What is Uveitis?
Uveitis, also known as eye inflammation, is classified as an autoimmune disease. This means it occurs as a reaction of the body to itself.
It is closely related to various diseases, and rheumatic diseases are among the most common autoimmune diseases, hence the common name “eye rheumatism.”
The human eye has three distinct layers: vascular, nerve, and connective tissue. The vascular layer in the center of the eye, responsible for its nourishment, is called the uvea. The uvea consists of the iris, choroid, and ciliary body tissues.
The iris gives the eye its color, the choroid nourishes the eye, and the ciliary body is responsible for maintaining the shape of the lens, which is directly related to the iris and choroid. Inflammation in the uvea can affect all three of these layers.
What are The Types ?
The type of uveitis is classified according to where inflammation occurs in the uvea:
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Anterior Uveitis:
Also called anterior uveitis. It is an inflammation of the anterior part of the uvea layer.
Because the iris is located in the anterior part of the uvea, this inflammation usually affects the iris.
Inflammation of the iris is called ‘iritis’. It can affect both eyes as well as in one eye. It is the most common type of uveitis in the community. Anterior uveitis is mostly seen in those without comorbidities.
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Middle Uveitis:
This condition is also known as moderate uveitis. The iris and part of the ciliary body are affected.
Inflammation in this area is called iridocyclitis.
Moderate uveitis is most often seen in people without other underlying diseases.
However, it can also occur in people with autoimmune diseases such as multiple sclerosis (MS).
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Posterior Uveitis:
In this condition, also called posterior uveitis, the posterior part of the uvea becomes inflamed. This area contains the choroid part and inflammation affects the choroid.
Since the vessels in the choroid feed the retina, its inflammation can cause damage to the retina. Posterior uveitis can often cause more serious problems than other types of uveitis.
Posterior uveitis can develop due to health problems such as infection and autoimmune disease. It occurs rarely compared to other types of uveitis.
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Pan-Uveitis:
In this species, the entire uvea is impacted. As a result, pan-uveitis encompasses all the characteristics found in other forms of uveitis. Behçet’s disease serves as an example of a condition that can lead to pan-uveitis.
What Causes Uveitis?
The underlying cause of uveitis remains unidentified in 30-40% of patients. This condition can stem from factors like viruses, fungi, and parasites, or it may manifest as a symptom linked to another underlying systemic disease.
This situation may be due to:
- Viruses,
- Fungi,
- Parasites,
Such factors, or it may develop as a symptom of an underlying systemic disease affecting the eye.
. Therefore, it is necessary to investigate diseases with various assays. In addition, uveitis can occur in the presence of systemic diseases that we define as collagen tissue and autoimmune origin. Examples of these are Behçet’s disease, ankylosing spondylitis and rheumatoid arthritis.
What Diseases Can Cause Uveitis?
- Behcet ‘s Disease
- Immune System Diseases
- Ulcerative Colitis
- Crohn’s Disease
- Ankylosing Spondylitis
- Rheumatic Diseases in Adults and Children
- Infections such as bacteria, viruses, parasites or fungi (tuberculosis, syphilis, herpes, toxoplasmosis, etc.)
- Eye Trauma
Uveitis is an extremely complex disease. It can follow a different course in each patient.
Treatment is as individual as the course of the disease.
What are The Symptoms of Uveitis?
Symptoms of uveitis may differ depending on the site of inflammation and may occur in one eye, in both eyes simultaneously or with a time difference.
If uveitis occurs in the anterior region of the eye, symptoms such as eye pain, discomfort from light and floating objects may occur. In addition, if the inflammation has intensely flowed into the eye, blurred vision may occur.
These symptoms can sometimes be accompanied by changes in the pupil of the eye. Because of the inflammation, the iris can stick to the lens or the edges. This condition is accompanied by redness of the eyes.
If the inflammation occurs in the middle region, floaters and blurred vision may occur in the eye.
If uveitis has occurred on the back surface of the eye, the problem of blurred vision and vision loss occurs with the sudden damage that may occur in the tissues.
Other symptoms of uveitis are:
- Bleeding in the Eye,
- Glare,
- Watering in the Eyes,
- Sudden Flashes of Light,
- Reduction in Pupil,
- Vascularization and Edema in the Iris Layer of the Eye
- Headache,
- Symptoms such as heterochromia (different colors of the two eyes) can also be observed.
What are The Risk Factors ?
- Genetic Predisposition:
As a result of the predisposition to this disease in the genes transferred to the person from previous generations, the probability of uveitis increases in people.
- Infection:
Some disorders seen in different parts of the body also affect the eye and cause uveitis.
- Finding a Person’s Autoimmune or Inflammatory Disease History:
Diseases such as Behçet’s disease, ankylosing spondylitis, sarcoidosis, psoriatic arthritis, Crohn’s disease and ulcerative colitis increase the risk of uveitis.
- Finding a Person’s History of Eye Trauma:
Occurrence of conditions such as eye injury may cause uveitis, and sometimes even after the healing of the injury in the eye, uveitis may develop.
What are The Complications ?
If left untreated, uveitis can lead to the following complications:
- Vision Loss,
- Increased Intraocular Pressure (Glaucoma),
- Optic Nerve Damage,
- Cataract Corneal Blurring Or Band Keratopathy,
- Retinal Complications such as Fluid Accumulation (Edema),
- Hole,
- Membrane Formation,
- Retinal Tear,
- Retinal Detachment in the Macula (Yellow Spot).
Which Tests are Performed in a Patient Suspected to Have Uveitis?
- Detailed eye and systemic disease history, detailed eye examination.
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Specialized eye tests, including fluorescein angiography and optical coherence tomography (OCT), might be necessary.
- Depending on the characteristics of uveitis, the physician may order special examinations (PCR), blood tests, imaging examinations from the eye fluid or may request consultation from other specialties.
How is Uveitis Diagnosed?
Uveitis, regardless of its severity, requires immediate medical attention. Delaying treatment can worsen the condition and lead to irreversible complications such as pupillary deformities, cataracts, and increased intraocular pressure due to swelling.
It is crucial to consult an ophthalmologist specializing in uveitis treatment as soon as symptoms appear.
Waiting too long for this initial assessment can result in permanent vision loss.
While some types of uveitis have distinct features that make diagnosis easier, more complex cases often require advanced diagnostic tools.
Techniques such as angiography, ultrasonography, and electroretinography (ERG) are particularly important when inflammation affects the back of the eye.
These tests provide crucial information about how the condition affects vision and help track the success of treatments.
For example;
Angiography using a dye called indocyanine green (ICG) can provide definitive diagnostic details in ambiguous cases.
After the initial diagnosis, collaboration with specialists such as rheumatologists, pulmonologists, dermatologists, and neurologists may be necessary to uncover possible underlying causes and develop a comprehensive treatment strategy.
Behçet’s disease is a disease that appears in the form of recurrent “aphthae“-shaped sores in the mouth and genital area and causes uveitis in the eye. However, Behçet’s disease is a chronic inflammatory disease that can affect almost all systems in the body, causing involvement of joints, large and small vessels, respiratory, central nervous system and digestive system organs.
The signs and symptoms of the disease appear as flare-ups in the affected organs.
Although some symptoms persist for a long time, there are periods when lesions are not visible and the person does not complain, varying from person to person.
How is Treated?
- If uveitis is caused by an underlying condition, the priority should be to properly treat and manage the root cause.
- Treating the root cause is often crucial to controlling symptoms and preventing further complications.
- Wearing sunglasses is generally recommended for people with uveitis.
This helps reduce light sensitivity and protect the eyes from potential harm from sunlight exposure. - This is an additional concern for those struggling with this condition.
- Unlike many other health problems, uveitis usually doesn’t require patients to significantly limit their daily activities.
- It’s important to be cautious when undertaking tasks that require intense concentration or attention.
- This is especially important.
- Because some prescription eye drops can dilate the pupil, making clear vision difficult and temporarily impairing vision.
- Patients undergoing cortisone treatment as part of their care regimen are often advised to follow a low-salt diet.
- This dietary adjustment can help minimize potential side effects of cortisone, such as water retention or high blood pressure.
In terms of treatment options, various medications are used to manage uveitis. - These include eye drops, cortisone tablets, and injection treatments, depending on the patient’s condition and specific needs.
- Regular monitoring plays a critical role in the treatment process. Healthcare professionals utilize periodic check-ups to identify significant changes or findings that may affect the course of care.
- These discoveries often serve as valuable indicators.
- And can even lead to adjustments in treatment strategies.
- In some cases, this information may trigger a shift to an entirely different treatment approach. And it can allow care to be tailored to the patient’s changing needs.
- This underscores the importance of attending follow-up check-ups for optimal management and recovery.
Frequently Asked Questions About Uveitis
What is uveitis and how does it affect the eye?
Uveitis is a form of eye inflammation that affects the middle layer of tissue in the eyewall, known as the uvea. This layer includes the iris, ciliary body, and choroid. Inflammation in this area can be particularly dangerous because the uvea contains many blood vessels that nourish the eye.
If left untreated, uveitis can lead to serious complications including glaucoma, cataracts, or permanent optic nerve damage.
It is classified by where it occurs:
- Anterior (front),
- Intermediate (middle),
- Posterior (back),
- or panuveitis (all layers)).
What are the early warning signs and symptoms of uveitis?
The symptoms of uveitis can develop suddenly or gradually, depending on the type.
Common signs include:
- Eye redness: Often described as a deep, dull ache in the eyeball.
- Pain: Especially when focusing on objects or in bright light.
- Blurred vision: A sudden decrease in visual clarity.
- Floaters: Dark, floating spots in your field of vision.
- Light sensitivity (Photophobia): Discomfort when exposed to sunlight or indoor lighting.
What causes uveitis? Is it always an infection?
No, uveitis is not always caused by an infection. While it can result from viruses (like shingles or herpes) or bacteria, many cases are non-infectious. These are often linked to autoimmune disorders where the body’s immune system attacks healthy eye tissue.
Common underlying conditions include sarcoidosis, ankylosing spondylitis, lupus, and Crohn’s disease. In many instances, the specific cause remains “idiopathic,” meaning the trigger is unknown despite thorough testing.
Can uveitis lead to permanent blindness?
Yes, uveitis is one of the leading causes of preventable blindness worldwide. However, with early diagnosis and aggressive treatment, most patients can preserve their vision. The risk of permanent loss increases if the inflammation reaches the retina or optic nerve (posterior uveitis) or if chronic inflammation leads to secondary conditions like macular edema.
How is uveitis typically treated by specialists?
Treatment focuses on reducing inflammation and preventing tissue damage.
The standard approach includes:
- Corticosteroids: Administered via eye drops (for anterior uveitis), injections, or oral tablets.
- Mydriatic drops: Used to dilate the pupil and prevent painful spasms of the eye muscles.
- Immunosuppressants: For chronic or severe cases that do not respond well to steroids.
- Biologics: Modern targeted therapies used for systemic autoimmune causes.
How long does a uveitis flare-up last?
An acute flare-up of anterior uveitis typically lasts 6 to 12 weeks with proper treatment. However, some forms are chronic and require long-term management over months or even years. Consistency with prescribed eye drops is crucial to prevent the inflammation from returning immediately after stopping treatment.
