Uveitis and Ocular Immunology
Physicians
Steven Yeh, MD, director
Purnima Patel, MD
What is Uveitis?
Uveitis is a general term describing a group of inflammatory diseases that produces swelling and destroys eye tissues. These diseases can slightly reduce vision or lead to severe vision loss.
The term "Uveitis" is used because the diseases often affect a part of the eye called the uvea. Nevertheless, uveitis is not limited to the uvea. These diseases also affect the lens, retina, optic nerve, and vitreous, producing reduced vision or blindness.
Uveitis may be caused by problems or diseases occurring in the eye or it can be part of an inflammatory disease affecting other parts of the body.
It can happen at all ages and primarily affects people between 20 – 60 years old.
Uveitis can last for a short (acute) or a long (chronic) time. The severest forms of uveitis reoccur many times.
Eye care professionals may describe the disease more specifically as:
Anterior Uveitis
Intermediate Uveitis
Posterior Uveitis
Panuveitis Uveitis
Eye care professionals may also describe the disease as infectious or noninfectious uveitis.
How is uveitis detected?
Diagnosis of uveitis includes a thorough examination and the recording of the patient's complete medical history. Laboratory tests may be done to rule out an infection or an autoimmune disorder.
A central nervous system evaluation will often be performed on patients with a subgroup of intermediate uveitis, called pars planitis, to determine whether they have multiple sclerosis which is often associated with pars planitis.
The eye exams used, include:
An Eye Chart or Visual Acuity Test: This test measures whether a patient's vision has decreased.
A Funduscopic Exam: The pupil is widened (dilated) with eye drops and then a light is shown through with an instrument called an ophthalmoscope to noninvasively inspect the back, inside part of the eye.
Ocular Pressure: An instrument, such a tonometer or a tonopen, measures the pressure inside the eye. Drops that numb the eye may be used for this test.
A Slit Lamp Exam: A slit lamp noninvasively inspects much of the eye. It can inspect the front and back parts of the eye and some lamps may be equipped with a tonometer to measure eye pressure. A dye called fluorescein, which makes blood vessels easier to see, may be added to the eye during the examination. The dye only temporarily stains the eye.
How is Uveitis Treated?
Uveitis treatments primarily try to eliminate inflammation, alleviate pain, prevent further tissue damage, and restore any loss of vision. Treatments depend on the type of uveitis a patient displays. Some, such as using corticosteroid eye drops and injections around the eye or inside the eye, may exclusively target the eye whereas other treatments, such immunosuppressive agents taken by mouth, may be used when the disease is occurring in both eyes, particularly in the back of both eyes.
An eye care professional will usually prescribe steroidal anti-inflammatory medication that can be taken as eye drops, swallowed as a pill, injected around or into the eye, infused into the blood intravenously, or, released into the eye via a capsule that is surgically implanted inside the eye. Long-term steroid use may produce side effects such as stomach ulcers, osteoporosis (bone thinning), diabetes, cataracts, glaucoma, cardiovascular disease, weight gain, fluid retention, and Cushing's syndrome. Usually other agents are started if it appears that patients need moderate or high doses of oral steroids for more than 3 months.
Other immunosuppressive agents that are commonly used include medications such as methotrexate, mycophenolate, azathioprine, and cyclosporine. These treatments require regular blood tests to monitor for possible side effects. In some cases, biologic response modifiers (BRM), or biologics, such as, adalimumab, infliximab, daclizumab, abatacept, and rituximab are used. These drugs target specific elements of the immune system. Some of these drugs may increase the risk of having cancer.
Anterior Uveitis Treatments
Anterior Uveitis may be treated by:
- Taking eye drops that dilate the pupil to prevent muscle spasms in the iris and ciliary body (see diagram).
- Taking eye drops containing steroids, such as prednisone, to reduce inflammation.
Intermediate, Posterior, and Pan-Uveitis Treatments
Intermediate, posterior, and pan-uveitis are often treated with injections around the eye, medications given by mouth, or, in some instances, time-release capsules that are surgically implanted inside the eye. Other immunosuppressive agents may be given. A doctor must make sure a patient is not fighting an infection before proceeding with these therapies.
A recent NEI-funded study, called the Multicenter Uveitis Treatment Trial (MUST), compared the safety and effectiveness of conventional treatment for these forms of uveitis, which suppresses a patient's entire immune system, with a new local treatment that exclusively suppressed inflammation in the affected eye. Conventionally-treated patients were initially given high doses of prednisone, a corticosteroid medication, for 1 to 4 weeks which were then reduced gradually to low doses whereas locally-treated patients had a capsule that slowly released fluocinolone, another corticosteroid medication, surgically inserted in their affected eyes. Both treatments improved vision to a similar degree, with patients gaining almost one line on an eye chart. Conventional treatment produced few side effects. In contrast, the implant produced more eye problems, such as abnormally high eye pressure, glaucoma, and cataracts. Although both treatments decreased inflammation in the eye, the implant did so faster and to a greater degree. Nevertheless, visual improvements were similar to those of patients given conventional treatment.
The information provided on this page courtesy: National Eye Institute, National Institutes of Health (NEI/NIH).
