Uveitis is a collection of diseases that cause inflammation inside the eye (see image: iris, ciliary body and choroid) resulting in pain, redness, floaters and loss of vision.
- Anterior Uveitis (sometimes called iritis): caused by inflammation of the iris or the colored part of the eye that makes the pupil. This is the most common type of uveitis and usually starts abruptly with eye redness, pain, light sensitivity and blurriness. Many cases occur in healthy people and may only affect one eye but sometimes both eyes are involved. The eye inflammation can at times be associated with rheumatologic, skin, gastrointestinal, lung and infectious diseases.
- Intermediate Uveitis: More common in young adults and usually causes floaters (black specs in your field of vision) and blurriness. The inflammation is centered on the vitreous gel that fills the back of the eye. Many cases have no underlying cause but some are caused by sarcoidosis or multiple sclerosis.
- Posterior Uveitis: The least common form of uveitis. Affects the retina or the layers under the retina usually due to an autoimmune disease or infection.
- Panuveitis: affects all parts of the eye from front to back.
It can affect all age groups but the most common age is between 20-60. The inflammation can be caused by autoimmune conditions, infections, trauma and rarely cancers.
- Autoimmune conditions happen when the body’s own immune system begins to attack normal tissue. Normally the immune system protects us from foreign invaders like bacteria and viruses but sometimes the immune system gets confused and begins to attack normal tissue in the body, in this case the eye, resulting in potentially devastating damage to vital eye structures. Some common autoimmune diseases include lupus, rheumatoid arthritis, Behcet’s disease, Ankylosing spondylitis, psoriasis.
- Other conditions that cause inflammation in other parts of the body as well as the eye include Sarcoidosis and Multiple Sclerosis.
- Infections caused by herpes viruses (the virus that causes cold sores, chicken pox and shingles), syphilis, tuberculosis, Lyme disease, toxoplasmosis and many others can cause severe eye inflammation.
In addition to a thorough dilated eye exam, the evaluation usually involves in office imaging including optical coherence tomography to look for swelling of the macula, fluorescein angiography to assess the blood vessels in the retina and sometimes indocyanine green angiography to look at the layers under the retina. Blood testing for various relevant diseases and sometimes MRI or CT scans may be ordered. Sometimes, surgical procedures are necessary to test eye fluids or remove the gel from the back of the eye for biopsy. Since many conditions that cause uveitis can also affect other parts of your body, consultation with your PCP is important and possibly referral to specialists such as a rheumatologist or dermatologist.
Uveitis can cause severe vision loss and even blindness, so prompt and aggressive treatment is important to prevent irreversible damage to vital and sensitive eye tissue. Depending on the type of inflammation and its severity you may be treated with eye drops, antibiotics, prednisone, cortisone injections, immunosuppressive drugs, implants or possibly a combination of the above. Sometimes the condition is short lived and only a few weeks or months of treatment is necessary but in many cases these diseases last several months or years requiring ongoing treatment with immunosuppressive drugs, drops and/or injections.