Ocular Inflammatory Disease,
Eye Inflammation, & Uveitis
Ocular Inflammatory Disease (OID) is a general term for inflammation that affects any part of the eye or surrounding tissue. Inflammation is a characteristic reaction of tissue to injury or disease and results from the body’s attempt to eliminate a foreign body, toxin, substance, microorganism or its effects and helps to prevent further injury. Normal healthy tissue can be injured by inflammation if the resulting damage occurs in or around the eyes, the affected area including the eyelids, the sclera, the iris, the uvea, the retina or the optic nerve can become inflamed and potentially damaged. Inflammation of the many structures of the eye can include the fairly common allergic conjunctivitis that patients experience during the spring, as well as the more potentially serious conditions such as Uveitis, Choroiditis, Retinitis, Iritis, Scleritis, Episcleritis, Cellulitis, Optic Neuritis, Keratitis, Orbital Pseudotumor, Retinal Vasculitis and Chronic Conjunctivitis.
Ocular Inflammatory Disease (OID) and Uveitis are the third most common cause of blindness in developed countries as a result of not being adequately treated and controlled or because patients are prescribed steroid medications for prolonged periods of time. If chronic low grade or severe eye inflammation is allowed to exist for long periods it can result in swelling of the central area of the retina called macular edema, optic nerve damage, glaucoma, cataracts or even adhesions of the iris, the colored part of the eye, which are called synechiae. In addition long term use of steroid medication treatment can cause sight threatening side effects such as glaucoma or cataracts.
The eye is composed of three basic layers. The outermost layer is the sclera or “white” of the eye and the cornea-the curved dome in the front of the eye. The innermost layer is the retina, and the middle layer is the uvea. The uvea or uveal tract includes the iris, the ciliary body and the choroid which provide most of the blood supply to the retina. Inflammation in any of the parts of the uveal tract is called uveitis. Uveitis can be caused by autoimmune disorders such as Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriatic Arthritis, Reactive Arthritis, Sarcoidosis, Systemic Lupus Erythematosus (SLE), Multiple Sclerosis and Inflammatory Bowel Disease. Uveitis can also be caused by a wide range of infections including Herpes Simplex, Varicella Zoster (Chicken Pox or Shingles), Epstein-Barr Virus, Cytomegalovirus, Syphilis, Lyme Disease, Tuberculosis, Fungal Infections, Cat Scratch Disease or Toxoplasmosis.
Types of Uveitis
However, in many cases the cause is unknown. There are different types of uveitis depending on what parts of the eye are affected.
- Anterior Uveitis is inflammation in the front of the uveal tract of eye, and called Iritis or Iridocyclitis.
- Intermediate Uveitis is inflammation in the middle part of the uveal tract of eye, and called Pars Planitis or Vitritis.
- Posterior Uveitis is inflammation of the back of the uveal tract of eye, such as Choroiditis, Retinal Vasculitis, Retinitis, Neuroretinitis, Retinochoroiditis, or Chorioretinitis.
Inflammation inside the eye is a medical emergency because if untreated it will lead to vision loss.
Symptoms of Uveitis
The common symptoms of uveitis include redness, blurry vision, pain, light sensitivity and even flashes & floaters. Any or all of these can occur in one or both eyes. There are even some types of uveitis that can occur without any symptoms at all, such as uveitis associated with juvenile idiopathic arthritis.
Treatment of Uveitis
The primary goal of treating uveitis is getting rid of inflammation as fast as possible.
Corticosteroids are the mainstay of therapy for acute uveitis of non-infectious causes, and can be used along with antibiotics in some cases of infectious uveitis. They can be given by drops, injection around or inside the eye, by mouth, or by intravenous infusion, depending on location and severity of inflammation. Unfortunately, they can never be depended upon for long term control of uveitis as they inevitably cause their own complications, such as cataract and glaucoma. Other drops used in uveitis include cycloplegic drops (dilating drops), which are used to help limit light sensitivity, pain, and scarring of the iris to the lens (synechiae). Also, glaucoma from uveitis can be treated with drops that lower pressure in the eye.
Sometimes systemic therapy, by mouth, injection, or intravenous infusion, is necessary to treat stubborn cases of uveitis that recur after being treated acutely with steroids. Antibiotic or antiviral medication can be used, sometimes long term, to achieve remission.
A step-ladder approach to therapy has been adopted by most uveitis specialists to treat patients with stubborn or severe forms of non-infectious uveitis, with therapy again based on type and severity, as well as the extent of complications already suffered. This can include chemotherapy-style medications which require regular examinations and blood work monitoring. Side effects of medication can generally be avoided.
Surgery can be useful both for diagnosis and treatment of uveitis. Cataracts can be removed to improve vision as well as the uveitis specialist’s view inside the eye. Vitrectomy, removal of the gel center of the eye, can be used to perform biopsy as well as rid bothersome cells and debris to improve vision. Sometimes medication releasing implants or laser therapy with or without surgery can also be used to treat active inflammation.
When disease is caught early enough, prior to complications, inflammation can usually be treated successfully with appropriate therapy. However, when disease is not detected early enough, or when providers who are unfamiliar or uncomfortable dealing with uveitis fail to refer to a specialist, complications are much more prevalent and prognosis usually worse. Occasionally uveitis is severe and may lead to complications despite aggressive and timely therapy.