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Uveitis

The Uvea of the eye is the layer that supplies the nutrition to the inner parts of the eye and is an extremely vascular structure. The part of the Uvea in the front (Anterior) portion of the eye is the Iris, followed by the Ciliary Body just behind and finally, the Choroid, which lies deeper to the retina in the back of the eye (Posterior zone). Inflammation of any part of the Uveal layer is called UVEITIS.

Inflammation of the Iris (the colored part of the eye) is called IRITIS (also called Anterior Uveitis). Inflammation of the Ciliary body is called CYCLITIS (also called Intermediate Uveitis), and jointly with iritis is called IRIDOCYCLITIS. Choroidal inflammation is called CHOROIDITIS or Posterior Uveitis. When the entire pigmented vascular coat comprising of Iris, Ciliary body, and the Choroid is collectively inflamed, it is called PAN-UVEITIS.

Uveitis is a fairly serious disease, caused by infections or toxins or auto-immune antibodies traveling via the blood from other sources within the body. It may commonly affect both eyes, causing serious complications and may also cause loss of vision.

Recurrent attacks of uveitis can damage the crystalline lens and other vital tissues of the eye causing cataract, glaucoma and loss of vision by damaging the retina.

  • Symptoms of uveitis (and iritis/iridocyclitis)

    • Blurring of Vision
    • Redness
    • Sensitivity to Light
    • Pain in eyes
    • Sensitivity to touch
     
  • Causes of Uveitis

    The commonest reason for anterior uveitis is the post-operative inflammation set up after a cataract or other surgery. This inflammation is mild, quite normal and transient and settles completely with medication.

    Since uveitis is often caused by general problems in other parts of the body, the management includes investigating the cause. In many cases the exact cause of uveitis may not be ascertained, but damage due to severe inflammation can be minimized by proper treatment. Some of the causes of uveitis are listed below:

    Uveal tissue is susceptible to lodge bacterial infection (such as Staphylococcal, Streptococcal etc), fungal infection (such as Histoplasmosis), and parasitic infection (such as Toxoplasmosis). Uveitis may also occur following perforating injuries of the eye or sometimes after eye surgery. Uveitis can also occur due to a focus of infection in the body, such as tuberculosis of lungs, lymph nodes etc. It is also associated in patients suffering from arthritis such as JCA, Fuchs’ heterochromic cyclitis etc. Connective tissue disorders such as Ankylosing Spondylitis, SLE, Sarcoidosis, and diseases such as inflammatory bowel disease, Tuberculosis, Syphilis and AIDS can also present with uveitis.

  • Pathophysiology (Mechanism)

    In all such patients the presenting complaint is that of redness and light sensitivity of the eyes.

    In cases of injury, there is microbial contamination along with accumulation of necrotic products which gives rise to an inflammatory response. When uveitis occurs with autoimmune disorders, the mechanism may be a hypersensitivity reaction involving deposition of immune complexes in the uveal tract.

  • Treatment

    • Steroid and pupil dilating eye drops (cycloplegics) are generally used. However, as these drugs have many side effects, they must be used only under supervision of the specialist, who will be monitoring for side effects.
    • For any deeper inflammation, oral medication in the form of corticosteroids may also be required.
    • Local injections of steroids may be given in or around the eye as warranted, or if the inflammation is very severe.
  • Complications of Uveitis

    • Cataract
    • Glaucoma
    • New blood vessel formation.
    • Retinal detachment in the long run
    • Shrinkage of the eyeball
    • Blindness