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Uveitis

Uveitis Treatment

Uveitis Treatment In Trivandrum

Uveitis is inflammation of the uvea, the middle layer of the eye comprising the iris, ciliary body, and choroid. It can involve other eye structures such as the retina, vitreous, or optic nerve. Uveitis can be acute or chronic, affect one or both eyes, and, if untreated, may lead to vision loss.

Symptoms and Causes

What are the symptoms of uveitis?

Symptoms of uveitis may include:

  • Redness and pain in the eye.
  • Blurred vision.
  • Sensitivity to light (photophobia).
  • Dark spots or floaters in vision.
  • Decreased vision.

What are the different types of uveitis?

Uveitis is classified by the part of the eye affected, as each type causes different symptoms and requires specific management.

  • Anterior uveitis (iritis): Inflammation primarily affecting the front part of the eye, including the iris and ciliary body. It is the most common form of uveitis and often causes redness, pain, and light sensitivity.
  • Intermediate uveitis: Involves inflammation of the vitreous cavity and the ciliary body. Patients may experience floaters, blurred vision, or mild discomfort, often without significant redness.
  • Posterior uveitis: Affects the back of the eye, including the retina and choroid. This type can lead to more severe visual disturbances, such as blurred vision, dark spots, or vision loss if not treated promptly.
  • Panuveitis: Involves all layers of the uvea, causing widespread inflammation throughout the eye. It is usually more severe and can rapidly affect vision if not managed appropriately.

What causes uveitis?

Uveitis can result from a variety of factors, including systemic diseases, infections, eye injuries, or unknown causes.

  • Autoimmune or inflammatory disorders: Conditions such as rheumatoid arthritis, sarcoidosis, ankylosing spondylitis, and inflammatory bowel disease can trigger inflammation in the eye.
  • Infections: Certain viral, bacterial, or parasitic infections, including herpes virus, syphilis, tuberculosis, and toxoplasmosis, can lead to uveitis.
  • Eye trauma or surgery: Physical injury or recent eye surgery can provoke inflammatory responses within the eye.
  • Idiopathic causes: In many cases, no identifiable cause is found, and the uveitis is classified as idiopathic.

Diagnosis of Uveitis

Diagnosing uveitis begins with a thorough eye examination and medical history, followed by targeted tests to confirm inflammation and identify any underlying cause.

  • Complete Eye Examination: An eye specialist (ophthalmologist) checks visual acuity, examines the front and back of the eye, and looks for signs of inflammation using tools like a slit lamp and ophthalmoscope. This helps detect inflammatory cells and structural changes in different parts of the eye.
  • Slit‑lamp and Dilated Exam: A slit lamp (microscope with bright light) magnifies the eye’s internal structures. Dilating drops widen the pupil so the physician can carefully inspect the retina, optic nerve, and uveal tract for inflammation.
  • Tonometry (eye pressure measurement): Measuring intraocular pressure helps determine if inflammation has affected eye fluid dynamics, as some forms are noninvasive or lower eye pressure.
  • Optical Coherence Tomography (OCT): OCT is a noninvasive imaging test that uses light waves to create detailed cross-sectional images of the retina and choroid, helping detect swelling, fluid, or other subtle signs of inflammation.
  • Fluorescein Angiography (with dye): A harmless dye is injected into a vein to highlight blood vessels in the eye. Specialized photos show areas of leaking or inflamed vessels, which assist in diagnosing posterior or complex uveitis.
  • Blood Tests and Systemic Evaluation: Blood tests can detect infections, autoimmune markers, or inflammatory conditions that may be causing uveitis. Depending on symptoms, your doctor may also recommend imaging like a chest X‑ray, CT, or MRI to check for systemic conditions.

What are the uveitis risk factors?

Certain factors can increase the likelihood of developing uveitis or make the condition more difficult to control.

  • Genetic Predisposition: Individuals with specific genetic markers, such as HLA‑B27 and other gene changes, are at a higher risk of uveitis. People with these genes often have associated inflammatory conditions.
  • Autoimmune and Inflammatory Diseases: Conditions in which the immune system attacks the body—including ankylosing spondylitis, rheumatoid arthritis, psoriasis, Behçet’s disease, lupus, inflammatory bowel disease, and multiple sclerosis—significantly increase the risk of uveitis.
  • Infections: Certain infections can trigger uveitis, especially herpes viruses. Syphilis, tuberculosis, toxoplasmosis, and cytomegalovirus (CMV) in immunocompromised individuals.
  • Smoking: Cigarette smoking has been linked with a greater risk of developing uveitis and with a disease that is harder to control.
  • Age and Demographic Factors: Uveitis can occur at any age, but it is most commonly seen in adults aged 20–60.
  • Medication Exposures: Some medications (e.g., cidofovir, rifabutin, bisphosphonates) have been associated with triggering uveitis in susceptible individuals.
  • History of Eye Trauma or Surgery: Eye injury or recent surgical procedures can provoke inflammation leading to uveitis.

What treatment options are available for uveitis?

Treatment is tailored to the type of uveitis, its severity, and whether an underlying cause (such as infection) is present.

Medications: Treatment of uveitis primarily focuses on reducing inflammation, relieving symptoms, and preventing complications. Corticosteroids are the mainstay and can be administered as eye drops for anterior uveitis, oral or injectable forms for more severe or posterior involvement, or as intraocular implants for chronic cases. Cycloplegic drops help relieve pain and prevent scar formation in the iris. If an infection is identified, targeted antibiotics, antivirals, or antiparasitic drugs are prescribed. For chronic, recurrent, or steroid-resistant uveitis, immunosuppressive or biologic therapies such as methotrexate or anti-TNF agents may be used to control immune-mediated inflammation. Close monitoring is essential to ensure effectiveness and minimize side effects.

Vitrectomy: Removal of the vitreous gel may be considered in select cases, particularly when there is severe vitreous inflammation, traction, or hemorrhage, to help clear inflammation or facilitate therapy.

Intraocular Steroid Implants: For persistent or difficult‑to‑control posterior uveitis, a steroid‑releasing implant can be placed in the eye to deliver medication steadily over months or years.