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Uveitis

Uveitis

What is Uveitis?

Uveitis literally means inflammation of the "uvea" or the "uveal tissue" in our eyes.

Majority of the uvea inside our eyes lies sandwiched between various tissues and is not easily visible from the outside.

The only visible part of the uvea is the "iris" or one that gives a distinct colour to our eyes. So when we characterise a person as having "brown eyes" or "black eyes", we are simply looking at the color of his or her "iris tissue".

Since the iris is stationed in the anterior part of the eye, any inflammation of this iris or "iritis" is simply called "anterior uveitis".

Hence to simplify, any inflammation of the posterior part of the uvea is called "posterior uveitis" and if we have to characterise any inflammation in-between the anterior and posterior part is called "intermediate uveitis".

When all parts of the eye are affected, this most severe form of uveitis is called "pan uveitis".

One or both the eyes, simultaneously or one after another can be affected by uveitis.

How would you know that you may be suffering from uveitis?

Uveitis can affect people of all age groups.

Most cases of uveitis will be symptomatic with complaints such as "seeing floaters or cobwebs", "increased sensitivity to light", "redness", "pain" or "blurred or loss of vision".

At times, your symptoms may be very subtle and not to bother you at all.

Many of us would choose to brush away these subtle symptoms and skip a doctor's visit. Only eventually as the disease progresses in its late stages and endangers our vision, we would then rush to a specialist.

What causes Uveitis?

Most cases of uveitis may not point towards a "specific cause" even after investigating extensively.

In some others, there may be an "infective" or a "non-infective" cause that may present during the attack of uveitis or may come up sometime later.

Listed are a few causes of uveitis :

1) After an eye surgery or after trauma to the eyes.

2) The non-infective entities causing uveitis may have "a connection" with inflammation in other parts of the body. For example, people with joint pains or those suffering from an entity called as ankylosing spondylosis have a very likely chance of presenting with uveitis.

A few associated autoimmune and inflammatory disorders are as follows :

  • Vogt Koyanagi Harada disease
  • Ankylosing spondylitis
  • Juvenile idiopathic arthritis
  • Rheumatoid arthritis
  • Sarcoidosis
  • Systemic lupus erythematosus
  • Behcets disease
  • Inflammatory bowel disease such as Crohn's disease or ulcerative colitis
  • Multiple Sclerosis

3) Infections may be localised to the eyes or may be connected with an infection elsewhere in the body. It may be caused by a virus, bacteria, fungus or a parasite. A few common examples are as follows :

  • Tuberculosis
  • Herpes zoster
  • Toxoplasmosis
  • Syphilis
  • Cat-scratch disease
  • Lyme's disease
  • Histoplpasmosis
  • Cytomegalovirus
  • Candidiasis
  • AIDS

4) Cancers and malignancies involving the body can also involve the eyes such as lymphoma or leukemia.

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How urgent should you consult a uveitis specialist?

Symptoms of uveitis often present suddenly and can worsen very quickly.
Uveitis has the potential to cause permanent damage to vision.
Hence early diagnosis and treatment are of utmost importance.

Emergency:

In case of unexpected sudden loss of vision or severe eye pain, visit your doctor immediately.

What is the available treatment of uveitis?

The aims of treatment are to reduce the inflammation & alleviate the pain. Control of inflammation thus limits further tissue damage and helps restore loss of vision.

If an infective cause is found responsible for the inflammation, it has to be specifically treated with an antibiotic, antiviral, anti fungal agent or an anti-parasitic agent as and when needed in adequate dosages.

Steroids in all forms help in reducing inflammation of the eyes.

Topical steroids in the form of eye drops are often used as a first line of treatment for reducing the inflammation. Other methods include injecting steroids and other anti-inflammatory agents around the eye or inside the eye.

In cases of severe inflammatory reactions, oral steroids are required to reduce the inflammation.

Intravenous steroid pulses are reserved as an emergency to bring sight-threatening inflammation under control.

Biological agents, immune-suppressive therapy, disease modifying drugs & non-steroidal anti-inflammatory drugs are also utilised depending on the type of disease, severity and chronicity of the inflammation.

Since all the above agents required to treat inflammation have possible side effects, close monitoring is required by ways of regular eye checkups and blood investigations as deemed necessary.

When uveitis simultaneously involves other body systems, patients often require multi-specialty evaluation and co-ordination with various branches of medicine.

Various specialties like Rheumatology, Chest Medicine, Infectious Diseases, Paediatrics & Oncology are a few specialties that act in co-ordination to co-manage a uveitis patient.

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Complications of uveitis:

Uveitis or inflammation can also affect other delicate tissues of the eye such as the lens, vitreous, retina and the optic nerve. Cataract and glaucoma are the common complications of uveitis and its treatment.

Statistics:

According to the Uveitis Society of India, Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States. Blindness in India due to uveitis sequelae is being increasingly recognised due to heightened awareness of uveitis conditions.