INFLAMMATORY EYE DISEASES
Ocular immunology is a highly specialized branch of medicine devoted to diagnosing and treating patients with inflammatory eye diseases. These diseases can slightly reduce vision or lead to severe vision loss.
Ophthalmologists use the general term, uveitis, when referring to the range of inflammatory diseases that affect the uvea. In addition, uveitis is used to describe any inflammatory disease that produces swelling and destroys eye tissues, including within the retina. It’s commonly associated with systemic diseases, such as rheumatoid arthritis. Anatomically, uveitis is classified into anterior, intermediate, posterior, and panuveitic forms, depending on which part of the eye is affected.
Uveitis by definition involves inflammation of the Uvea, the layer of the eye which lies under the sclera and contains the blood supply for the retina. In practice the inflammation is commonly seen spilling over to the retina, vitreous and anterior chamber. It can be classified in several ways; including anterior or posterior, granulomatous or non-granulomatous, and infectious or autoimmune.
The most common form of Uveitis is Anterior Uveitis, referred to as Iritis. Iritis may be associated with autoimmune diseases, but most cases occur in healthy people. The disorder may be unilateral or bilateral. It may represent spillover from Intermediate or Posterior Uveitis, in which case it is classified with its deeper source. It is most common in young and middle-aged people. Iritis is frequently idiopathic.
Intermediate Uveitis includes Pars Planitis and Cyclitis. This inflammation affects the area (pars plana) where the retina inserts into the iris and ciliary body. Pars planitis usually occurs in young men and is generally not associated with any other disease. However, some evidence suggests it may be linked to Crohn's disease and multiple sclerosis. Persons over age 25 with Pars Planitis should have an MRI of their brain and spine to rule out the association with multiple sclerosis.
Posterior Uveitis involves primarily the choroid, the layer of blood vessels and connective tissue underlying the retina. This type of Uveitis is called Choroiditis. If the retina is also involved, it is called Chorioretinitis. Posterior Uveitis is usually easier to associate with an underlying disease, but may be refractory to therapy and is associated with the greatest threat of visual loss.
A complete medical history and eye examination should be performed for all forms of Uveitis. Laboratory tests may be done to rule out infection or an autoimmune disorder.
UVEITIS CAN BE ASSOCIATED WITH ANY OF THE FOLLOWING:
- Ankylosing spondylitis
- Behcet syndrome
- CMV retinitis
- Herpes zoster infection
- IBD (Crohn’s and Ulcerative Colitis)
- Kawasaki disease
- Lyme disease
- Juvenile Rheumatoid Arthritis
- Reiter’s syndrome
Symptoms may develop rapidly and can include:
- Blurred vision
- Dark, floating spots in the vision
- Eye pain
- Redness of the eye
- Sensitivity to light
Mild Anterior Uveitis is usually treated with topical steroids and dilation of the iris to relieve pain. More severe Iritis may require systemic steroids. Iritis associated with Juvenile Rheumatoid Arthritis frequently requires long term immunosuppression.
Pars planitis is often treated with topical steroids, but may require periocular or system steroids. Treatment of Posterior Uveitis depends on the underlying cause but almost always includes oral steroids. Infectious Uveitis always involves the use of the appropriate antimicrobial therapy. Frequently, chemotherapy for autoimmune Uveitis is required.
With proper treatment, most attacks of anterior Uveitis go away in a few days to weeks. However, relapses are common. Inflammation related to posterior Uveitis may last from months to years and may cause permanent vision damage, even with treatment.
Jeffery L. Willig, MD
Ocular Immunologist specializing in Uveitis and General Ophthalmology.