Uveitis: Uveal Tract Inflammation
Definition
Uveitis is the inflammation of the uveal tract, which consists of the iris, ciliary body, and choroid. It can also involve adjacent structures like the retina, vitreous, and optic nerve. Uveitis can lead to serious complications, including vision loss if not treated properly.
Types of Uveitis
- Anterior Uveitis (Iritis): Affects the iris and ciliary body.
- Intermediate Uveitis: Involves the vitreous and peripheral retina.
- Posterior Uveitis: Affects the choroid, retina, and optic nerve.
- Panuveitis: Involves all layers of the uveal tract.
Causes of Uveitis
Infectious Causes:
- Viral: Herpes simplex, Cytomegalovirus, HIV
- Bacterial: Tuberculosis, Syphilis, Lyme disease
- Fungal: Candida, Histoplasmosis
- Parasitic: Toxoplasmosis
Autoimmune and Inflammatory Causes:
- Ankylosing spondylitis (AS is a long-term autoimmune disease that causes inflammation in the spine and other joints. It can also cause bony bridges to form between the vertebrae in the spine, making it less flexible and leading to a hunched posture. )
- Sarcoidosis (It is a rare disease that causes the immune system to overreact, forming inflamed lumps called granulomas in the body's organs. )
- Behçet's disease (It is a rare, chronic inflammatory disorder that damages blood vessels and tissues in the body. It can cause a variety of symptoms, including painful sores, eye inflammation, and arthritis. )
- Reactive arthritis (It is a type of arthritis that occurs after an infection in another part of the body. It can cause joint pain, swelling, and inflammation in the joints, eyes, and urinary tract. )
- Systemic lupus erythematosus (SLE also known as lupus, is a chronic autoimmune disease that causes inflammation in the body's tissues. SLE can affect many organs and systems, including the skin, joints, kidneys, brain, heart, and lungs.)
- Trauma or surgery
- Drug-induced (e.g., bisphosphonates, checkpoint inhibitors)
- Malignancies (e.g., lymphoma, leukemia)
Signs and Symptoms
Symptoms vary based on the type of uveitis.
Anterior Uveitis:
- Redness
- Eye pain
- Photophobia (light sensitivity)
- Blurred vision
- Small, irregular pupil (due to posterior synechiae)
Intermediate Uveitis:
- Floaters
- Blurred vision
- Minimal pain or redness
Posterior Uveitis:
- Floaters
- Loss of vision
- Night blindness (in severe cases)
Panuveitis:
- Combination of anterior, intermediate, and posterior symptoms
Diagnosis and Investigations
A thorough clinical evaluation and investigations are necessary for accurate diagnosis:
Ophthalmic Examination:
- Slit-lamp examination
- Fundoscopy
- Tonometry (to check intraocular pressure)
Laboratory Tests:
- Complete blood count (CBC)
- Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)
- Autoimmune markers (HLA-B27, ANA, RF, ACE levels for sarcoidosis)
- Infectious screening (PPD for tuberculosis, VDRL/RPR for syphilis, Toxoplasma IgM/IgG)
Imaging Studies:
- Optical coherence tomography (OCT) for retinal involvement
- Fluorescein angiography
- B-scan ultrasonography (for posterior segment involvement)
- MRI/CT scan if systemic involvement is suspected
Treatment of Uveitis
Treatment depends on the cause and severity of uveitis.
Corticosteroids (Anti-inflammatory drugs):
- Prednisolone acetate 1% eye drops (for anterior uveitis)
- Dexamethasone eye drops
- Oral Prednisone (40–60 mg/day, tapering gradually)
- Intravitreal steroids (e.g., Dexamethasone implant for posterior uveitis)
Cycloplegics (To relieve pain and prevent synechiae formation):
- Atropine 1% eye drops
- Homatropine 2% eye drops
Immunosuppressive Therapy (For autoimmune uveitis):
- Methotrexate
- Azathioprine
- Cyclosporine
- Biologics (e.g., Adalimumab, Infliximab for refractory cases)
Antibiotics/Antivirals (For infectious causes):
- Acyclovir (For herpes-related uveitis)
- Rifampicin, Isoniazid (For tuberculosis-associated uveitis)
- Trimethoprim-sulfamethoxazole (For Toxoplasma-related uveitis)
Anti-glaucoma Medications (If increased intraocular pressure):
- Timolol eye drops
- Acetazolamide (oral)
Medications to Avoid
Some medications can worsen uveitis and should be avoided unless necessary:
- Prostaglandin analogs (e.g., Latanoprost, Bimatoprost) – May exacerbate inflammation.
- Epinephrine eye drops – Can increase inflammation.
- NSAIDs (In some cases, may worsen posterior uveitis).
Role of Vitamins in Uveitis
Certain vitamins can help in managing uveitis and promoting eye health:
- Vitamin A – Supports retinal function and immune response.
- Vitamin C – Reduces oxidative stress and inflammation.
- Vitamin D – Plays a role in modulating the immune system.
- Vitamin E – Helps in reducing free radical damage.
- Omega-3 Fatty Acids – Beneficial for reducing inflammation in chronic cases.
Lifestyle Recommendations
- Avoid Smoking and Alcohol: These can worsen inflammation.
- Use Sunglasses: Protects eyes from UV light and reduces photophobia.
- Maintain a Healthy Diet: Include green leafy vegetables, fish, nuts, and fruits.
- Manage Systemic Conditions: Control autoimmune disorders like rheumatoid arthritis.
- Reduce Screen Time: Helps prevent eye strain and discomfort.
Complications of Uveitis
If left untreated, uveitis can lead to:
- Cataracts
- Glaucoma
- Retinal detachment
- Permanent vision loss
- Macular edema
- Synechiae formation (adhesion of iris to lens or cornea)
Management and Follow-Up
Regular Eye Check-ups: Essential to monitor inflammation and prevent complications.
Tapering Medications Carefully: Sudden withdrawal of steroids can cause a rebound inflammation.
Early Detection of Relapses: Patients with autoimmune disorders should monitor for early symptoms.
Compliance with Treatment: Taking prescribed medications on time is crucial.
Conclusion
Uveitis is a serious eye condition that requires prompt diagnosis and treatment. Proper management, including anti-inflammatory medications, immunosuppressive therapy, lifestyle modifications, and regular follow-ups, can prevent complications and preserve vision.