Uveitis

INTRODUCTION

Uveitis (You-We-Eye-Tis) is a broad term used for eye inflammation. The name comes from the fact that the inflammation most commonly arises in the middle layer of the eye called UVEA. The suffix ‘-itis’ means inflammation in Greek; and just like inflammation of JOINTS (Greek - ‘arthron’), or LIVER (Greek - hêpar) is known as arthritis or hepatitis respectively, the inflammation of the uvea is called UVEITIS.

Uvea is the middle layer of the eye and the name has originated from the Latin word, Uva; which means a purple grape. Uveal layer is majorly composed of blood vessels and is responsible for supplying nutrition to the retina (the sensory part of the eye).

Uveitis is not a single disease but actually comprises of about 50 different conditions based on location, cause and type. The scope of uveitis is actually any inflammatory disease of the eye and includes inflammation of any part of the eye and not just the uvea. It includes the cornea, sclera and the retina.

TYPES

Uvea comprises of 03 parts:
1) Iris
2) Pars Plana / Ciliary Body
3) Choroid

Uveitis can be broadly classified into 4 major types based on location and are as follows:

1) Anterior Uveitis: (front of the eye) Includes iritis & iridocyclitis.
2) Intermediate Uveitis: (middle of the eye) Includes cyclitis, vitritis & pars planitis.
3) Posterior Uveitis: (back of the eye) Includes retinitis & choroiditis.
4) Panuveitis: (all parts of the eye) Includes all the structures.

SYMPTOMS

A uveitis attack may start off suddenly or may persist silently. Nevertheless, the patient can experience the following symptoms:

1) Severe redness in the eye
2) Pain
3) Blurry vision
4) Light Sensitivity
5) Floaters (floating spots in vision)

CAUSES

The major causes of uveitis are:

1) Auto-Immunity: Auto-Immunity is said to occur when the body’s own immune system turns up against the body tissues itself. There can be multiple triggers or none at all. Many cases of uveitis are caused by mechanisms still unknown to modern science and are termed “Idiopathic / Undifferentiated”. But as research is progressing, more and more horizons are opening up into the insight of the cause.

2) Association with systemic conditions: Uveitis may occur in association with other systemic conditions e.g. Rheumatoid Arthritis, Psoriasis, Sarcoidosis, Ankylosing Spondylitis etc.

3) Infection: Uveitis can be a result of infection as well e.g. Herpes Virus, Tuberculosis etc.

WHAT TO EXPECT AT THE UVEITIS SPECIALIST’S OFFICE?

Your uveitis specialist will take a detailed look at you and your visit will comprise of:

1) Detailed history about your eye condition
2) Detailed history about your physical condition and general well being.
3) A thorough examination of your eyes including:
I. Vision.
II. Examination of front part of the eye on a slit-lamp.
III. Eye pressure.
IV. A vigorous examination of the back of the eye for which your eyes would be dilated after instillation of drops.

MANAGEMENT

The first thing is to determine what kind of uveitis do you have: this will help us to create a customized treatment plan for you. Management includes the following steps:

1) A thorough history & examination (as explained above).
2) Blood tests to find a cause.
3) Special imaging of eye to assess the condition: OCT & FFA

TREATMENT

There is no “one-size-fits-all” treatment regimen for uveitis. Your specialist will assess your situation and create a customised treatment plan for you. The goal of treatment of uveitis is to:

1) Find the cause
2) Control the inflammation
3) Minimize the damage
4) Restore as much vision as possible
5) Ensure long term follow-up

Treatment options for uveitis include:

1) Antibiotocs for infectious uveitis
2) Eyedrops: Steroids, NSAIDs, Cycloplegics
3) Steroid eye injections: Periocular, Intravitreal, Suprachoroidal
4) Steroid tablets
5) Immunosuppression therapy

PROGNOSIS

The prognosis of uveitis depends on the type of disease that a patient has. Most of uveitic diseases have a good prognosis if management is started within due time frame. Close follow-up and monitoring by the uveitis specialist is mandatory. 
Uveitis attacks may occur once or multiple times, it is difficult to say; but it is a very much controllable disease and patients with proper management do appropriately well.

DR. SOHAIB ABBAS MALIK

DR. Sohaib Abbas Malik is a skilled ophthalmic surgeon working as an associate ophthalmologist at LRBT, Multan Rd. Hospital. He is formally trained in UVEITIS through a fellowship program from Dept. of Ophthalmology, University of Utah, Salt lake city USA.

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eyedoc786@gmail.com

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