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Uveitis


Alternative names

Iritis; Pars planitis; Choroiditis; Chorioretinitis; Anterior uveitis; Posterior uveitis

Definition

Uveitis is an inflammation of the the uvea , the layer between the sclera and the retina , which includes the iris , ciliary body , and the choroid .

Causes, incidence, and risk factors

Uveitis is an inflammation inside the eye, affecting the uvea. The uvea provides most of the blood supply to the retina. Causes of uveitis can include autoimmune disorders, infection, or exposure to toxins. However in many cases, the cause remains unknown.

The most common form of uveitis is anterior uveitis, which involves inflammation in the front part of the eye, which is usually isolated to the iris. This condition is often called iritis. The inflammation may be associated with autoimmune diseases such as rheumatoid arthritis or ankylosing spondylitis , but most cases occur in healthy people and do not indicate an underlying disease. The disorder may affect only one eye and is most common in young and middle-aged people. A history of an autoimmune disease is a risk factor.

Pars planitis is inflammation of the pars plana, a narrow area between the iris and the choroid. Pars planitis usually occurs in young men and is not associated with any other disease. It is usually mild.

Posterior uveitis affects the back portion of the uveal tract and involves primarily the choroid. This is called choroiditis. If the adjacent retina is also involved it is called chorioretinitis. Posterior uveitis may follow a systemic infection or occur in association with an autoimmune disease.

The inflammation causes spotty areas of scarring on the choroid and retina that correspond to areas with vision loss . The degree of vision loss depends on the amount and location of scarring. If the central part of the retina, called the macula is involved, central vision becomes impaired.

Uveitis, affecting one or both eyes, can be associated with any of the following:

  • Toxoplasmosis
  • Histoplasmosis
  • Tuberculosis
  • Sarcoidosis
  • Syphilis
  • AIDS
  • CMV retinitis or other cytomegalovirus infection
  • Sympathetic ophthalmia following trauma
  • Ulcerative colitis
  • Rheumatoid arthritis
  • Kawasaki disease
  • Herpes zoster infection
  • Ankylosing spondylitis
  • Behcet's syndrome
  • Psoriasis
  • Reiter's syndrome

Symptoms

  • Redness of the eye
  • Blurred vision
  • Sensitivity to light
  • Dark, floating spots in the vision
  • Eye pain

Note: Symptoms may develop rapidly.

Signs and tests

A complete medical history and eye examination should be performed. If there is suspicion of an associated systemic disease, a physical examination and laboratory tests may be needed to look for underlying causes.

Treatment

Iritis is usually mild. Spasm of the pupil constriction muscle causes pain which is relieved by drops to dilate the pupil. Dark glasses may be helpful. Steroid eye drops or ointment may be needed. More severe cases require a search for an underlying cause.

Pars planitis is usually mild and can be followed without medications.

Choroiditis requires determination of the underlying cause, and treatment of the underlying disease. The underlying disease may be serious, and additional specialists in infectious disease or autoimmunity may be needed for such diseases as syphilis, tuberculosis, AIDS, sarcoidosis, or Behcet's syndrome.

Treatment is consistent with treatment for the systemic diseases of toxoplasmosis , tuberculosis , sarcoidosis , and so forth. For infectious diseases, corticosteroids are often used along with antibiotic therapy. For autoimmune diseases, various forms of suppression of the immune system may be required.

Expectations (prognosis)

In anterior uveitis, most attacks last from a few days to weeks with treatment, but relapses are common. In posterior uveitis, the inflammation may last from months to years and may cause permanent vision damage, even with treatment.

Complications

  • Glaucoma
  • Cataracts
  • Fluid within the retina (cystoid macular edema)
  • Retinal detachment
  • Vision loss

Calling your health care provider

Call for an appointment with your health care provider if uveitis symptoms are present (if eye pain or reduced vision are present, this condition is more urgent that if symptoms are very mild).

Prevention

Treatment of the causative disorders may help to prevent uveitis for some people with existing systemic diseases.

Update Date: 12/22/2002

Raymond S. Douglas M.D., Ph.D. Department of Ophthalmology, UCLA Medical Center, Los Angeles, CA. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT
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