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Uveitis

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

 

Uveitis is swelling and irritation of the uvea. The uvea is the middle layer of the eye. The uvea provides most of the blood supply to the retina.

Causes

 

Uveitis can be caused by autoimmune disorders. These diseases occur when the body's immune system attacks and destroys healthy body tissue by mistake. Examples are:

  • Ankylosing spondylitis
  • Psoriasis
  • Reactive arthritis
  • Rheumatoid arthritis
  • Sarcoidosis
  • Ulcerative colitis

Uveitis can also be caused by infections such as:

  • AIDS
  • Cytomegalovirus (CMV) retinitis
  • Herpes zoster infection
  • Histoplasmosis
  • Kawasaki disease
  • Syphilis
  • Toxoplasmosis
  • Tuberculosis

Exposure to toxins or injury can also cause uveitis. In many cases, the cause is unknown.

The most common form of uveitis involves inflammation the front part of the eye. It is often called iritis because it most often only affects the iris. The iris is the colored part of the eye. In most cases, it occurs in healthy people. The disorder may affect only one eye. It is most common in young and middle-aged people.

Posterior uveitis affects the back part of the eye. It involves primarily the choroid. This is the layer of blood vessels and connective tissue in the middle layer of the eye. This type of uveitis is called choroiditis. If the retina is also involved, it is called chorioretinitis.

Another form of uveitis is pars planitis. Changes involve the narrowed area (pars plana) between the colored part of the eye (iris) and the choroid. Pars planitis most often occurs in young men. It is generally not associated with any other disease. However, it may be linked to Crohn disease and possibly multiple sclerosis.

 

Symptoms

 

Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include:

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

 

Exams and Tests

 

The health care provider will take a complete medical history and do an eye exam. Lab tests may be done to rule out infection or a weak immune system.

If you are over age 25 and have pars planitis, your provider will suggest a brain and spine MRI. This will rule out multiple sclerosis.

 

Treatment

 

Iritis (anterior uveitis) is most often mild. Treatment may involve:

  • Dark glasses
  • Eye drops that dilate the pupil to relieve pain
  • Steroid eye drops

Pars planitis is often treated with steroid eye drops. Other medicines, including steroids taken by mouth, may be used to help suppress the immune system.

Posterior uveitis treatment depends on the underlying cause. It almost always includes steroids taken by mouth.

If the uveitis is caused by a body-wide (systemic) infection, you may be given antibiotics. You may also be given powerful anti-inflammatory medicines called corticosteroids.

 

Outlook (Prognosis)

 

With proper treatment, most attacks of anterior uveitis go away in a few days to weeks. However, the problem often returns.

Posterior uveitis may last from months to years. It may cause permanent vision damage, even with treatment.

 

Possible Complications

 

Complications may include:

  • Cataracts
  • Fluid within the retina
  • Glaucoma
  • Irregular pupil
  • Retinal detachment
  • Vision loss

 

When to Contact a Medical Professional

 

Symptoms that need urgent medical care are:

  • Eye pain
  • Reduced vision

 

Prevention

 

If you have a body-wide (systemic) infection or disease, treating the condition will prevent uveitis.

 

 

References

Goldstein DA, Horsley M, Ulanski LJ II, Tessler HH. Complications of uveitis and their management. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 4, chap 60.

Goldstein DA, Patel S, Tessler HH. Classification, symptoms, and signs of uveitis. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 4, chap 32.

Jap A, Chee SP. Pars planitis and other intermediate uveitis. In: Yankoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 7.21.

Nair UK, Cunningham ET Jr. Uveitis: Diagnostic approach and ancillary analysis. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 20132:vol 4, chap 37.

Yanoff M, Cameron DJ. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 423.

 
  • Eye

    Eye - illustration

    The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle tunic layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

    Eye

    illustration

  • Visual field test

    Visual field test - illustration

    Central and peripheral vision is tested by using visual field tests. Changes may indicate eye diseases, such as glaucoma or retinitis.

    Visual field test

    illustration

    • Eye

      Eye - illustration

      The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle tunic layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

      Eye

      illustration

    • Visual field test

      Visual field test - illustration

      Central and peripheral vision is tested by using visual field tests. Changes may indicate eye diseases, such as glaucoma or retinitis.

      Visual field test

      illustration

    Tests for Uveitis

     

       

      Review Date: 8/20/2016

      Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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