Eye involvement in ocular inflammatory diseases
Think of the eye as a hollow, fluid-filled, 3-layered ball – the outer layer is the sclera, a tough coat, the innermost is the retina, the thin light-gathering layer, and the middle layer is the uvea. The uvea is made up of the iris, ciliary body and choroid. Intraocular inflammation, also called uveitis, affects this layer.
What are the types of Uveitis?
Inflammation in the front of the eye affects the iris and is termed anterior uveitis. In the back of the eye, if the choroid is involved, it is termed posterior uveitis, while if the tissues between these two are affected, it is termed intermediate uveitis. If the entire uvea is involved, this serious condition is called panuveitis.
Why is Uveitis such a serious problem?
The uvea is made up of different parts, and the problems of each part are quite different – viz., if the iris is affected, the treatment is very different than for diseases of the choroid. Inflammation in the uvea very often affects other parts of the eye such as the retina. A large number of medical conditions cause uveitis and need to be treated in addition to the intraocular inflammation.
Intraocular Inflammation
How will I know if I have uveitis?
If the inflammation is predominantly anterior, then the eye tends to get red, is painful, sensitive to bright light, and vision is blurred. If the condition affects the intermediate and posterior tissues, visual symptoms predominate – floaters, blurred vision, distorted vision, or more severe loss of vision can occur.
What are the causes of uveitis?
There are a number of causes of uveitis – and sometimes, no discernable association or cause can be detected despite intensive testing. Some of the causes that need to be looked for include – infections (virus, fungus, parasites), autoimmune diseases (with or without involvement of other systemic disease),
injuries to the affected eye or even the other eye in the past,
What tests are required in uveitis?
The doctor will perform a thorough evaluation of your eye to assess the tissues affected by the inflammation. This will include slit-lamp examination for the front of the eye, indirect ophthalmoscopy for the back of the eye, fundus fluorescein angiography to evaluate the state of the blood vessels, and if necessary, ultrasonography. The doctor will also document the effects of the inflammation on the eye by recording vision, intraocular pressure, and if required, visual fields and photographs. Since other systems may be involved, a detailed systemic history, blood test, X rays, and scans may also be required.
What are the goals of treatment in uveitis?
The main aims of treatment are – to relieve pain and discomfort, prevent sight loss due to the disease or its complications, and treat the cause of the disease where possible. Since many of the medications used in the treatment of uveitis have significant side effects, your doctor will discuss with you the risk-benefit ratio involved in the use of these drugs, and will monitor the therapy closely.
How is uveitis treated?
Since uveitis is characterized by inflammation, the most commonly used drugs are steroids. These powerful agents can be used to control the inflammation and are administered as drops, injections around the eye, as tablets, or as intravenous preparations, depending on the site and extent of inflammation. If these prove unsatisfactory, other medications termed immunosuppressives, may be used. These often require that you also see a physician (suggested by your eye doctor). Sometimes, other options such as injections into the eye, cryotherapy, and even surgery may be required.
General information
Although uveitis cannot be “cured”, the medicines can control the inflammation and protect your eye and vision, until the disease “burns itself out”. The treatment needs to be continued as long as the inflammation is active, and in any patient, it is not possible to know how long the disease will last and when it will go away. Hence sometimes, prolonged treatment is required. Many of the drugs used to treat uveitis are unsuitable for pregnant women, and hence if you are contemplating pregnancy or are pregnant, please inform your doctor.