Uveitis
Background
Uveitis is a general medical term for inflammation in the eye(s). It includes a broad spectrum of more specific conditions that affects different parts of the eye. For example, iritis involves the front (anterior) of the eye and choroiditis involves the back (posterior) of the eye. The incidence of new cases each year is estimated to be around 25 per 100,000 individuals. This makes uveitis far less common than macular degeneration, diabetic retinopathy, and glaucoma, but it contributes to 10% of blindness in North America. Uveitis affects all age groups including children and young adults but most patients are over the age of 30 at the time of diagnosis. It is also more common in females than males similar to other rheumatologic (inflammatory) diseases.
What Do Uveitis Patients Notice? (Symptoms)
The location of involvement within the eye determines what symptoms a patient might develop. In most cases the onset is sudden with progression of symptoms until treatment is initiated. There is rarely significant fluctuation or spontaneous improvement. Symptoms include:
- Eye redness
- Eye pain
- Light sensitivity
- Decreased/blurry vision
- New floaters
What Causes Uveitis (Etiology)
Uveitis can affect the front (cornea and anterior chamber), middle (vitreous cavity), and/or posterior segment (retina/choroid) of the eye. It can also involve the outside of the eye (sclera) and surrounding ocular tissues.
Most cases result from infection or an autoimmune process. In autoimmune disease, the body’s immune system attacks itself as if it is a foreign substance. There are many autoimmune diseases that affect different parts of the body, such as rheumatoid arthritis, which affect the joints.
There are also less common conditions, such as intraocular lymphoma, that can also cause uveitis. It often requires an expert to differentiate between these disease processes. Laboratory blood workup and other diagnostic tests are frequently indicated, and are based on the clinical presentation and history of disease. It is not uncommon for autoimmune cases to be classified as idiopathic (no identifiable etiology). Examples of identifiable etiologies are listed below:
Infections
- Toxoplasmosis
- Herpes Simplex Virus
- Varicella Zoster Virus (Shingles)
- Cytomegalovirus
- Bartonella (cat-scratch-disease)
- Syphilis
- Tuberculosis
Autoimmune
- HLA-B27
- Sarcoidosis
- Systemic Lupus Erythematus
- Rheumatoid Arthritis
- Juvenile Idiopathic Arthritis
Treatment
Treatment largely depends on the underlying etiology. Topical steroid drops are frequently used either alone or in combination with other agents. In cases of infection, therapy is targeted against the organism. If there are other areas of inflammation in the body from a systemic disease such as sarcoidosis, systemic therapy is frequently used to control inflammation throughout the body. Often a rheumatologist is involved in the diagnosis and treatment of such cases. There have been many advances in the treatment of uveitis in the past 15 years. Ocular steroid injections and steroid implants are now available and control ocular inflammation with great success.
Who Should Treat Uveitis?
Not all cases of uveitis require a uveitis specialist for diagnosis and treatment. However, in recurrent, chronic, or complex cases an eye care provider may refer a patient to a specialist for further evaluation. At Retina Associates of Kentucky (RAK) all of our physicians have extensive training in ophthalmic and retinal diseases including uveitis. Dr. Blake Isernhagen MD completed a one year dedicated uveitis fellowship at the Bascom Palmer Eye Institute and sees many of the uveitis patients at RAK. The physicians at RAK work closely with the patient’s primary eye care provider and other physicians such as rheumatologists to assist in the diagnosis and treatment of complex cases of uveitis.
