Uveitis and Iritis

Uveitis is the inflammation of the ciliary body (tiny ring-like muscle behind the iris), iris (coloured part of the eyes) and the choroid (tissue layer in between the sclera and the retina which contains blood vessels and pigments that absorb excess light) or the uveal tract. The condition is further classified into the specific parts of the tract is affected.
The symptoms are varied because of this. This condition can have a sudden onset or acute or may either be the long-lasting or the chronic. Acute uveitis does not last very long while the chronic uveitis can relapse and is very persistent once the patient acquires it. Treatment of the condition involves steroid eye drop solution which can reduce inflammation and relieve the patients of the symptoms. If uveitis is not treated, it can cause serious problems which may lead to blindness.

Apart from the uveal tract and the parts to which it may commonly affect, the following parts can also be affected:

  • Optic nerve – nerve that delivers signals to the brain for vision
  • Retina: interior lining of the eye which is light sensitive
  • Sclera – the white of the eyeball
  • Vitreous humour – gel-like substance filling the portion behind the lens.

Types of Uveitis

The condition is organized into the part of the uveal tract which is infected:

  • Intermediate uveitis. Occurs when the infection is in the middle portion of the uveal tract. It can affect the retina.
  • Anterior uveitis. Occurs when the infection is in the anterior portion of the uveal tract. The condition can affect the iris or a condition called the iritis. It can also affect the ciliary body and the iris or the condition called iridocyclitis. This type is the most common.
  • Posterior uveitis. Occurs when the infection is in the retina and the choroid. This also includes neurotinitis, retinitis and retinochoroiditis.
  • Panuveitis. Occurs when the infection happens in the entire uveal tract.

Causes of uveitis

There are a lot of causes for uveitis. This condition is associated to a myriad of other disorders and illnesses. But it is very common and accepted that no specific cause is found for uveitis. This condition is called idiopathic uveitis. Causes for uveitis are the following:

  • Infection. Bacterial, viral and fungal strains can cause the inflammation of the eyes and cause uveitis. These would include infections like the herpes simplex eye infection, toxoplasmosis, herpes zoster, syphilis, cytomegalovirus, tuberculosis, gonorrhoea, and Lyme disease.
  • Autoimmune diseases. The makes antibodies to protect the body from invading foreign bodies like bacterial, viral and other germ strains which can cause serious infection. In autoimmune disease, the antibodies made by the immune system attack the healthy cells and tissues of the body. How this is triggered is not yet known but some people are higher at risk than some other. Autoimmune disorders like Reiter's and Behcets syndromecan cause uveitis. Behcets syndrome causes chronic mouth ulcers and other parts of the body like the lungs, heart, joints, gut and the nervous system.
  • Eye injury. Infection due to an eye injury also causes uveitis.
  • Latrogenic causes. Latrogenic means the inevitable or unforeseen side effects a patient will have after undergoing medical treatment. Latrogenic uveitis is uveitis that resulted from an eye injury.
  • Inflammatory diseases. Patients who already have inflammatory diseases are at a higher risk of contracting uveitis. Inflammatory diseases like Crohn's disease, sarcoidosis, rheumatoid arthritis, ankylosing spondylitis, and ulcerative colitis causes uveitis. Sarcoidosis causes the chronic inflammation of the lungs. Sarcodoisis causes breathing and coughing difficulties.
  • Cancers. Some form of cancer is related to uveitis or inflammation. This would include lymphoma, leukemia and lastly, malignant melanoma.

Symptoms for uveitis

The symptoms are largely dependent on the type of uveitis the patient has:

Anterior uveitis. This affects only one eye and the symptoms include eye pain inside or around the eyeballs, photophobia and redness of the eye. Blurring of the vision or eventually vision loss can also result but this is temporary. Headaches are also common and the iris of the infected eye may change its color from time to time. Watering of the eyes can also occur and the symptoms for the condition develop in a matter of hours or a few days.

Intermediate uveitis. This is painless and can cause blurring of the vision. It is rare that the patient will experience photophobia and redness of the eye. Floaters are also common and these are small dark shaped objects in the eye which are clearly visible when looking in bright lights or the blue sky. Both eyes can be affected with this type of uveitis.

Posterior uveitis. This is the painless blurring of the vision. To some people, it can cause severe vision loss. Having this type of uveitis can cause the patient to see floaters and they could develop scotomata which are tiny areas that are less sensitive vision in the eye. These parts are surrounded by areas of normal sight. One eye is usually infected and the symptoms for this condition take a longer period to develop.

Diagnosis for uveitis

The condition is diagnosed based on the symptoms that the patient has. Once the doctor suspects that the patient has uveitis, the patient will be referred to an eye specialist for further confirmation and examinations.
Testing the patient's vision is the first thing to be done. This is done to asses if there are differences in the vision of both eyes. This means that uveitis causes the patient's vision to become worse.
An opthalmoscope is a hand-held machine that the doctor uses to examine the interior of the patient's eyes. The machine directs light into the eye and allows the eye specialist to see the inside of the patient's eye where the light falls. Eye drops are used before directing light unto the eyes. These special eye drops make the pupils dilate to make examining them easier. Another machine, called the slit lamp, can also be used to examine the eyes. If uveitis symptoms are present, the doctor will see specific changes in the eyes to make proper diagnosis.
Other examinations would include urine and blood test and having x-rays.

Treatment of uveitis

The treatment for this condition helps to ease the discomfort and pain in the infected eye, reduce inflammation and to treat any other underlying causes such as other eye complications. The treatments are successful enough to prevent vision loss. New treatments are also available but are still investigated. These drugs are the TNF-alpha blockers. Examples of these are the infliximab and the etanercept.
Treatments for uveitis are as follows:

Treatment for relieving discomfort and pain

  • Cycloplegic eye drops. This is a special eye drop solution that relieves pain by dilating the pupils in the eyes. The eye drop relaxes the muscle of the ciliary body which results in the dilation of the pupils. Pain is reduced, as a result, and the inflammation of the iris subsides. Cyclopentolate and atropine are examples of cycloplegic eye drops but they have the following side effects. They can cause temporary blurring of the eyes and focusing on an object becomes difficult. Once the eye drops' effect wears off, the side effects will also disappear. The eye drops should be applied once every hour. If eye drops are not used, the inflamed iris becomes stuck to the eye lens and will cause permanent scarring.
  • Dark glasses. Photophobia is one of the symptoms for uveitis and wearing dark glasses can protect the eyes from bright lights.
  • Painkillers. Orally taken, these drugs can also help. Example of painkillers is paracetamol.
  • Steroid eye drops. This reduces inflammation in uveitis. This is the main treatment for a lot of eye complications and problems. But steroid eye drops should not be used when uveitis is due to viral or bacterial infection. Steroid eye drops are effective but they also have side effects like corneal ulcers which are painful and will affect the vision and if used for a long period of time, it can even cause glaucoma or cataract. These eye drops are prescribed by ophthalmologists who will monitor how the patient is doing.
  • Steroid by injection or mouth. In cases where uveitis is severe, steroids are directly injected into the eyes or taken orally. These products are effective but when used for long term, they can also cause serious side effects like osteoporosis or the bones are becoming thin, skin is also becoming thin, muscle wasting, weight gain and increased risk of acquiring serious infection.

Treatment for underlying causes

Other underlying problems which cause uveitis should also be treated. Underlying causes would include autoimmune diseases, infection and inflammatory diseases.

  • Surgery. Minor surgery can be advised to treat uveitis. If the patient has chronic floaters which affects their vision, the removal of the vitreous humour is done. Floaters are the result of an inflammation due to damage in the vitreous humour. Surgery is can also be done to treat cataracts which can be a complication when having uveitis.

Complications for uveitis

Uveitis should be treated quickly to avoid serious side effects which can lead to blurring of vision or to blindness:

  • Synechiae formation. Synechiae is the band of tissues that form between the lens and the iris because of the inflammation.
  • Glaucoma. Synechiae that forms indicate that the fluid cannot drain normally in the eyes. This leads to the pressure build-up in the eyes which leads to glaucoma.
  • Cataract formation. Inflammation causes some changes in the eye lens and the formation of cataract.
  • Retinal detachment. Inflammation causes a 'pull' on the retina so it detaches out of place. This causes floaters, flashing lights and vision problems. If the patient suspects that he has retinal detachment, he should contact a doctor immediately to do an urgent surgery.

Prognosis for uveitis

Uveitis should be treated as soon as possible. Uveitis can recur especially if there are underlying causes which contribute in the inflammation of the eye, or if the patient has autoimmune diseases or inflammatory diseases. Those who have recurring uveitis are often given with steroid eye drops to use when the symptoms are back. Patients with recurring uveitis should be under an eye specialist and should have regular eye check-ups. When uveitis is caused by a general infection, the symptoms go away or subside once the cause of the infection is treated.

Important notice