Overview

Uveitis is an inflammatory condition that affects the uvea, the middle layer of the eye, which includes the iris, ciliary body, and choroid. This inflammation can also impact surrounding eye structures such as the retina, vitreous, and optic nerve. Uveitis is a potentially sight-threatening condition that requires prompt diagnosis and treatment. It can occur in one or both eyes and affects people of all ages, though it is more common in adults between 20 and 60 years old. Depending on its location, uveitis is classified into anterior, intermediate, posterior, or panuveitis. Early intervention is crucial to prevent complications such as glaucoma, cataracts, and permanent vision loss.

Causes

Uveitis can be caused by a wide range of factors, but in many cases, the exact cause remains unknown (idiopathic). Common causes and risk factors include:

• Autoimmune Disorders: Conditions like ankylosing spondylitis, rheumatoid arthritis, sarcoidosis, and Behçet’s disease are frequently associated with uveitis.
• Infections: Viral (herpes simplex, herpes zoster), bacterial (tuberculosis, syphilis), parasitic (toxoplasmosis), and fungal infections can cause uveitis.
• Eye Trauma: Injury or surgery involving the eye can lead to inflammation and subsequent uveitis.
• Inflammatory Disorders: Inflammatory bowel disease (Crohn’s disease, ulcerative colitis) and psoriasis are linked to uveitis.
• Cancers: Rarely, certain cancers like lymphoma can cause masquerade syndromes mimicking uveitis.
• Drug Reactions: Certain medications and vaccinations have been reported to trigger uveitis in susceptible individuals.
• Idiopathic Uveitis: In many cases, no specific cause is identified despite thorough investigation.

Symptoms

The symptoms of uveitis depend on the type and location of the inflammation:

• Anterior Uveitis (Iritis):
  • Eye redness, especially around the iris
  • Eye pain and tenderness
  • Blurred vision
  • Light sensitivity (photophobia)
• Intermediate Uveitis:
  • Floaters (small specks or clouds moving in the visual field)
  • Blurred vision
  • Mild eye discomfort without significant redness
• Posterior Uveitis:
  • Floaters
  • Blurred or decreased vision
  • Less prominent pain or redness
• Panuveitis:
  • Symptoms affecting all parts of the eye, combining redness, pain, floaters, and vision loss

Diagnosis

Diagnosing uveitis involves a combination of clinical evaluation, eye examinations, and laboratory investigations to determine the underlying cause:

• Comprehensive Eye Examination: Slit-lamp examination helps detect inflammation in the anterior chamber, while fundus examination evaluates the posterior eye structures.
• Visual Acuity Test: Measures the clarity of vision.
• Ocular Pressure Measurement: Intraocular pressure is checked, as uveitis can lead to secondary glaucoma.
• Blood Tests: Investigations for autoimmune diseases, infections, and inflammatory markers.
• Imaging Studies: Optical coherence tomography (OCT), fluorescein angiography, or ultrasound may be used to assess retinal and choroidal involvement.
• Chest X-ray or CT scan: To identify systemic conditions like sarcoidosis or tuberculosis.
• Aqueous or Vitreous Tap: Rarely, fluid from the eye may be sampled to identify infectious causes.

Treatment

The treatment of uveitis focuses on controlling inflammation, relieving symptoms, treating the underlying cause, and preventing vision loss:

• Corticosteroids: The mainstay of treatment, administered as eye drops, oral medication, periocular injections, or intravenous infusions depending on severity and location of inflammation.
• Immunosuppressive Agents: Drugs like methotrexate, azathioprine, or biologics (adalimumab, infliximab) may be prescribed in chronic or severe autoimmune-related uveitis.
• Antibiotics or Antivirals: Used in infectious uveitis to treat the specific underlying infection.
• Mydriatic Eye Drops: Dilate the pupil to relieve pain from ciliary spasm and prevent the formation of synechiae (adhesions in the eye).
• Intraocular Pressure Management: Medications to control elevated eye pressure and prevent glaucoma.
• Surgical Interventions: In cases of severe complications like cataract, glaucoma, or persistent vitreous opacities, surgery such as vitrectomy may be required.

Prognosis

The prognosis for uveitis varies depending on its cause, severity, and timeliness of treatment:

• Anterior Uveitis: Typically responds well to treatment, especially when addressed early, with a good visual outcome in most cases.
• Intermediate and Posterior Uveitis: May require longer-term treatment and careful monitoring but can often be controlled with appropriate therapy.
• Chronic Uveitis: In cases with recurrent or long-term inflammation, there is a higher risk of complications such as glaucoma, cataracts, or vision loss.
• Vision Recovery: Many patients experience significant improvement in vision after treatment, though some may have residual visual disturbances.
• Importance of Follow-up: Regular ophthalmic follow-up is crucial to monitor disease activity, adjust treatment, and prevent relapse or complications.

With early diagnosis and proper management, most individuals with uveitis can maintain good vision and quality of life. However, delayed or inadequate treatment increases the risk of permanent visual impairment.