Uveitis (patient information)

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 * Assistant Editor(s)-In-Chief: Erin E. Lord

Overview
Uveitis specifically refers to inflammation of the uvea. The uvea consists of the iris, ciliary body, and choroid, and it provides most of the blood supply to the retina. Uveitis may occur in either eye or both eyes.

Uveitis may be classified into the following forms, depending on which part of the uvea is primarily affected by the inflammation:
 * Anterior uveitis involves inflammation in the front part of the eye. It is the most common form of uveitis, making up 40-70% of all uveitis cases .   It is often called iritis because it is usually only effects the iris.


 * Intermediate uveitis (also known as cyclitis, pars planitis, or vitritis) involves inflammation of the ciliary body, the vitreous humor, and the front end of the retina. This is the least common form of uveitis, constituting 7-15% of cases.


 * Posterior uveitis (also known as choroiditis if just the choroid is involved, or chorioretinitis if the retina is also involved) affects the back part of the uvea and involves primarily the choroid, a layer of blood vessels and connective tissue in the middle part of the eye. It can also involve inflammation of the retina and optic nerve. It makes up 15-22% of all uveitis cases.


 * Panuveitis is the inflammation of the entire uvea, and it effects all layers of the uvea.

What are the symptoms of uveitis?
Uveitis can affect one or both eyes. Symptoms may develop rapidly and may vary depending on the form of uveitis: Anterior uveitis
 * Light sensitivity
 * Eye redness, tenderness, or pain
 * Difficulty focusing on objects

Intermediate and Posterior Uveitis
 * Floaters
 * Blurry vision
 * Difficulty focusing on objects
 * Chronic inflammation lasting for at least six weeks

Panuveitis
 * Floaters
 * Blurry vision
 * Vision loss

What are the causes of uveitis?
Uveitis can have many causes, including injury to the eye, viruses, bacteria, parasites, and exposure to toxic substances such as acid. Uveitis can also be caused by inflammatory diseases, autoimmune disorders such as rheumatoid arthritis or ankylosing spondylitis, or genetics. However, in many cases the cause is unknown.

Uveitis can be associated with any of the following:


 * AIDS
 * Ankylosing spondylitis
 * Behcet syndrome
 * CMV retinitis
 * Herpes zoster infection
 * Histoplasmosis
 * Injury
 * Kawasaki disease
 * Psoriasis
 * Reactive arthritis
 * Rheumatoid arthritis
 * Sarcoidosis
 * Syphilis
 * Toxoplasmosis
 * Tuberculosis
 * Ulcerative colitis

Additionally, the causes may vary depending on the form of uveitis:
 * Anterior uveitis may be associated with autoimmune diseases, but most cases occur in healthy people for unapparent reasons. The disorder may affect only one eye. It is most common in young and middle-aged people.


 * Intermediate uveitis usually occurs in young men and is generally not associated with any other disease. In most cases, the cause is unknown .  However, some evidence suggests it may be linked to Crohn's disease and possibly multiple sclerosis.


 * Posterior uveitis may develop in people who have an autoimmune disease or who have had a systemic (body-wide) infection. The most common cause of posterior uveitis is infections resulting from toxoplasmosis

Who is at highest risk?
People of all ages and both sexes can develop uveitis, although it is more common in women. Additionally, people are more likely to develop uveitis as they age.

How to know you have uveitis?
A complete medical history and comprehensive eye examination must be performed by an optometrist or ophthalmologist to properly diagnosis uveitis. Laboratory tests may be done to rule out infection or an autoimmune disorder.

Persons over age 25 with intermediate uveitis should have an MRI of their brain and spine to rule out multiple sclerosis.

When to seek urgent medical care
Call for an appointment with your health care provider if you have symptoms of uveitis (e.g. eye pain or reduced vision). Uveitis requires an urgent referral and thorough examination by an optometrist or ophthalmologist along with urgent treatment to control the inflammation.

Treatment options
Generally speaking, uveitis is typically treated with glucocorticoid steroids, either as topical eye drops (prednisolone acetate) or oral therapy with corticosteroids. In addition to corticosteroids, topical cycloplegics, such as atropine or homatropine, may be used. In some cases an injection of PSTTA (posterior subtenon triamcinolone acetate) can also be given to reduce the swelling of the eye.

If the uveitis is caused by a body-wide infection, treatment may involve antibiotics and powerful anti-inflammatory medicines called corticosteroids.

Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatment with Infliximab or other anti-TNF's infusions may prove helpful.

More specifically, the treatment regimen differs among the various forms of uveitis:


 * Anterior Uveitis is usually mild. Treatment may involve: dark glasses, eye drops that dilate the pupil to relieve pain, and steroid eye drops or ointment. In the event that uveitis is unresponsive to drops and ointments, steroids may be injected next to the eye and rarely, steroid pills may be prescribed.  Additionally, if the uveitis causes an increase in eye pressure, the doctor may lower the pressure to avoid damage to the optic nerve by prescribing eye drops.


 * Intermediate Uveitis and Posterior Uveitis treatment often depend on the underlying cause of the inflammation. If the cause is non-infectious, treatment is administered to reduce inflammation, often through the use of corticosteroids.  If the cause is infectious, treatment must involve an anti-infective agent. Additional specialists in infectious disease or autoimmunity may be needed for such diseases as syphilis, tuberculosis, AIDS, sarcoidosis, or Behcet's syndrome.  Intermediate uveitis is often treated with steroid eye drops, whereas posterior uveitis would have to be treated with steroid pills, as eye drops and ointments cannot reach the back of the eye.

Where to find medical care for uveitis?
Directions to Hospitals Treating uveitis

Prevention of uveitis
Treatment of an underlying disorder may help to prevent uveitis in persons with a body-wide (systemic) infection or disease.

What to expect (Outlook/Prognosis)?
When left untreated, uveitis can lead to permanent vision loss. Additionally, a more serious, potentially life-threatening medical condition could worsen if the uveitis is caused by an underlying disorder that is left untreated. Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States.

With proper treatment, most attacks of anterior uveitis go away in a few days to weeks. However, relapses are common.

Inflammation related to posterior uveitis may last from months to years and may cause permanent vision damage, even with treatment.

Possible complications of uveitis include:
 * Cataracts
 * Fluid within the retina
 * Glaucoma
 * Retinal detachment
 * Vision loss

Additional links
http://www.nlm.nih.gov/medlineplus/ency/article/001005.htm