Uveitis

WHAT IS UVEITIS?

Uveitis is an inflammation of the inside of the eye, specifically the layer of the eye called the uvea [comprising of the iris, ciliary body and the choroid].

WHAT CAUSES UVEITIS?

• Infection - virus (eg. herpes) fungus (eg. histoplasmosis)
• Parasite - toxoplasmosis
• Autoimmune Disease - This is when our immune system recognises a part of our own body as foreign
• Trauma to the eye, or even the other eye in the past, can lead to Uveitis
• Unknown - The commonest type, this may well mean that the uveitis is of the autoimmune type. The word "idiopathic" may often be used to describe this group.
• Associated medical conditions - Ankylosing Spondylitis, Juvenile rheumatoid arthritis and inflammatory bowel disease.

Different types of Uveitis [by describing the part of the eye that is affected]

Anterior Uveitis

This affects the front of the eye, normally the iris (iritis) or the ciliary body (iridocyclitis). Iritis is by far the most common type of Uveitis and also the most readily treated. Iritis needs quite close monitoring because complications such as raised eye pressure and cataracts can occur.

Intermediate Uveitis

This affects the middle of the eye, the ciliary body (cyclitis) or the pars plana (pars planitis).

Posterior Uveitis

This affects the back of the eye. That part of the uvea is called the choroid. An inflammation in the choroid would be called choroiditis. The inflammation may also arise in, or affect, the retina (retinitis) or in the blood vessels at the back of the eye (vasculitis).

Symptoms

• Redness of the eye
• Pain
• Avoiding.bright light
• Blurring of vision and\or the presence of floaters (black dots or wispy lines that move across the field of vision).

Diagnosis

• Tests and examinations
• Because of the quite diverse types of causes of Uveitis and also due to the many other medical conditions associated with it, then you can expect to receive a number of tests and thorough questioning. All these are straightforward and painless enough but may seem far removed from your eye problem. It is important to establish the correct type of Uveitis so that the best treatment can be planned.

HOW IS UVEITIS TREATED?

One of the most important things to remember about Uveitis is that:

1. There are many quite different causes.
2. There are different types of Uveitis normally depending on which part of the eye is affected ie. anterior, intermediate or posterior

The treatment of Uveitis aims to achieve the following:

1. Relief of pain and discomfort (if present)
2. To prevent sight loss due to the disease or its complications
3. To treat the cause of the disease where possible.

Like the varied nature of uveitis, the treatment of it may differ from case to case quite considerably. Corticosteroids are often the mainstay of treatment but now are, importantly, being joined by some other newer drugs, usually used along with the steroids. Various eye-drops are used, particularly to treat anterior uveitis.

Treatment
To relieve pain and photophobia

Dilating eye drops that relax the muscles of the iris and ciliary body. (It is the movement of these inflamed muscles that causes the pain). When these drops have taken their effect the pupils will be dilated.

To treat the inflammation

Steroids are used in the form of eye drops. Occasionally, but not often, injections of steroids are used around the eye. These may be uncomfortable but are straightforward and are done at the Uveitis Clinic. Even more rarely steroid tablets are used. The type of steroid treatment and the length it is used will, again vary a lot for different people. Occasionally, a situation may arise when rapid control of an acute episode of inflammation is needed. This may be if the sight is threatened and a high dosage of steroid needs to be delivered quickly. Side effects of prolonged use of steroid drops can include raised eye pressure which may cause glaucoma and cataracts, for which the eye is closely monitored.

Treatment of any associated diseases
To decrease the autoimmune response of the body

Cyclosporin tablets may be used with/without steroids to reduce the dosage of steroids or if side effects are a problem.

HOW LONG WILL THE CONDITION LAST?

It is possible that the condition may be around for several years. The condition also varies in its severity enormously and can be quite unpredictable in its course. The main aim of the treatment is to thoroughly treat and monitor the inflammation so that it causes minimal or no damage to the eyes as and when the condition hopefully "burns out".

WHAT WILL HAPPEN TO MY EYES?

This, once again, varies considerably, but there is a growing confidence, especially with the newer drug treatments, that the condition can be stabilised over the long term.

UVEITIS CLINIC

Uveitis, much more than most other medical conditions, offers a huge challenge for patients to understand their condition. Uveitis is complex. There are many different types of uveitis. There are many different causes, there are different parts of the eye which are affected, one or both eyes may be affected, and the severity of the disease may be extremely variable.

Even two cases of uveitis with the same specific diagnosis e.g. intermediate uveitis may be completely different for the patients involved, and so require different treatment and may not have the same outcome.

Our centres run Uveitis Clinics for the special purpose of preserving sight in conditions such as uveitis.

1. The patient receives specialized care provided by our Uveitis specialists
2. Uveitis needs regular follow-up since the condition can recur and cause loss of vision if poorly treated or neglected
3. Our Uveitis Clinic is backed by a pathology laboratory which specifically caters to the needs of Uveitis patients
4. At the clinic we record images and maintain records of your eye condition for comparison on following visits.