Uveitis

Uveitis is inflammation of the eye's uvea. The uvea is the eye's middle layer that consists of the iris, ciliary body and choroid.

Uveitis is classified by which part of the uvea it affects. Anterior uveitis refers to inflammation of the iris alone (called iritis) or the iris and ciliary body. Anterior uveitis is the most common form. Intermediate uveitis refers to inflammation of the ciliary body. Posterior uveitis is inflammation of the choroid. Diffuse uveitis is inflammation in all areas of the uvea.

Many cases of uveitis are chronic, and they can produce numerous possible complications, including clouding of the lens (cataract) or cornea, elevated intraocular pressure (IOP), glaucoma, and retinal problems (such as swelling of the retina or retinal detachment). These complications can result in vision loss.

Uveitis occurs most frequently in people ages 20 to 50. A recent California study* estimated that more than 280,000 people in the United States are affected by uveitis each year, which is almost three times greater than previously thought. The study, based on medical records from six northern California communities, also estimated that uveitis is the reason for 30,000 new cases of blindness a year and up to 10 percent of all the cases of blindness. It is more common in women and more likely to develop with age, according to that study. (However, a previous study, done on a Minnesota community, showed a higher incidence of uveitis in people aged 25 to 44, rather than in elderly people.)

With anterior uveitis, your symptoms will likely affect only one eye. You will feel mild to strong pain and will have redness and light sensitivity. Your vision may also be blurred.

Both intermediate and posterior uveitis are usually painless. Symptoms are blurred vision and floaters, typically in both eyes. Most people who develop intermediate uveitis are in their teens, 20s or 30s.

Diffuse uveitis has a combination of symptoms of all types of uveitis.

Uveitis has dozens of causes, including viral, fungal and bacterial infections. But, in many cases, the cause is unknown (idiopathic). Eye care practitioners can sometimes identify the cause if there has been trauma to the eye, such as from surgery or a blow, or if you have an infectious or immunological systemic disorder.

Some of the many different systemic disorders that can cause uveitis include:

Your doctor will likely prescribe a steroid to reduce the inflammation in your eye. Whether the steroid is in eye drop, pill or injection form depends on the type of uveitis you have. Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops. Intermediate uveitis can go either way, and posterior uveitis usually requires tablets or injections.

Steroids and other immunosuppressants can produce many serious side effects, such as kidney damage, high blood sugar, high blood pressure, osteoporosis and glaucoma. This is especially true of steroids in pill form because the dose must be relatively high in order for enough of the drug to find its way to the back of the eye. So it is important to follow your doctor's dosage instructions carefully and to keep visiting him or her regularly to monitor the progress.

In April 2005 the FDA approved Bausch & Lomb's drug Retisert for chronic non-infectious posterior uveitis. Retisert is a drug implant and is the first of its kind for treatment of uveitis. It consists of a drug reservoir that delivers sustained amounts of fluocinolone acetonide, an anti-inflammatory corticosteroid, for about two and a half years. It is implanted into the back of the eye. During clinical trials the recurrence of uveitis fell from 40-54 percent to 7-14 percent. The most common side effects noted during those studies were cataract progression, increased intraocular pressure, procedural complications and eye pain.
 

If you have anterior uveitis, your doctor will likely prescribe, in addition to the steroids, pupil-dilating eye drops to reduce pain. You may also need eye drops to lower your intraocular pressure if it's elevated.

If you have a known systemic condition, your doctor or doctors will treat that as well.