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Uveitis

If you think of the eye as a ball, its wall is made up of three tunics. Externally there is the sclera of the eye, between the uvea and the retina. The uvea consists of the iris and the radial body forward and the choroid backward. The uvea has a rich vascular network.

Therefore, it can be affected by a number of systemic diseases, some of which are autoimmune and hit the vessels and tissues of the uvea with their antibodies, resulting in their inflammation, called uveitis and is distinguished in the following forms:
– Anterior uveitis (or iridocyclitis), where the anterior segment of the eye is affected. It is the most common form and is usually treated with drops
– Posterior uveitis, where the posterior segment of the eye is affected and often requires pills or injections for
– Intermediate uveitis, where the area between the anterior and posterior segment of the eye is affected.
When uveitis is generalized (inflammation of all three segments), then it is called panuveitis.

Why did I have uveitis?

There are many causes for developing uveitis. The main ones are:
– a virus
– some bacteria or microbe
– some fungus
– a parasite
– some systemic disease
– trauma or past surgery
It should be emphasized that in many cases the cause remains unknown. This, however, is not a deterrent to receiving the appropriate treatment.

What are the symptoms?

– redness
– pain, particularly in nearby vision
– blurred vision
– photosensitivity (photophobia)
– floaters (black spots or floaters on the field of vision)
– lacrimation

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You diagnosed me with Anterior uveitis (iridocyclitis). Can you explain what it is?

Iridocyclitis refers to the anterior part of the uvea, which is the iris and the circular body. However, they may also come from systemic or ocular causes. Sometimes their exact cause is not found. Anterior uveitis can be followed by an injury or surgery, while herpes infections of the eye, including shingles, are a common cause. Systemic diseases, such as seronegative arthritis (ankylosing spondylitis, psoriatic arthritis, etc.) and tuberculosis, syphilis and sarcoidosis can be causes of iridocyclitis.
Symptoms include photophobia, pain that worsens with reading, blurred vision, tearing and redness, which may be more pronounced around the cornea. Iridocyclitis can be acute or chronic, unilateral or bilateral, and quite often they relapse.
Most cases respond well to treatment with mydriatic eye drops and cortisone drops. If the disease is not controlled, complications such as glaucoma, cataracts and macular edema may occur.

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What is posterior uveitis?

It is an inflammation of the choroid, the posterior part of the uvea. Like anterior uveitis, it can be an isolated disorder, or part of a multisystemic disease.
Usually there is no pain, nor redness on the outside of the eye. Symptoms include floaters and blurred vision (due to the existence of inflammatory elements in the vitreous, i.e. the gel inside the eye). In order to determine the exact cause, a series of tests should be done, such as angiography with the CT available, laboratory blood tests and chest X-ray. Treatment depends on the cause, but usually includes the use of corticosteroids locally or systematically or by injecting corticosteroids into the eye cavity. Ozurdex is the most technologically advanced drug released intravascularly slowly and has the best results.

What is Interstitial Uveitis?

It typically affects adolescents and young adults, who develop myopia and blurred vision in one or both eyes. The term interstitial uveitis is used to describe the location of inflammation between the anterior and posterior parts of the eye. Other synonymous terms are parplanitis and cyclitis.
Intermediate uveitis may be due to a microbe (infectious) or be the result of an overreaction of the body to a non-infectious cause (autoimmune). Interstitial uveitis usually affects adolescents, however it can also occur in young children. People older than 40 are not often affected by this condition.

Symptoms of interstitial uveitis
Interstitial uveitis is generally not painful and usually the eyes are not red. Both eyes are often affected, however, the involvement may be asymmetric and not concurrent. The condition may be present for a long time until diagnosed, without causing any symptoms to the patient. However, when it is perceived, its gravity varies. Patients often report that they see moving particles in their visual field and may experience a decrease in vision due to any of the following causes:

– vitreous opacities: this occurs when the inflammation causes small ‘garbage’ to disperse into the jelly of the eye, the vitreous, which is normally transparent. Thus, floaters may appear which can simply be annoying or accompanied by a fall in vision.
– macular edema: the macula is the area of the retina that is responsible for central vision. Fluid can accumulate in the macula and cause disturbances in vision. Reading, facial recognition and other functions that depend on central vision may be affected. It is also possible to show metamorphopsia, that is, deformation of straight lines.
– cataract and glaucoma: other complications that can occur in patients with intermediate uveitis are clouding of the crystalline lens of the eye and development of cataracts. Also often caused an increase in intraocular pressure that can lead to glaucoma.

Aetiology of interstitial uveitis

As in other cases of uveitis the cause is unknown. However, as there can often be a correlation with other diseases such as sarcoidosis, thorough examination is necessary.

How long will the interstitial uveitis last?
This is normally a chronic condition that can last for many years. The aim of treatment is to prevent and treat the complications mentioned above, so as not to cause damage to vision until the disease completes its cycle. This will be achieved by achieving longer and longer periods of remission of inflammation with as few or no drugs as possible.

Can there be other causes of uveitis?

Yes, the cause may be some tumor such as retinoblastoma, leukemia, lymphoma, malignant melanoma. These and peripheral retinal detachment can create anterior or posterior uveitis, which is why they are called disguise syndromes. The main problem with these conditions is that considered initially uveitis lead to incorrect treatment and delay of the correct treatment, resulting in increased ophthalmic morbidity and even the life of the patient is threatened.

What are the necessary diagnostic tests to investigate uveitis?

You should be thoroughly examined to determine the type of uveitis and to investigate the possibility of a coexisting condition. This may include blood tests, immunological tests, x-rays, etc.

Diagnostic tests and measurements include:
– measurement of visual acuity using special tables for the qualitative assessment of central vision.
– Examination of the Fundus of the eye after instillation of mydriatic drops
– OCT, Visual Coherence Tomography, which can show if there is cystic macular edema
– Angiography, which along with the OCT, are the most advanced technological tests, performed on patients with posterior and intermediate uveitis. Angiography takes pictures of the retina and choroid vessels and examines if they become inflamed, if they lose fluid, etc

What is the treatment of uveitis?

Depending on the severity and the part of the uvea affected by the therapeutic approaches for uveitis are:
– use of pharmaceutical anti-inflammatory eye drops usually with corticosteroids
– periocular or intraocular steroid injections
– oral administration of steroids or other immunosuppressive drugs or less frequently intravenous or subcutaneous

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