Uveitis is a general term used to describe a group of diseases that cause red eyes, eye pain and inflammation. These diseases typically affect the uvea, the eye’s middle layer. They can also affect other parts of the eye. If not treated, uveitis can cause permanent blindness or vision loss.
Does Uveitis Affect Both Eyes?
Uveitis may develop in one eye or both eyes. It can affect the:
. Retina: The innermost layer of the eye senses colors and light and sends images to the brain.
. Uvea: The middle layer of the eye includes the iris (colored part of the eye), choroid (membrane with most of the eye’s blood vessels) and ciliary body (connects the iris and choroid and provides nutrients to the eye).
. Sclera: The eye’s white outer part.
How Common Is Uveitis?
An estimated 30,000 Americans lose their eyesight every year due to uveitis.
Who Might Get Uveitis?
Uveitis affects people of all ages, even children. Women and people between 40 to 60 years old have a slightly higher risk.
What Are the Types of Uveitis?
Healthcare providers typically classify uveitis based on where the eye inflammation occurs. Types of uveitis include:
. Anterior: The most common type, anterior uveitis causes inflammation in the front of the eye. Symptoms may appear suddenly and can occasionally resolve on their own if they are mild. Some people have chronic, recurring eye inflammation that goes away with treatment and then comes back. You may be more prone to anterior uveitis if you have:
. Arthritis, including ankylosing spondylitis (AS).
. Autoimmune diseases, such as sarcoidosis or juvenile idiopathic arthritis.
. Gastrointestinal disorders, such as inflammatory bowel disease (IBD).
. Prior infections with the herpes virus (cold sore or genital herpes) or the chicken pox virus.
. Intermediate: Young adults are more prone to intermediate uveitis. This condition causes inflammation in the middle of the eye. Also called cyclitis or vitritis, it often affects the vitreous, the fluid-filled space inside the eye. Symptoms may improve, go away and then come back and get worse. About one in three people with intermediate uveitis also have:
. Multiple sclerosis (MS).
. Posterior: The least common form, posterior uveitis affects the inner part of the eye. It is often also the most severe. It can affect the retina, optic nerve and choroid. The choroid contains blood vessels that supply blood to the retina. It’s sometimes called choroiditis or chorioretinitis. This type can cause recurrent symptoms that last months or years. Potential causes include:
. Birdshot chorioretinopathy.
. Viral etiologies such as herpes virus or chicken pox virus.
. Panuveitis: Rarely, uveitis affects all three layers of the eye. This type is more severe and raises the chances of permanent vision loss. Potential causes include:
. Bacterial or fungal retinitis.
. Viral retinitis.
. Tuberculosis (TB).
Symptoms and Causes
What Causes Uveitis?
An estimated one in three uveitis cases have no known cause. People who smoke are more prone to uveitis. Eye inflammation may also result from:
. Eye injury.
. Eye surgery.
. Infections, such as the herpes virus, chicken pox virus, TB, syphilis.
. Inflammatory diseases, such as lupus, IBD and rheumatoid arthritis.
What Are the Symptoms of Uveitis?
Uveitis symptoms may come on gradually or suddenly. You may experience:
. Blurred vision.
. Dark, floating shapes in your field of vision (eye floaters).
. Eye pain or pressure.
. Light sensitivity.
. Red eyes.
. Vision loss.
How Is Uveitis Diagnosed?
The healthcare provider caring for your eyes will look at the inside of your eye during an eye exam. A standard eye exam usually includes:
. Visual acuity test (reading eye charts) to check for vision loss.
. Ocular pressure test (tonometry) to measure pressure inside the eye.
. Slit-lamp exam to examine the inside of the eye with a special microscope called a slit lamp.
. Dilated eye exam to widen pupils so your healthcare provider can look inside your eyes using a special lens.
Your healthcare provider may also order other tests, such as:
. Blood tests to rule out infections or underlying autoimmune diseases.
. Imaging of your chest or brain to look for systemic inflammatory causes.
. Fluorescein angiography to get images of blood vessels in the back of the eye.
. Gonioscopy to examine the front of the eye where liquid drains.
. Optical coherence tomography (OCT) to get detailed images of the back of the eye, including the retina.
. Optical coherence tomography angiography (OCTA) to produce 3D images of blood flow through the eye.
. Visual field test to check for damage to the optic nerve that may affect your ability to see things off to the side (peripheral vision).
Management and Treatment
How Is Uveitis Managed or Treated?
Untreated uveitis can lead to blindness. It’s important to see your healthcare provider right away if you have eye redness, inflammation, or pain. In many instances, treatments help restore lost vision. They can also prevent more tissue damage and ease inflammation and pain. If a health condition contributed to uveitis, getting that disease treated should also relieve the eye inflammation.
Some forms of uveitis take a long time to go away. Some come back after treatment. Depending on the disease type, treatments include:
. Antibiotics, antivirals or antifungals: These medications treat uveitis caused by an infection.
. Eye drops: Dilating (widening) the pupils with eye drops can reduce pain and swelling. Eye drops can also keep the iris and lens from sticking together, a complication that can occur with anterior uveitis. Your healthcare provider may also prescribe eye drops to relieve pressure in the eye (ocular hypertension).
. Steroidal anti-inflammatories: Medications that contain corticosteroids (steroids) alleviate eye inflammation. These medications come in many forms: drops, ointments, oral pills, injections inside or around the eye, intravenous (IV) infusions or a capsule that your eye healthcare provider surgically implants inside the eye.
. Immunosuppressants: These medications calm the immune system’s response to autoimmune disease or systemwide inflammation. Your provider may prescribe these drugs if uveitis affects both eyes, doesn’t respond to steroids or threatens your vision. You may take the medication orally as a pill, as an injection or through an IV infusion into a vein.
What Are Uveitis Treatment Side Effects or Risks?
Certain immunosuppressants can increase your risk of cancer. Long-term steroid use may lead to:
. Cataracts or glaucoma (high eye pressure).
. Cushing’s syndrome (excess cortisol).
. Heart disease.
. Peptic (stomach) ulcers.
. Weight gain, fluid retention and swelling (edema).
What Are the Complications of Uveitis?
An estimated one in five people with uveitis will develop high pressure in the eye (ocular hypertension). This condition can lead to glaucoma and irreversible vision loss. People with uveitis are also at risk for other eye problems, including:
. Posterior synechiae.
. Cystoid macular edema (CME), swelling of the eye macula in the retina.
. Damage to the vitreous gel substance that fills the eye.
. Detached retina.
. Damage to the retina leading to vision loss.
How Can I Prevent Uveitis?
Healthcare providers usually don’t know what causes most cases of uveitis. There isn’t much you can do to prevent the disease.
Doing what you can to maintain good eye health is always wise. Getting care for diseases, infections or other health conditions linked to uveitis can help protect your vision. You can also lower your risk by quitting smoking.
What Is the Prognosis (Outlook) For People with Uveitis?
Most people who get prompt treatment for uveitis have little, if any, long-term vision problems. Treatments can stop disease progression and restore lost vision. Severe forms may need long-term treatment. Severe disease is more likely to cause vision loss or even blindness. If you have conditions that put you at risk for uveitis, regular eye exams are essential. Talk to your eye care healthcare provider any time you have red eyes, eye pain or inflammation.
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