The eyeball is made of three major layers. The outermost is called sclera the white of the eye. The innermost is the retina, which is the light sensitive layer. In between the two is a layer call the Uvea. This has a lot of blood suply and is primarily responsible for providing adequate nutrition to the retina. A part of this layer can be seen in front as the brown part of the eye. This part of the uvea is called iris. Swelling of the uvea is called Uveitis.

If only the front part i.e. The iris shows swelling , it is called Anterior Uveitis (also known as Iritis / Iridocyclitis)

If the part behind the retina (choroid) shows swelling , it is called Posterior Uveitis (also called Choroiditis)

If the part in between the two and the vitreous ( gel like transparent substance inside the eye in front of retina) shows swelling, it is called Intermediate Uveitis (also called Pars Planitis)

And

If all the three show swelling it is called Pan Uveitis

What causes Uveitis?

The exact cause of uveitis cannot be determined in a majority of cases. It is just that the body itself is causing the swelling due to yet unknown reasons. However, in some patients it can be related to infections causes by viruses, tuberculosis, toxoplasma, syphilis, HIV or it can be related to other diseases such as sarcoidosis, SLE, Ankylosing spondylitis. Trauma & surgery can also lead to uveitis or it may be associated with some joint disorders like Rheumatoid Arthritis, Ankylosing Spondylitis, etc.

Who are at risk?

As the cause of the disease cannot be determined in many cases it is difficult to say who all are at risk. But definitely, patients with certain infections like tuberculosis, toxoplasma, HIV, Syphilis, herpes virus, sarcoidosis and autoimmune disorders, i.e. disorders in which the body reacts to itself.Also patients suffering from arthritis & joint pains are at a higher risk.

What are the symptoms & signs?

The common symptoms of uveitis are -

1. Redness of eye
2. Pain in the eye
3. Photophobia – difficulty in opening eyes in bright light
4. Floaters – Seeing black spots/ lines floating in front of the eye
5. Fall in vision

How is it diagnosed?

It can be diagnosed by an eye specialist on a routine eye examination. Sometimes some special tests like fluorescein angiography are required to assess posterior uveitis. OCT may be required to assess for swelling at the macula ( central part of the retina) which may develop secondary to uveitis.

What is the treatment?

The main treatment of uveitis is administration of steroids in the form of eye drops & / or orally or by injections.
Treatment of anterior uveitis consists of dilating eye drops , which help to dilate the pupil by pulling the iris. This helps to prevent complications of uveitis. Also steroid eye drops are given to resolve the swelling.

In cases of Intermediate / Posterior uveitis steroids may be required in oral / injectable form. In cases where there are frequent relapses immunosuppressive therapy may also be needed.

In cases where a cause is found such as tuberculosis, specific antibiotics / anti-virals need to be added.

What are the surgical options?

Surgery may be required for managing complications of uveitis. Important complications are cataract and glaucoma. These may require surgical management, which is mostly done after the uveitis has subsided.

What are the outcomes?

Timely and proper management can help preserve vision in most cases. The main concern with uveitis is reoccurrence. As in most cases we do not know the root cause of the disease and are treating only the symptoms and preventing complications, there are chances of reoccurrence of the disease. However, if properly managed every time , vision can still be preserved in many cases.

What are the complications?

The main complications of anterior and intermediate uveitis are catarct formation and secondary glaucoma.

Intermediate and posterior uveitis can also decrease vision by causing selling of the macula (cystoid macular oedema).

Posterior uveitis may cause permanent damage to vision if it directly affects the macula and later causes scarring.

Author: Dr. Rohan Chawla
Date: 27 November 2008