Uveitis: A serious problem that should not be underestimated

Uveitis refers to the inflammation of the uvea, and early diagnosis is vital to minimising sight loss. This article provides a clinical overview of the condition and discusses the diagnosis and management of uveitis from the clinician’s perspective.

What is uveitis?

It is inflammation affecting the inside of the eye, specifically referring to the uveal tract (iris (iritis), ciliary body (cyclitis), choroid (choroiditis)).

What types are there?

Uveitis can be classified by:

Time-course of disease

  • Acute (short spells of inflammation)
  • Chronic (long-term inflammation)

Which part of the eye is affected?

  • Anterior (front part of the eye)
  • Intermediate (mostly affecting the vitreous; a gel-like substance that helps the eye maintain a round shape)
  • Posterior (affecting the vitreous, choroid and retina)

Cause of underlying inflammation

Infectious (bacterial, viral, fungal)

Non-infectious (auto-immune)

What are the symptoms of uveitis?

By far the most common uveitis is acute anterior uveitis. This causes pain with light, red eye/s, and sometimes blurred vision. Intermediate uveitis can cause floaters, and posterior uveitis can have a number of symptoms including loss of vision to varying degrees.

How is uveitis investigated?

Simple, mild, anterior uveitis (iritis) is usually clinically obvious to the examining ophthalmologist, and apart from examining the fellow eye (to confirm only one eye is affected) and examining the vitreous and retina (to confirm that it is purely anterior uveitis), no tests are usually necessary. Severe, recurrent, or bilateral simultaneous iritis (i.e. both eyes affected at once) can often be associated with other inflammatory conditions and investigations may be requested Intermediate and posterior uveitis are more likely to be associated with other conditions in the body, so more tests are often ordered, including blood tests, chest X-rays, etc.

What is the treatment for uveitis?

Iritis is usually treated with eye drops alone, with steroid drops used to settle the inflammation and dilating drops used to widen the pupil and prevent (or if already present, break) adhesions between the iris and lens capsule. If the iritis is severe, can require injections of steroid underneath the conjunctiva lining of the eye. Intermediate and posterior uveitis will be managed with either local or oral therapy, which depends on many factors, including the specific diagnosis, the age and general health of the patient, and the use of other treatments for unrelated diseases. Exclusion of an infectious process is essential before aggressive therapy with steroids or immunosuppressive drugs is started.

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