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Uveitis: Inflammation in the Eye

Not a super common scenario, but if for whatever reason an individual's immune system is working especially hard, such as fighting an infection, then #uveitis can present. The inflammation with uveitis is within the eye itself and can damage the part of the eye called the uvea, although it can impact other parts of the eye as well. Sometimes uveitis goes away quickly; other times it comes back or remains chronic. It can also happen in both eyes or just one. The real concern is permanent vision loss when untreated.



The uvea is the middle layer of the eye between the sclera (white part of the eye) and the retina (light sensitive layer at the back of the eye). The uvea includes the iris, which is the colored part of the eye, as well as the ciliary body which is the part that helps the lens focus, and also the choroid, or the part of the eye that connects the retina to the sclera.

There are a few different types of uveitis which impact different parts of the eye. Anterior uveitis affects the iris at the front of the eye, and is the most common type, usually less serious as well. Posterior uveitis affects the retina and the choroid at the back of the eye. Intermediate uveitis affects the ciliary body and the vitreous or the gel-like fluid that fills the eye, and then there is panuveitis which affects all the parts of the uvea, from the front to the back of the eye.


What are the Symptoms of Uveitis?


Symptoms usually present fairly suddenly. Blurry vision, floaters, eye pain, red eyes, and sensitivity to light are common. Untreated, vision loss can occur so definitely connect with an #optometrist right away if you have concerns. Anyone can suffer uveitis, but it is most common in people age 20 to 60 years. If you smoke cigarettes, you are at even higher risk, but don't rule this out in pediatrics; I've certainly seen it.


What Causes Uveitis?


More often this is related to autoimmune disease than eye infections themselves. If you have AIDS, ankylosing spondylitis, Behcet's disease, Lupus, Multiple sclerosis, Psoriasis, Rheumatoid arthritis, Sarcoidosis, Ulcerative colitis, or Vogt-Koyanagi-Harada (VKH) disease then uveitis may be familiar to you. One in three people with uveitis have either Multiple Sclerosis or Sarcoidosis.


Sometimes it is caused by an infection or condition such as Cytomegalovirus (CMV) retinitis, Histoplasmosis, Herpes virus including the chickenpox, Reactive arthritis, Shingles, Syphilis, or Toxoplasmosis. Uveitis can also be caused by cancers that affect the eye, like #lymphoma.


Interestingly, the autoimmune diseases, arthritis and inflammatory bowel diseases, even herpes infections are more inclined to cause anterior uveitis. Young adults are more prone to intermediate uveitis, but these are the cases that should really be evaluated for Multiple Sclerosis and Sarcoidosis. The posterior cases are the least common form, but also the most severe. This can affect the retina, optic nerve and choroid. This one is also more related to Birdshot chorioretinopathy, herpes or chickenpox, Lupus, Sarcoidosis, Syphilis, and Tuberculosis; hence, more vial etiologies. Rarely as well are all three layers affected, as in panuveitis, which is more severe and raises the risk of permanent vision loss. Bacterial and fungal causes should be evaluated here, but also some of the autoimmune conditions.


How Does My Eye Doctor Evaluate & Treat Uveitis?


An optometrist will dilate your pupils to best evaluate for inflammation in the eye. This exam really is quite simple and painless. They will administer eye drops which dilate the pupil so they can better evaluate the eye. They will also ask a bit about your medical history, and maybe recommend a few additional tests to see if you have an infection or another disease that may be an underlying cause.


Of course, you will also have a visual acuity test where you read the eye charts, because they want to assure you haven't suffered any vision loss. Tonometry can help measure the pressure inside the eye, and a slit-lamp exam can help see within the eye with the assistance of a special microscope. Blood tests can help rule out other issues, maybe even imaging of your chest or brain, and maybe fluorescein angiography to get imagines of blood vessels in the back of the eye.


If they determine you are suffering with uveitis, steroids are their most common approach as these can help reduce the inflammation in your eye. This may be offered as an eye drop, which is through prescription. Sometimes they do give this to you in pill form, and other times this may be via injections around the eye. There are times however, that treatment doesn't work and surgery may be suggested so they can introduce a small device called an implant which will administer small doses of steroid over time. It might also be that you need treatment for any underlying condition. Like all medications, there are risks for steroids. They can increase your risk of cataracts and glaucoma so consistent eye exams are vital.


If you identify these symptoms, get evaluated quickly. Your vision is important and loss is rare with treatment. Dig into the underlying cause though if you do suffer uveitis.

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