Uveitis: symptoms, causes and treatment

What is uveitis

Uveitis is inflammation that occurs in the eye, precisely in the part of the uvea, which is located in the middle layer of the eye. This condition causes swelling and damage to the eye tissue.

The human eye resembles the shape of a tennis ball, with three distinct layers surrounding the vitreous. The deepest part of this layer is the retina. The layer in the middle, which is between the sclera and retina, is called the uvea.

The uvea includes the colored part of the eye (iris), the thin membrane that contains many blood vessels (choroid) and the body of the cilia (the part of the eye that connects them all).

The uvea is very important because it contains many blood vessels and arteries that deliver blood to other parts of the eye.

This disease can affect the quality of your vision. Most cases of uveitis are chronic and can lead to other health problems, such as cataracts, glaucoma, and even the risk of permanent blindness.

Therefore, early diagnosis and treatment is needed to prevent complications from this disease.

How common is this condition?

Uveitis is a disease that can occur in patients in various parts of the world. However, most cases are found in Finland.

This disease is also more common in patients aged 20-50 years. As many as 10% of cases of blindness are caused by this disease.

Types of uveitis

There are several types of uveitis, depending on the part of the eye that is affected. The following is a division of inflammation in the uvea:

1. Anterior uveitis

Anterior uveitis is a type of eye inflammation that occurs in the front (anterior) part of the eye, aka the iris. The iris is the part that determines the color of the eye. This condition can cause redness and pain in the eye. Its development is relatively fast and occurs in healthy people.

Quoted from published journals Ocular Therapeutics, two typesanterior uveitis is:

Iritis: Inflammation occurs only in the anterior chamber
Iridocyclitis: Inflammation occurs not only in the anterior chamber, but also in the anterior vitreous.

Anterior uveitis is the most common type, with 8-15 cases per 100,000 people. This disease attacks men and women with the same incidence.

Even so, the severity is low when compared to other types of eye inflammation.

2. Intermediate uveitis

When inflammation occurs in the middle of the eye, this condition is classified as a type of uveitis intermediate. This type usually causes blurry and ghosting of vision.

The part of the eye affected by this type of uveitis is the pars plana, which is located between the iris and the choroid of the eye. This type is generally associated with the presence of autoimmune diseases, such as multiple sclerosis.

3. Posterior uveitis

In this condition, inflammation occurs in the back (posterior) of the eye. This type is also often referred to as choroiditis because it occurs in the choroid of the eye.

The eye tissue and vessels in the choroid have an important role in supplying blood to the back of the eye.

Choroiditis usually occurs in people with viral, parasitic, or fungal infections. In addition, people who have autoimmune diseases are also at risk of developing choroiditis.

Posterior uveitis is usually much more serious than other types because it can cause injury to the retina. However, the incidence is much lower when compared to other types.

4. Panuveitis

This type of uveitis is inflammation that occurs in almost all parts of the eye. The symptoms and signs are generally a combination of all types of eye inflammation.

Type based on the duration of the disease

This disease can also be divided based on how long it has developed, namely:

Acute type
Inflammation of the eye that is classified as acute usually develops very quickly. However, the recovery process also takes a relatively short time, which is about three months.

Repetitive type
You may experience several times the inflammation of the uvea goes away and recurs within a few months.

Chronic type
Patients with chronic type of eye inflammation experience this disease for longer, and usually the disease will reappear 3 months after undergoing treatment.

Signs and symptoms of uveitis

The signs and symptoms of uveitis generally vary, depending on the severity and type. The following are the symptoms of eye inflammation based on the type:

1. Anterior uveitis or iridocyclitis

The symptoms that may appear if you have iridocyclitis (anterior uveitis) are:

Pain appears in the eye
Red eyes
Photophobia (sensitive to light)
Blurry vision
Excess tear production
Eye pain, which doesn't go away
Small pupils and other pupillary changes

2. Posterior uveitis or choroiditis

Some of the symptoms that may appear if you have choroiditis include:

Shadowed vision
Blurry vision

The pain is generally not felt. If someone with choroiditis feels pain, it may be due to another eye problem.

3. Intermediate

Inflammation of the uvea type intermediate may experience the following symptoms:

Shadowed and reduced vision (similar to the posterior type)
Photophobia
Mild inflammation on the outside of the eye

There may be signs and symptoms not listed above. If you have concerns about a particular symptom, consult your doctor.

When should I see a doctor?

Your doctor can refer you to an eye specialist if you have any of the above symptoms. The ophthalmologist will examine the eye in more detail using a microscope and light and can recommend other tests if uveitis is diagnosed.

Each sufferer's body shows signs and symptoms that vary. To get the most appropriate treatment and according to your health condition, always consult your problems and symptoms with your doctor.

Causes and risk factors for uveitis

Uveitis has a variety of causes, including viral, fungal, and bacterial infections. However, in most cases, it is not known what causes your uvea to become inflamed.

Generally, inflammation of the eyes is often associated with problems with the body's immune system. However, it is also possible that this disease is associated with a genetic problem.

There are several factors that increase your risk of developing uveitis, such as:

1. Age

This disease is mostly found in people aged 20-50 years. If you fall into this age range, you are more likely to develop eye inflammation.

2. Immune system problems

This disease often occurs in people who have autoimmune diseases. This means that the immune system, which is supposed to fight disease, attacks healthy body tissues.

Several types of autoimmune diseases associated with uveitis include:

Arthritis
Crohn's disease
Psoriasis
Multiple sclerosis
Juvenile idiopathic arthritis

3. Infection

The following are some infections, whether viral, fungal, bacterial, or parasitic, which can cause inflammation of the uvea:

Toxoplasmosis
Herpes simplex virus
Varicella-zoster virus
Cytomegalovirus
Tuberculosis (TB)
HIV and syphilis

4. Have had eye surgery

Having a surgical procedure or eye surgery can also increase your risk of developing eye inflammation the next time.

5. Using contact lenses

Use of contact lenses or soft lens also believed to have the potential to cause inflammation of the uvea.

6. The HLA-B27 gene

Although the disease is not inherited from family members, a gene named HLA-B27 is associated with a risk of developing inflammation of the anterior eye (front of the eye).

As many as half of patients with anterior type of eye inflammation have the HLA-B27 gene. This gene is found in people with certain autoimmune problems, such as arthritis and Crohn's disease.

7. Other causes

There are also other conditions that can cause this disease, such as:

Trauma or injury to the eye
One type of cancer, such as lymphoma

Uveitis complications

In some cases, this disease can cause complications if not treated seriously.

The likelihood of complications is greater if you are over 60 years of age, have a history of chronic uveitis, and experience inflammation of the uvea that occurs rarely (posterior or intermediate).

The following are complications that may occur:

1. Glaucoma

Glaucoma results from damage to the optic nerve, which is the nerve that connects your eye to your brain. This has the potential to cause blindness if not treated early on.

2. Cataracts

Inflammation of the uvea of the eye can also affect the appearance of shadows or tissue in the lens of the eye, so that the sufferer's vision will be hazy or cloudy (cataract).

3. Cystoid macular edema

This condition is a swelling that occurs in the retina. This complication is usually found in patients with chronic or posterior eye inflammation.

4. Posterior synechiae

Inflammation can also cause the condition of the iris to stick to the eye lens, or what is known as posterior synechiae.

Diagnosis & treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is this condition diagnosed?

If you experience signs or symptoms of uveitis, as listed above, it is very important to consult a doctor immediately.

Inflammation of the inside of the eye can permanently affect vision or cause blindness if not treated promptly.

The doctor will examine your eye and ask about your medical history. Then, you will also be asked to undergo several tests, such as laboratory tests to check for infections or autoimmune problems.

An eye exam can include:

Eye acuity test: this test measures whether the disease affects the sufferer's vision and eye acuity
Funduscopic examination (ophthalmoscopy): this exam uses eye drops and an optic light to dilate the eye so as not to interfere with examining the inside of the eye.
Tonometry to measure the pressure of the eyeball.
Slit lamp examination: used to measure eye pressure. Dye (fluorescent) will be placed in your eye to make the blood vessels easier to see

How to treat uveitis?

Treatment generally depends on the cause and the part of the eye that is affected. Usually, doctors prefer medical treatment with drugs.

However, in some rare cases, the doctor will recommend a surgical procedure. The following are the medications that doctors recommend to treat uveitis:

1. Treatment with steroids

Some cases of uveitis can be treated with steroid (corticosteroid) treatment. The drug that is usually used is prednisolone.

Corticosteroids work by affecting the function of the body's immune system, so that the immune system will not produce chemicals that cause inflammation.

Several types of corticosteroids that can be given are:

Corticosteroid eye drops
Corticosteroid eye drops are usually given for inflammation of the anterior uvea. Depending on your symptoms, the dosage usually varies.

Corticosteroid injection
If inflammation occurs at the back of the eye (uveitis or posterior intermediate), or the eye drops don't work, you will need a corticosteroid injection. Before being given the injection, you will be given a local anesthetic to prevent pain or soreness.

Corticosteroid tablets or capsules
Corticosteroid drugs taken in capsule or tablet form are the strongest types of corticosteroids. This drug is usually given when other types of corticosteroid treatment are not effective.

2. Mydriatic eye drops

If you have anterior (front of the eye) uveitis, you may be given mydriatic eye drops, which can dilate the pupil and soothe your eye muscles.

This medication can also help reduce the risk of developing other eye problems, such as glaucoma.

3. Treatment of infection

If you have eye inflammation due to an infection, the doctor will give you medicines that can help fight the infection. Drugs that doctors usually recommend are immunosuppressants and antibiotics.

4. Operation

In very rare cases, a surgical procedure called a vitrectomy is performed to treat the disease. This procedure is performed when the inflammation is very severe.