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Uveitis – a
general term meaning any inflammation of the uveal tract
(the middle vascular coat of the eye)
Uveal tract- is
made up of the iris in front, the ciliary body in the middle, and
the choroid in the back of the eye. The retina is technically not
part of the uvea but is involved in many uveitis conditions
Iritis - Inflammation
of the iris.
Iridocyclitis - Inflammation
of the iris and ciliary body. (the most common form of uveitis)
Cyclitis - Inflammation
of the ciliary body alone(Pars planitis is the most common
form of cyclitis)
Choroiditis - Inflammation
of the choroid.
Retinitis - Inflammation
of the retina.
Chorioretinitis
or Retinochoroiditis - Inflammation of the
choroid and retina .
Panuveitis - Inflammation
of all the structures of the uveal tract.
Scleritis – inflammation
of the sclera.
Orbital inflammatory
syndrome - An inflammatory disorder affecting
all of the structures outside of the eye but within the
bony orbit.
Panophthalmitis – inflammation
of all of the structures within the orbit including the entire
eye.
The diagnosis of uveitis in the eye will often be made by your
eye care provider. It will be based on your ocular symptoms and
findings on detailed microscopic examination of the eye. The location
of the inflammation may be determined by examination. This will
allow the eye doctor to determine the type of uveitis. Further
testing using Ultrasound imaging (B-scan), Optical Coherence Tomography
(OCT), and Fluorescein Angiography (RSFA or FA) may be required
to determine the nature of the inflammation and its effects (anatomic
and functional) on the eye.
Laboratory testing will be required for most forms of uveitis.
This typically includes skin tests for Tuberculosis, blood tests
for infectious diseases like syphilis, Lyme disease, Cat scratch
disease, Histoplasmosis, and blood tests for other auto-immune
diseases such as Lupus, Sarcoidosis, rheumatoid arthritis and many
others.
Surgery may be required to determine the cause of the inflammation
allowing us to safely biopsy the vitreous or fluid in the front
of the eye. This fluid and the cells within it can be examined
microscopically by a pathologist and/or cultured for infectious
agents, and/or be evaluated using PCR ( a from of DNA fingerprinting
called Polymerase chain reaction)
Despite all of the available testing methods, about 50% to 66%
(1/2 to 2/3) of patient with uveitis will not have any known identifiable
cause.
Treatment of uveitis is based on the cause of the uveitis.
Infectious causes (such as syphilis, tuberculosis, Lyme disease,
cat scratch disease) are treated with antibiotics often combined
with corticosteroids (potent anti-inflammatory agents).
Non-infectious causes (autoimmune conditions) are generally treated
with corticosteroids. These may be given as drops, depot injections
in or around the eye, and/or pills. Steroids are extremely effective
in reducing inflammation quickly. Ocular complications from steroids
include cataract and glaucoma. But if the inflammation in the eye
is not well controlled, cataract and glaucoma may result. So, steroid
therapy can control but not cure the uveitis. Treatment involves
creating a balance between treatment and disease and reducing side
effects of treatment and disease.
If non infectious causes do not respond to treatment with steroids
or cannot be tolerated due to severe side effects, other agents (cytotoxic
or cystostatic immunosuppressives) are often utilized. These agents
include methotrexate, azathioprine (Imuran), cyclosporine A(Neoral,
Sandimmune), and cyclophosphamide (cytoxan). Other newer agents called
biologics may also be used if immunosuppressives fail. These biologics
include Infliximab(Remicade) and Etarnercept(Enbrel). These agents
are typically managed in conjunction with a rheumatologist, an internal
medicine doctor who specializes in the treatment of autoimmune disorders.
The choice of which agents to use will be decided upon by the patient,
uveitis specialist, and the rheumatologist.
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