Uveitis Information

Uveitis– a general term meaning any inflammation of the uveal tract
(the middle vascular coat of the eye)
Uveal tract - 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

Other conditions that fall into the realm of the uveitis specialist include :

Scleritis – inflammation of the sclera
Orbital inflammatory syndrome - orbital inflammatory syndrome
Panophthalmitis – inflammation of all of the structures within the orbit including the entire eye

Diagnosis of Uveitis

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 form 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

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.