Ocular Inflammation

Uveitis is inflammation of the uveal tract, the middle layer of the eye which includes the iris, ciliary body and the choroid.

The uveal tract lies between the retina (innermost layer) and sclera (outermost layer), it consists of several components:

• The iris acts as a shutter, enlarging and constricting to control the amount of light entering the eye.
• The ciliary body supports the muscles that allow the lens to change shape, focusing light onto the retina.
• The choroid is rich in blood vessels that supply the eye with oxygen and nutrients.

As the uveal tract consists of different anatomical compartments, the types of Uveitis are classified based on the site of inflammation.

• Anterior Uveitis (also known as iritis or iridocyclitis), affects the iris or ciliary body.
• Intermediate Uveitis (including vitritis and pars planitis), affects the middle part of the eye, i.e. vitreous and pars plana.
• Posterior Uveitis (including retinitis, choroiditis, chorioretinitis and neuroretinitis), affects the retina and choroid.
• Panuveitis, when the whole uveal tract is inflamed.

Broadly speaking, uveitis may be an isolated condition just affecting the eye or it may be part of a more generalised disease which also affects other parts of the body.

Uveitis may result from a wide variety of causes, including:

• Infections, including bacterial infections, viral infections especially herpes viruses, fungal infections, or parasitic infections such as toxoplasmosis.
• Autoimmune diseases
• Severe injury of the affected eye or of the fellow eye in the past, i.e.sympathetic ophthalmia)
• Drugs.
• Cancer, i.e. masquerade syndromes
• Unknown causes, i.e. idiopathic.

The symptoms of Uveitis are as follows:

Below are pictures showing possible findings in some Uveitis patients.

• Irregular pupil from posterior synechiae

• Keratic precipitates

A detailed eye examination by an ophthalmologist will be conducted to determine the presence, type and cause of Uveitis. This will include vision assessment and fundus examination. As Uveitis is associated with a variety of medical conditions, multiple investigations including blood tests, skin tests or X-rays may be required to assist in the diagnosis. These investigations may take time and incur a certain amount of costs but are very important to arrive at the correct diagnosis and underlying cause in order to plan for the best treatment.

As Uveitis can be associated with the diseases in the rest of the body, your ophthalmologist may want to obtain the expert opinions regarding your overall health from your primary care physician or other medical specialists.

The treatment aims to:

• Relieve pain and discomfort
• Prevent vision loss from the disease and its complications
• Treat the underlying cause of disease where possible

Steroids are the mainstay medication and may be given as eyedrops or sometimes as tablets, especially in severe cases, to reduce inflammation. Other medications may be prescribed as adjuncts to steroids. Pupil dilating drops which may be used to reduce pain can result in temporary blurring of vision.

If you are on steroid eye drops, you will need to return to your doctor for regular appointments to check to see if you are developing any of the side effects from the eye drops. This may include developing an early cataract or getting elevated eye pressure. Your doctor will monitor you closely for the development of such issues and advise you accordingly if any issues arise during the course of the treatment.

Inflammation of the eye can permanently affect sight and even lead to complications such as blindness if left untreated.

Uveitis can have these complications:

• Glaucoma (raised eye pressure)
• Cataract (clouding of the native lens of human eyes)
• Neovascularization (growth of new, abnormal blood vessels)
• Cystoid Macular Edema (swelling of the macula)

These complications may occur in chronic, severe eye inflammation. Specialist care is essential to ensure your eye condition is appropriately managed.

The outcomes vary considerably, depending on the type of Uveitis. Technically, Uveitis cannot be cured. Instead, treatment suppresses the inflammation until the disease becomes inactive. It is not possible to know how long the disease will last as it can sometimes recur.

Some patients develop recurring episodes of Uveitis despite medications prescribed by their eye specialist. Unfortunately, in these patients, there may not be a way to permanently prevent the Uveitis attacks from occurring but medication can be given to try to reduce the frequency of attacks.

Uveitis may be an immensely frustrating disease to cope with as a permanent ‘cure’ may not be possible. However, in most cases, with proper treatment and follow up, the disease does not cause permanent visual loss. If you feel a flare of your Uveitis starting to happen, it is important that you get an eye checkup as soon as possible so that treatment may be started earlier. Delaying treatment may result in a longer course of treatment required.