Uveitis (including Iritis)

Uveitis technically refers to inflammation in a layer of the eye (anterior, middle or interior).

The American Uveitis Society estimates that uveitis is responsible for close to 20% of the blindness in the United States and other developed countries. Uveitis requires thorough examination by an optometrist or an ophthalmologist; and if a referral is needed it should be an urgent referral because it is an urgent matter to begin treatment to control the inflammation.

Types of Uveitis

Uveitis is usually categorized in one of four ways:

  • Uveitis cases that are anterior in location (anterior uveitis) are frequently termed iritis due to the inflammation of the iris and anterior chamber. This condition can occur as an isolated incident and subside with the proper treatment begum prior to significant progression. However, it may alternatively take on a chronic or recurrent nature.

Dr. Singh looks for signs, including certain dilated vessels, presence of certain cells or flare in the anterior chamber, and keratic precipitates (“KP”) located on the posterior surface of the cornea. A KP is an inflamed cellular deposit on the corneal endothelium. Acute ones are white and round while older ones are faded and more irregular in shape.

  • Intermediate uveitis consists of vitritis which are a certain type of inflammatory cells.
  • Posterior uveitis involves inflammation of the retina and possibly some other areas.
  • Pan-uveitis is the term used when there is inflammation of all the layers of the uvea.

EyeWithRedBloodVessels

Symptoms can include decreased vision, injected conjunctiva, pain and red eye. Even slight redness, as shown above, can be an early indication of uveitis. However, the redness can become much worse, as shown below.

EyeWithWorseningRedBloodVessels

Causes of Uveitis

There are a myriad of conditions that have the potential to lead to the development of uveitis. One of these possibilities is a systemic disease (of which there are several) and another is a syndrome confined to the eye (of which there are also several).

Systemic Disorders Causing Uveitis

  • Acute posterior multifocal placoid pigment epitheliopathy
  • Ankylosing spondylitis
  • Beh├žet’s disease
  • Birdshot retinochoroidopathy
  • Brucellosis
  • Herpes simplex
  • Herpes zoster
  • Inflammatory bowel disease
  • Juvenile rheumatoid arthritis
  • Kawasaki’s disease
  • Leptospirosis
  • Lyme disease
  • Multiple sclerosis
  • Presumed ocular histoplasmosis syndrome
  • Psoriatic arthritis
  • Reiter’s syndrome
  • Sarcoidosis
  • Syphilis
  • Systemic lupus erythematosus
  • Toxocariasis
  • Toxoplasmosis
  • Tuberculosis
  • Vogt-Koyanagi-Harada syndrome

Treatment for Uveitis

Therapeutic goals for uveitis are to prevent damage to ocular structures, and prevent long-term visual loss, and reduce inflammation.

Corticosteroids have long been the mainstay of treatment for posterior uveitis and are most commonly administered systemically or sometimes through injections that are periocular (the immediate area surrounding the eyeball).

Topical routes are generally not used because medications administered in this way do not reach the important therapeutic levels in the posterior segment of the eye.