Uveitis is inflammation of the inside of the eye which affects one or more of the three parts of the uvea: the iris (which gives the eye its colour), the ciliary body (behind the iris, where the aqueous humour is produced) and the choroid (behind the retina). It is responsible for 10-15% of the cases of blindness in developed countries and may occur at any age. It is most common in young to middle-aged patients.
Types of uveitis are classified according to their anatomical localisation:
The types of uveitis have different symptoms depending on the localisation. Anterior and intermediate uveitis present with redness, eye pain, tearing, photophobia (intolerance to light) and blurred vision. On the other hand, posterior uveitis usually presents with myodesopsia (perception of floaters), and a loss of vision which varies depending on the size and location of lesions.
Inflammation can occur in only one eye or both (simultaneously or separately in time). It can manifest itself acutely and suddenly or chronically with a more gradual and longer onset. Relapses or recurrences may be common.
The origins of intraocular inflammation may be very diverse. Uveitis may be the reflection of a disease occuring in other part of the body that has perhaps gone unnoticed, becoming a warning sign.
We can divide the causes of uveitis into infectious and non-infectious. The infectious agents that may cause intraocular inflammation include viruses (such as herpes), bacteria (such as tuberculosis, syphilis) or parasites (such as toxoplasmosis).
Toxoplasmosis is the most common infectious cause. This parasite, ingested in contaminated meat or vegetables, embeds itself in the retina and causes chorioretinitis which, once cured, leads to the appearance of a scar. When this occurs in the macula (the central part of the retina), the loss of vision is severe.
Non-infectious uveitis may affect the eye only or be related to general illnesses like idiopathic juvenile arthritis, ankylosing spondylitis, Behcet's disease, an inflammatory intestinal disease or sarcoidosis, etc.
We must remember that almost 35% of patients never get to the bottom of the cause or exact origin of the inflammation, so these are considered cases of idiopathic uveitis.
Treatment for uveitis depends on the cause of the inflammation, and should be started as soon as possible. In those of infectious origin, antibiotic treatment can cure it.
In most patients, corticosteroids are the mainstay of treatment in the acute phase, in form of eye drops, injections around or in the eye, or by systemic route (oral, intramuscular or intravenous).
In some cases of uveitis that are immunological, chronic and difficult to manage or have complications arising from the use of corticosteroids, it might be necessary to use immunomodulatory drugs to control inflammation (for a prolonged time or even lifelong). Some of these drugs might have side effects that require close monitoring.
In other cases, a surgical procedure with diagnostic purposes may be necessary in order to treat some of the complications associated with intraocular inflammation (especially in chronic forms), such as cataracts, glaucoma, persistent opacity of the vitreous body, intraocular bleeding, or retinal detachment.
Frequently asked questions
To diagnose uveitis, a thorough eye examination and a complete medical history, both general and ophthalmic, is essential to be able to investigate the cause of the inflammation. Different eye diagnosis tests, such as an optical coherence tomography or fluorescein angiography, help us to complete the study of each case.
Uveitis is one of the eye diseases most frequently associated with other diseases of the human body, meaning a study and multidisciplinary management which includes an internal medicine doctor or rheumatologist is a good idea. At the Barraquer Ophthalmology Centre, we do a comprehensive assessment of our patients in close collaboration with the ophthalmologist and the Internal Medicine service, as a joint follow-up with the two consultants is fundamental.
During the initial study and monitoring, most patients may require blood tests, X-ray examinations or other special additional tests. In more specific cases, a puncture or biopsy of the inside of the eyeball may be required to search for cells, inflamed molecules or DNA, which would help give a more precise diagnosis of the type of uveitis.
Very few types of uveitis are hereditary. In only a small percentage of patients is uveitis due to the modification of a gene. What may exist is a certain immunogenetic predisposition to suffering certain types of uveitis. For example, people with the positive HLA-B27 gene are at a higher risk of suffering recurring anterior uveitis as well as rheumatological problems. However, aside from genes, many other factors are involved in the development of uveitis.
Nowadays, it is very uncommon to go blind due to uveitis if you receive an early diagnosis and appropriate treatment. We have very precise diagnostic methods and multiple effective therapeutic options that act quickly, providing good control of the disease over the long-term and considerably reducing the risk of sequelae. It is fundamental to follow the advice given by your ophthalmologist and make an appointment if you have any symptoms or get worse.