Understanding Uveitis: Causes, Types, Symptoms, Diagnosis, and Treatment

Uveitis is a group of inflammatory eye diseases that can lead to redness, pain, and vision loss if left untreated.

It affects the Uvea, the middle layer of the eye, and can also impact other eye parts.

According to a 2018 study in NCBI regarding the aging eye, Uveitis is more prevalent in women and usually happens to people between 20 and 60.

It can occur when the immune system fights infection in the eye and mistakenly attacks healthy eye tissue.

Prompt diagnosis and appropriate treatment are crucial to prevent permanent damage and preserve vision.

This article provides a comprehensive overview of Uveitis, including its causes, types, symptoms, diagnosis methods, treatment options, and preventive measures.

Anatomy of the eye and the Uvea

The Uvea is referred to as the middle layer of the eye, situated between the Sclera (the white part of the eye) and the retina (the light-sensitive layer at the back of the eye).

The eye consists of three components:

the iris (colored part of the eye)
the ciliary body (which helps focus the lens)
the choroid (which connects the retina to the Sclera)

Understanding the anatomy of the eye helps comprehend the different types of Uveitis and how they affect specific structures.

Types of Uveitis

Uveitis can manifest in different forms depending on the specific area of the eye affected. The main types include:

Anterior Uveitis

This type primarily affects the iris and is the most common form of Uveitis.

It is also called Iritis or Iridocyclitis.

Anterior Uveitis can cause symptoms such as eye redness, pain, sensitivity to light (photophobia), blurred vision, and the appearance of floaters.

Intermediate Uveitis

Intermediate Uveitis involves inflammation of the ciliary body and the Vitreous humor, the gel-like fluid that fills the middle of the eye.

It may also be called Cyclitis or Pars Planitis.

Symptoms of intermediate Uveitis may include floaters, blurred vision, and mild eye discomfort.

Fact:

Pars planitis or Intermediate Uveitis predominantly affects children and adolescents and accounts for 5-26.7% of pediatric Uveitis.

Posterior Uveitis

This type affects the retina and choroid at the back of the eye.

Posterior Uveitis can be further classified into two subtypes:

Choroiditis, which primarily affects the choroid
Retinitis, which primarily affects the retina

Symptoms of posterior Uveitis may include reduced vision, floaters, flashes of light, and loss of peripheral vision.

Panuveitis

Panuveitis involves inflammation in all parts of the Uvea, from the front (anterior) to the back (posterior) of the eye.

It is the most severe form of Uveitis and can cause a combination of symptoms associated with anterior, intermediate, and posterior Uveitis.

Symptoms of Uveitis

Early symptoms of Uveitis may include:

Eye redness

Redness in the affected eye is a common symptom of Uveitis.

It results from the dilation of blood vessels in the thin tissue layer called the conjunctiva, which covers the front of the eye.

Eye pain

Uveitis can cause varying degrees of eye pain or discomfort.

The pain is a dull ache, throbbing sensation, or sharp stabbing pain and can worsen with eye movement.

Blurred vision

Inflammation in the Uvea can disrupt the normal flow of light through the eye, leading to blurred or decreased vision.

This can make it challenging to see objects clearly or read small print.

Floaters

Floaters are tiny specks or shapes that appear to float across the visual field.

Eye floaters are caused by debris or inflammatory cells in the vitreous humor, the gel-like substance that fills the back of the eye.

Sensitivity to light (Photophobia)

Uveitis can make the eyes more sensitive to light, causing discomfort or pain when exposed to bright light sources.

Individuals with photophobia may prefer dimly lit environments or wear sunglasses indoors.

Eye discharge

In some cases, Uveitis can cause increased tear production, leading to eye discharge.

The discharge may be watery or mucous-like in consistency.

Causes of Uveitis

Uveitis causes can have various causes, including:

Autoimmune disorders

Uveitis is often associated with autoimmune conditions, where the body’s immune system attacks healthy tissues mistakenly.

Autoimmune disorders commonly linked to Uveitis include,

Rheumatoid Arthritis
Ankylosing Spondylitis
Juvenile Idiopathic Arthritis
Systemic Lupus Erythematosus
Sarcoidosis.

Warning:

Systemic Lupus Erythematosus (SLE) requires prompt medical attention. Ignoring or delaying treatment can lead to severe complications such as organ damage and cardiovascular problems. Seek medical care for proper management of SLE.

Infections

Infections can trigger Uveitis, either directly in the eye or as a response to an infection elsewhere in the body.

Viral infections, such as Herpes simplex, Varicella-Zoster, and Cytomegalovirus, can be associated with Uveitis.

Additionally, bacterial infections like Tuberculosis, Lyme disease, and Syphilis can also contribute to the development of Uveitis.

Fungal infections, such as Histoplasmosis or Candidiasis, can also cause Uveitis in some cases.

Eye injuries

Trauma to the eye, like a penetrating injury or a blunt force impact, can lead to Uveitis.

The inflammation may occur immediately after the injury or develop over time as a delayed response.

Previous eye surgery

Uveitis can be a complication of previous eye surgeries, such as Cataract surgery or Intraocular lens implantation.

The inflammation may occur shortly after the procedure or manifest weeks or months later.

Genetic predisposition

Some individuals may have a genetic predisposition to Uveitis, making them more susceptible to developing the condition.

Certain genetic markers and variations have been associated with an increased risk of Uveitis.

Various genetic markers are associated with an increased risk of Uveitis, including HLA-B27, HLA-A29, HLA-DRB1, IL10, IL23R, and PTPN22.

Diagnosis of Uveitis

Diagnosing Uveitis requires a thorough evaluation by an ophthalmologist or Uveitis specialist.

The diagnostic process may involve the following:

Medical history

The doctor will inquire about the patient’s symptoms and medical history, including past ocular or systemic conditions and recent injuries or infections.

Visual acuity test

A visual acuity test measures the clarity of vision at various distances using an eye chart.

This helps assess the extent of visual impairment caused by Uveitis.

Slit lamp examination

A slit lamp is a specialized microscope with a bright light source that allows the doctor to examine the eye’s structures under high magnification.

This examination helps identify signs of inflammation, such as redness, swelling, or cellular deposits.

Ocular pressure measurement

Increased intraocular pressure may be an indicator of certain types of Uveitis.

This can be measured using a tonometer, a device that gently touches the cornea to assess the pressure inside the eye.

Pupil dilation

Dilating the pupils with eye drops enables a more comprehensive view of the eye’s internal structures, including the retina and optic nerve.

This allows for a more detailed assessment of the extent and location of inflammation.

Laboratory tests

Blood tests, such as complete blood count, Erythrocyte Srate, C-reactive protein, and specific Serological tests, may be ordered.

They will help identify any underlying systemic diseases or infections associated with Uveitis.

Imaging studies

Optical Coherence Tomography (OCT) and Fluorescein Angiography (FA) can provide detailed images of the retina and blood vessels.

They aid in diagnosing and assessing Uveitis by capturing high-resolution images of the retinal structures.

Indocyanine Green Angiography (ICGA) is another imaging technique that can help assess certain types of Uveitis.

Treatment options for Uveitis

The treatment of Uveitis aim to reduce inflammation, alleviate symptoms, prevent complications, and preserve vision.

The specific treatment approach depends on the severity, location, and underlying cause of Uveitis.

Some common treatment options include:

Medications

Corticosteroids: These anti-inflammatory medications are often the first line of treatment for Uveitis.
They can be administered topically as eye drops or ointments, injected into the eye, or prescribed in oral or intravenous forms for severe cases.
Immunosuppressive drugs: In chronic or recurrent Uveitis cases, immunosuppressive drugs may be prescribed to suppress the immune system and reduce inflammation.
These medications include Methotrexate, Azathioprine, Mycophenolate Mofetil, and Cyclosporine.

Biologic agents

Biologic medications, like Tumor Necrosis Factor (TNF) inhibitors or Interleukin inhibitors, may be used in refractory Uveitis cases that do not respond to conventional treatments.

Local therapy

Eye drops: Anti-inflammatory eye drops or lubricating eye drops may be prescribed to alleviate symptoms and reduce inflammation.
Intraocular injections: Medications can be injected directly into the eye to target inflammation more effectively.

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Surgery

In some cases of severe Uveitis, a Pars Plana Vitrectomy may be necessary.

This involves removing the vitreous gel and replacing it with a clear solution to improve visual acuity and manage complications such as retinal detachment or vitreous haemorrhage.

Side effects of Uveitis treatment

There are certain side effects of the medicines:

Steroids

The steroids given to treat Uveitis have the following side effects:

Cataracts: Prolonged use of steroids can increase the risk of cataract development, leading to clouding of the eyes lens and potentially causing vision impairment
Glaucoma: Steroids can raise intraocular pressure, increasing the risk of glaucoma, damaging the optic nerve, and resulting in vision loss
Increased blood sugar levels: Steroids may elevate blood sugar levels, potentially leading to developing or worsening diabetes in susceptible individuals
Osteoporosis: Long-term steroid use can weaken bones and increase the risk of osteoporosis, characterized by brittle and fragile bones
Fluid retention and weight gain: Fluid retention due to steroids can lead to swelling and weight gain

Immunosuppressants

Immunosuppressants suppress the immune system, making individuals more susceptible to infections.

It is crucial to balance the benefits of immunosuppression with the risk of infections.

Preventive measures

While Uveitis cannot always be prevented, taking certain precautions may help reduce the risk or minimize the severity of flare-ups:

Regular eye examinations: Routine eye examinations can help detect early signs of Uveitis and allow for timely intervention
Treating underlying conditions: Managing any underlying autoimmune disorders or infections can help prevent Uveitis or reduce its recurrence
Protecting the eyes: Wearing protective eyewear, such as goggles or safety glasses, during activities that pose a risk of eye injury can help prevent Uveitis caused by trauma
Prompt medical attention: Seeking immediate medical attention if experiencing eye pain, redness, or sudden changes in vision can aid in early diagnosis and treatment
Diet: A western diet increases the risk, while a diet with whole grains and antioxidants lowers it. Additionally, omega-3 fatty acids can reduce inflammation in Uveitis. Avoid processed and fatty foods, and include antioxidants and omega-3s in your diet

Conclusion

Uveitis is an inflammatory eye condition that can cause vision loss if not treated promptly. It affects the middle layer of the eye, known as the Uvea.

Symptoms of Uveitis include eye redness, pain, blurred vision, floaters, and sensitivity to light.

Autoimmune disorders, infections, eye injuries, previous surgeries, or genetic factors cause it.

Medications like Corticosteroids or Immunosuppressants are used to treat Uveitis. In severe cases, surgery may be necessary.

Regular eye exams, managing underlying conditions, protecting the eyes, and seeking prompt medical attention can help prevent complications.

Individuals can effectively manage Uveitis and maintain eye health by addressing symptoms early and following recommended treatment plans.

Frequently Asked Questions

Can Uveitis be cured?

Uveitis can be treated and managed effectively, but a complete cure may not always be possible. Treatment for Uveitis aims to control inflammation, alleviate symptoms, and preserve vision.

Can Uveitis be cured naturally?

While certain lifestyle modifications and natural remedies may help alleviate symptoms and support overall eye health, they cannot cure Uveitis on their own. Medical intervention and appropriate treatment are typically necessary to manage Uveitis effectively.

What vitamin deficiency causes Uveitis?

There is no specific vitamin deficiency known to cause Uveitis directly. However, maintaining a balanced and nutritious diet that includes essential vitamins and minerals is beneficial for overall eye health and may support the management of Uveitis.

Can Uveitis be cured without steroids?

Steroids, such as Corticosteroids, are commonly used to treat Uveitis due to their potent anti-inflammatory properties. In some cases, alternative medications or therapies may be used, but the effectiveness can vary depending on the severity and type of Uveitis.

Citations:
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