Uveitis - Symptoms, causes and treatment

Uveitis is inflammation of the uvea or the middle layer of the eye. This condition is indicated by wrong one or both eyes look very red, which can be accompanied by pain in the eyes and blurred vision.

The uvea is the middle layer on the inside of the eye which consists of the eye's rainbow membrane (iris), the eye's blood vessel lining (choroid), and the connective tissue between the iris and the choroid (ciliary body). The uvea is located between the white part of the eye (sclera) and the back of the eye that catches light (retina).

Based on the location of inflammation, uveitis is divided into several types, namely:

  • Uveitis in the front of the uvea (iritis or anterior uveitis), which is inflammation of the iris
  • Uveitis in the middle part of the uvea (uveitis intermedia or cyclitis), which is inflammation between the iris and the choroid
  • Uveitis in the back of the uvea (choroiditis or posterior uveitis), which is inflammation of the choroid
  • Uveitis throughout the uvea (panuveitis), which is when the entire uveal layer becomes inflamed

Uveitis is also divided according to the duration of the disease. Here is the explanation:

  • Acute uveitis, which is a type of uveitis that develops rapidly and improves in less than 3 months
  • Chronic uveitis, which is when inflammation persists for more than 3 months

Causes of Uveitis

Uveitis often has no known cause and is sometimes even experienced by healthy people. However, most uveitis is associated with autoimmune disorders. Some conditions or autoimmune diseases that are thought to trigger uveitis are:

  • Rheumatoid arthritis, which is inflammation of the joints
  • Psoriasis, which is inflammation of the skin
  • Ankylosing spondylitis, namely inflammation of the joints in the spine
  • Sarcoidosis, which is inflammation that appears in various parts of the body, such as the lungs, lymph nodes, eyes, and skin
  • Kawasaki disease, which is inflammation of the walls of blood vessels
  • Ulcerative colitis, which is inflammation of the large intestine
  • Crohn's Disease, which is inflammation that occurs in the digestive tract, from the mouth to the anus

In some other cases, uveitis is thought to also occur due to a viral or bacterial infection in the body, such as:

  • Herpes
  • Tuberculosis
  • Toxoplasmosis
  • Syphilis
  • HIV/AIDS
  • Histoplasmosis

Apart from autoimmune and infectious disorders, uveitis is also thought to be associated with a number of factors below:

  • Eye injury or surgery
  • eye cancer
  • Toxic exposure to the eyes

Symptoms of Uveitis

Symptoms of uveitis can appear suddenly or develop gradually over a period of several days. Symptoms of uveitis include:

  • Red eye
  • Pain in the eyes
  • Blurred vision
  • Eyes become sensitive to light
  • There are black spots that appear in the field of view (floaters)
  • Decreased visual function

When to go to the doctor

Check with your doctor if you feel the above symptoms. Your doctor may advise you to undergo further examinations to an ophthalmologist if your condition is serious.

Seek immediate medical attention if you experience more serious symptoms, such as:

  • Severe pain in the eye
  • Sudden loss of vision

There is a high chance of recurrence of uveitis. Therefore, if you have had uveitis in the past but the symptoms have recently reappeared, consult your doctor immediately.  

Uveitis Diagnosis

As a first step in diagnosis, the doctor will check the medical history and ask the patient's symptoms, then the doctor will perform a physical examination, especially on the patient's eyes.

After that, the doctor will conduct a follow-up examination to get a more accurate diagnosis. The follow-up examination can be in the form of:

  • vision test
  • Tonometry to measure pressure in the eyeball
  • Slit-lamp examination to see the presence of inflammatory cells in the front of the eye
  • Funduscopy to check the condition of the back of the eye
  • blood test
  • Scan test with CT scan or MRI
  • Eye fluid analysis
  • Eye angiography to see the presence of inflammatory cells in the blood vessel system in the eye
  • photographic imaging of the eye (optical coherence tomography) to measure thickness and see the presence of inflammatory cells in the retina and choroid   

Uveitis Treatment

The focus of treatment for uveitis is to reduce inflammation in the eye. There are several treatment options that may be carried out by doctors, namely:

Drugs

The following are some types of drugs that can be used to treat uveitis:

  • Corticosteroids

    Corticosteroids are drugs that doctors prescribe to reduce inflammation.

  • Antibiotics orantivirus

    If the uveitis is caused by an infection, the doctor will prescribe antibiotics or antiviral drugs to control the infection.

  • Drug immunosuppressive

    Immunosuppressive or cytotoxic drugs are generally given when uveitis occurs in both eyes, or treatment with corticosteroids fails or the uveitis worsens and the patient is at risk of blindness.

Operation

The surgical procedure is carried out if the symptoms that appear are severe enough or treatment with drugs is not effective. Some of the surgical procedures that can be performed are:

  • Vitrectomy, which is eye surgery to remove the vitreous fluid from the eye
  • Surgery to implant a drug-release device, which is an operation to implant a special device in the eye that functions to slowly channel corticosteroid drugs into the eye

In most cases, surgical implantation of a drug-release device is performed to treat difficult-to-treat posterior uveitis. Treatment with this tool generally lasts for 2-3 years. However, basically, the length of treatment for uveitis depends on the type and severity of the uveitis suffered.

Uveitis Complications

If not treated immediately, uveitis can cause complications such as:

  • Cataracts are changes that occur in the lens of the eye and cause blurred vision
  • Glaucoma, which is damage to the nerve that connects the eye to the brain, which can lead to blindness
  • Retinal detachment, which is a condition when the retina separates from the lining of blood vessels that provide oxygen and nutrients
  • Cystoid macular edema, which is swelling of the retina
  • Posterior synechiae, which is inflammation that causes the iris to stick to the lens of the eye

The risk of complications is higher if the patient has the following factors:

  • Aged 60 years and over
  • Suffering from uveitis intermedia or posterior uveitis
  • Suffering from chronic uveitis

Uveitis Prevention

It is difficult to prevent uveitis because most uveitis has no known cause. However, early detection and treatment can reduce the risk of permanent vision loss.