UveitisIntroduction:
The
uveal tract is the layer of the eye that contains the iris (the ring with your
particular eye color surrounding the pupil), the ciliary body and the choroid.
The anatomy and the various forms of uveitis are illustrated
in this link. The complications of uveitis can lead to permanent
loss of vision. The inflammation of the uveal tract can lead to cataracts,
retinal detachment, glaucoma, formation of new blood vessels (neovascularization)
of the retina, the optic nerve or the iris. Cystoid macular edema is one of the
complications of untreated uveitis that leads to a loss of vision. This can be
prevented when an eye specialist is consulted prompttly for early treatment. Signs
and symptoms: This table summarizes the major symptoms
of anterior uveitis (formerly called "iritis"). Note that
the first three symptoms, the triad of red eye, pain and photophobia are early
signs and are so typical, they should ring alarm bells to see an eye specialist
without hesitation.
| Symptoms of anterior
uveitis | | Symptom: | Description: |
| red eye | dilated
blood vessels in the conjunctiva adjacent to the cornea ("perilimbal flush")
| | pain in eyeball | this
is a deep gnawing pain radiating into the center of the eye |
| photophobia (light sensitivity) | light
makes the eye more teary and more painful; pupil is small |
| vision decreased | due
to the inflammation there is an accumulation of protein and cells behind the cornea
obstructing vision | The decrease in vision
is a late sign that should not develop as with early treatment all of the symptoms
will rapidly disappear within 24 hours. With intermediate uveitis
there is no pain, it presents with decreased vision and floaters. This is due
to the fact that the inflammation is at a deeper level as indicated in the link
under the introduction above. With slit lamp examination the eye specialist sees
a lot of inflammatory cells and other signs of deeper inflammation, which becomes
more evident with indirect
ophthalmoscopy. The advantage of this procedure is that the entire
retina can be visualized after the pupils have been dilated. Diffuse
uveitis can produce any of the symptoms mentioned above. Diagnostic
tests: The eye specialist will do the regular examination methods
such as measuring the intraocular eye pressure, using the slit lamp and possibly
doing indirect ophthalmoscopy. If autoimmune diseases such as rheumatoid arthritis
or ankylosing spondylitis are suspected, special blood tests will likely have
to be ordered by the specialist. With certain infectious diseases blood test titers
(specific Elisa tests) would be ordered.
Treatment: Treatment
has to be specifically directed against the underlying cause. However,
with anterior uveitis often the cause is unknown, particularly if it is the first
bout (cause unknown in about 70%). In these cases it is important to treat early
with corticosteroid eye drops, typically 1 drop in the affected eye every hour
when awake for several days. The eye doctor will want to see the patient again
in a few days to reexamine in order to verify that the uveitis is settling and
to check that the corticosteroid treatment has not elevated the eye pressure beyond
unsafe levels. From then on the corticosteroid drop treatment will be tapered
over a few weeks and then stopped. Occasionally a rheumatologist might
be required in cases of connective tissue disease. With severe rheumatoid
arthritis immune suppressive therapy might have to be added along
with the corticosteroid eye drops, which would stabilize the uveitis. If
uveitis is due to underlying infectious diseases such as syphilis,
herpes zoster, herpes simplex, histoplasmosis or cytomegalovirus,
these underlying infections would have to be treated, perhaps with the help of
an infection specialist. Not all cases of chronic uveitis can be solved
as research has not found an answer to all situations. For instance, birdshot
chorioretinopathy seems to be inherited and affects mostly women
in their 50's to 70's who often have a positive HLA-A29 marker (a special blood
test). These patients often end up with a chronic intermediate and posterior uveitis
in both eyes. Toxoplasmosis is a parasitic infection
that can also lead to a chronic choroiditis and retinitis. This is a chronic condition
that needs to be followed along by an eye specialist to prevent retinal detachment
and other complications.
Remember these THREE
THINGS: |
A PAINFUL eye that is RED and that is SENSITIVE TO LIGHT means that you must see
an eye specialist on the same day to rule out uveitis! |
|
