All about Uveitis - Symptoms, Causes, Types, Diagnosis, Treatment

What is Uveitis?

Inflammation of the Uvea - the middle layer of the eyeball - is called Uveitis. Uvea has many blood vessels that nourish the eye. Uveitis can damage vital eye tissue, leading to permanent vision loss. Uveitis symptoms often come on suddenly and get worse quickly. Early diagnosis and treatment are important to prevent complications and preserve vision.

Uvea is the middle layer of tissue in the wall of the eye between the Sclera (the outer white portion) and the Retina (the inner portion of the eye). Uvea consists of the following:

  • Iris: The colored circle at the front of the eye.

  • Ciliary Body: It is located between the iris and the choroid. It helps the eye focus by controlling the shape of the lens and it provides nutrients to keep the lens healthy.

  • Choroid: A thin, spongy network of blood vessels, which primarily provides nutrients to the retina.

Uveitis can affect one or both eyes, and it can affect people of all ages, even children. A study found that the incidence and prevalence of disease was lowest in children and highest in patients 65 years or older. Women had a higher prevalence and incidence of uveitis than men.

What are the symptoms of Uveitis?

Symptoms of Uveitis include:

  • Redness of the eye

  • Sensitivity to light (photophobia)

  • Pain in the eye 

  • Blurred vision

  • Dark, floating spots in the vision (floaters)

Sometimes there are no symptoms and Uveitis is diagnosed during a routine examination which is why it is important to get your eyes examined at least once a year.

What are the different types of Uveitis?

There are 4 types of Uveitis depending on which part of the Uvea is affected

Anterior Uveitis

It affects the front of the eye (between the cornea and the iris) and the ciliary body. It is also called Iritis or iridocyclitis and is the most common type of Uveitis. It predominantly affects young and middle-aged people. Many cases occur in healthy people and may only affect one eye, but some are associated with rheumatologic, skin, gastrointestinal, lung and infectious diseases.

 

Intermediate Uveitis

 

It affects the ciliary body. The center of the inflammation often appears in the vitreous. It is also called Cyclitis and is commonly seen in young adults. It has been linked to several disorders such as sarcoidosis and multiple sclerosis.

Posterior Uveitis

 

It affects a layer on the inside of the back of your eye, either the retina or the choroid or both. This type of uveitis is often called choroditis or retinitis or chorioretinitis. There are many infectious and non-infectious causes to posterior uveitis.

 

Panuveitis (or Diffuse Uveitis)

 

This is a type of Uveitis when all three parts of the Uvea are affected by inflammation. Behcet’s disease is one of the most well-known forms of pan-uveitis and it severely damages the retina.

Intermediate Uveitis, Posterior Uveitis, and Panuveitis are the most severe and highly recurrent forms of uveitis. They often cause blindness if left untreated.

What causes Uveitis?

The specific cause of Uveitis in an individual is often not clear. Uveitis may be caused by or you are more likely to get Uveitis if you have or have had the following:

  • Autoimmune disorder - Attack from the body’s own immune system 

  • Systemic inflammatory disease such as inflammatory bowel disease (IBD), rheumatoid arthritis or lupus

  • Infections such as shingles virus, herpes simplex virus, syphilis, Lyme disease, and parasites such as toxoplasmosis

  • Eye injury

Krishna Netralaya's team of specialist Ophthalmologists bring together years of experience of treating Uveitis 

How is Uveitis diagnosed?

Process of Uveitis diagnosis starts with a routine eye examination which includes:

  • Visual Acuity Test: Vision is tested with vision charts

  • Non-Contact Tonometry: The intraocular pressure is checked with a Non-Contact Tonometer

  • Slit lamp examination: Eyes are examined under magnification. This helps in evaluation of the anterior chamber. Signs of anterior chamber inflammation are keratic precipitates, cells and flare are looked for. If required, eyes are dilated to get a detailed view of retina also referred to as fundus exam

  • Fundus Exam: The retina is examined with a 90D or 78D lens on the slit lamp. Indirect ophthalmoscopy with 20D lens is done to assess the peripheral retina. It is a non-invasive method.

  • Fundus photography: to document fundus changes

  • Optical coherence tomography (OCT) imaging: It measures the thickness of the retina and choroid to reveal inflammation in these layers and is also very useful to pick up early macular edema

  • Fluorescein angiography or indocyanine green angiography: These require placement of an intravenous (IV) catheter in a vein in your arm in order to administer/ inject a dye. This dye will reach the blood vessels in the eyes. This will allow for photographs of blood vessel inflammation inside the eyes.

In addition to the above, blood tests and imaging tests such as radiography, CT and MRI scans may be required to confirm the cause of Uveitis.

How is Uveitis treated?

As per the type of Uveitis, following is an overview of the treatment method:

  • Anterior Uveitis treatment

    • Use of eye drops containing steroids to reduce inflammation

    • Use of eye drops that dilate the pupil and have cycloplegic action to prevent muscle spasms in the iris and ciliary body 

  • Intermediate Uveitis, Posterior Uveitis, and Panuveitis treatments

    • Along with the above treatment used in anterior uveitis, oral steroids are generally needed. 

    • Sometimes they are treated with injections around the eye or at times intravitreal injections of sustained release medications like a steroid implant e.g. Ozurdex injection

    • Other immunosuppressive agents may be indicated in certain cases. A doctor must make sure a patient is not fighting an infection before proceeding with these therapies.

    • In advanced cases with severe inflammation, Vitrectomy – a surgical procedure - may be indicated 

The focus of Uveitis treatment is primarily to reduce inflammation, reduce pain and contain any further damages to tissues. Corticosteroids remain the mainstay of treatment. While your Ophthalmologist will take care of the dosage and duration of the steroids and other immunosuppressants where indicated, it must be kept in mind that taking such medications for long term may produce side effects such as stomach ulcers, osteoporosis (bone thinning), diabetes, cataracts, glaucoma, cardiovascular disease, weight gain, fluid retention, and Cushing’s syndrome (a medical condition that develops due to exposure to high levels of hormone cortisol for a long time).

At Krishna Netralaya we take care of your eyes with the best ophthalmic equipment from world's leading companies. 

Have more questions about Uveitis ? Schedule a consultation with our Specialist.

Disclaimer: All information, provided above is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Read our full disclaimer here.