

    Iritis can present as 'subclinical' with no white blood cells visible, or as subtle microscopic white blood cells floating in the aqueous, the liquid in front of the iris. Sometimes uveitis is not so subtle with large numbers of cells visible and accumulations on the back of the cornea (the clear “dome-shaped” front cover of the eye). These clusters of cells are referred to as 'mutton fat deposits.' In extreme cases, the cells can also form a large pool in the space between the iris and the cornea. This is referred to as a 'hypopyon.'

    Cyclitis (intermediate uveitis) presents as white blood cells floating in the clear material just behind the iris (the vitreous) and collections of cells on the surface of uveal tissues behind the iris. Similarly, choroiditis presents as cells in the vitreous and uveal tissue, but further posterior (towards the back of the eye). An ophthalmologist will likely need to dilate the patient's eyes and use special examination techniques to visualize this.

    If an associated medical disease is suspected, additional tests or consultation with other specialists may be necessary to identify the condition. These tests might include laboratory evaluation of a small sample of aqueous or vitreous liquid from the eye, blood tests, and/or X-rays. These tests take time. Therefore, usually a treatment plan is initiated based on a clinical judgment before the cause can be definitively identified.

    What is the treatment for uveitis?

    Because uveitis is an inflammatory condition, the urgent treatment centers on control of the inflammation. This can be achieved with steroids given as eye drops, injection in or around the eye, orally (by mouth), or intravenously, depending on the extent and severity of the inflammation.

    In certain situations, alternatives to steroids (such as indomethacin, methotrexate, and others) may be used.

    The duration of the treatment may be as short as a week or several months or even years, depending on the cause.

    If the cause is infectious, an anti-infective medication will also be used (for example antibiotic, antiviral, or antifungal) to combat the underlying infectious agent.

    What is the prognosis for uveitis?

    The prognosis varies tremendously: some types are mild and occur only once, never to recur again. Others recur repeatedly over the years, coming and going at seemingly random and unpredictable intervals. Still other types never completely subside and linger for years, requiring chronic treatment to prevent flare-ups.

    What are the complications of uveitis?

    Uveitis has many potentially serious complications that can lead to permanent, irreversible vision loss. For this reason, it is imperative that uveitis be treated rapidly and to the best extent possible.

    If the inflammation continues unchecked, complications may include sudden or chronic rises in eye pressure that can lead to permanent damage of the optic nerves, resulting in irreversible vision loss (glaucoma). The inflammation can also damage delicate cells on the cornea and retina, causing fluid buildup that blurs and damages the vision, sometimes irreversibly.

    For these reasons, uveitis should ideally be treated as aggressively as possible. The medications used to treat uveitis have side effects of their own, some of them serious. The ophthalmologist, often together with the patient's other doctor(s), balances the risks and benefits of the drug(s) against the potential damage that can result from undertreated uveitis.

    Source: http://www.rxlist.com

    Because uveitis is an inflammatory condition, the urgent treatment centers on control of the inflammation. This can be achieved with steroids given as eye drops, injection in or around the eye, orally (by mouth), or intravenously, depending on the extent and severity of the inflammation.

    In certain situations, alternatives to steroids (such as indomethacin, methotrexate, and others) may be used.

    The duration of the treatment may be as short as a week or several months or even years, depending on the cause.

    If the cause is infectious, an anti-infective medication will also be used (for example antibiotic, antiviral, or antifungal) to combat the underlying infectious agent.

    Source: http://www.rxlist.com

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