Uveitis/ How Arthritis May Affect the Eyes

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Uveitis

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What Is It?

The uvea (also called the uveal tract) is a continuous layer of fibrous

tissue that surrounds the eye. It is made up of three structures:

The iris — the donut-shaped part that gives the eye its color, visible

when you look someone in the eye.

The ciliary body — a thick ring of tissue that helps control the shape

of the lens. It is attached to the iris and to the front portion of the

choroid.

The choroid — a membrane full of tiny blood vessels that lines the eye.

It extends from the ciliary body all the way around, stopping at the

point where the optic nerve enters at the back of the eye.

Uveitis is a general term referring to an inflammation of a portion or

all of the uvea. More specific terms may be used to define the exact

portion of the uvea affected. Anterior uveitis affects the front portion

of the uvea, the iris (also called iritis); intermediate uveitis affects

the middle portion, the ciliary body (also called cyclitis); and

posterior uveitis affects the back part of the uvea, the choroid (also

called choroiditis). Diffuse uveitis means inflammation of all portions

of the uvea.

The most common type of uveitis affects the iris, or the iris and the

ciliary body (also called iridocyclitis or anterior uveitis). Posterior

uveitis is rare. Although the exact mechanism that causes the uvea to

become inflamed is unknown, many cases are related to an autoimmune

disorder (such as ankylosing spondylitis, juvenile rheumatoid arthritis,

or sarcoidosis) or an infection, such as toxoplasmosis, herpes,

syphilis, or cytomegalovirus (especially among patients with AIDS). In

1/3 to 1/2 of cases, the cause is not known.

Symptoms

Symptoms of uveitis can vary depending on the location of the

inflammation. Acute and severe symptoms are generally associated with

anterior uveitis, and may include:

Eye pain

Eye redness

Sensitivity to light

Blurred or decreased vision

Intermediate and posterior uveitis can have more subtle symptoms,

including floaters (small specks or clouds that move in your field of

vision) and decreased vision.

Diagnosis

If your physician suspects uveitis, you are likely to be referred to an

ophthalmologist (eye specialist). A thorough eye exam is given,

including:

~ Tests of visual acuity, to determine if vision has decreased. These

can be as simple as reading an eye chart.

~ Funduscopic exam, in which the pupil is dilated so that the

ophthalmologist can peer into the eye and see structures at the back of

the eye.

~ Measures of intraocular pressure, to make sure that pressure inside

the eye has not reached levels that might be dangerous. This painless

test involves an instrument called a tonometer that either blows a puff

of air or lightly presses on the surface of the eye and measures how the

surface of the eye responds.

~ Slit-lamp exam, in which a narrow beam of light is shined into the eye

so that a magnifying lens can closely examine the highlighted portion of

the eye. A fluorescein dye is used to highlight anterior portions of the

eye, and dilating agents are used to see structures at the back of the

eye.

In addition, your physician probably will conduct a thorough medical

history and physical exam. Depending on the results of this medical

evaluation, he or she may order blood tests and X-rays (such as a chest

X-ray to look for evidence of sarcoidosis. Because uveitis is often

associated with a viral infection or an autoimmune disease, any

underlying disease needs to be discovered and treated as well.

Expected Duration

With treatment, most people with uveitis will improve within days or

weeks. However, it may last several months. Chronic forms of the disease

can be very difficult to cure, and may recur. If you have been

successfully treated for uveitis, you should expect to have follow-up

visits to your doctor every one to six months to make sure that the

disease remains stable.

Prevention

Other than avoiding certain infections (including syphilis or HIV),

there is no known way to prevent uveitis.

Treatment

Treatment of uveitis focuses on reducing inflammation and relieving

pain. Typically, treatment involves using prescription eye drops or

ointments containing corticosteroids to reduce inflammation. If the

uveitis affects the iris, eye drops that dilate the pupil may also be

prescribed so that the iris won't move and cause pain. Your doctor may

recommend sunglasses to avoid the discomfort bright light may cause. For

more severe cases, your ophthalmologist may recommend injections of

corticosteroids into the eye, oral forms of corticosteroids, or

additional immunosuppressive medications.

Any complications of uveitis, such as glaucoma or cataracts, will also

need to be treated. For many patients, a multidisciplinary team of

physicians will be involved, including the general medical physician,

ophthalmologist, and sometimes other specialists (for example,

infectious disease or arthritis experts).

When To Call A Professional

See your health-care provider if you experience blurred vision, pain in

one or both eyes, sensitivity to light, or eye redness.

Prognosis

The prognosis varies, depending on the type of uveitis, its severity and

duration, whether it promptly responds to treatment and whether there is

an associated illness. When diagnosed and treated promptly, prognosis is

generally good, and patients can expect to eventually recover. Left

untreated, the complications of uveitis can be serious, and may include

glaucoma, cataracts, or permanent loss of vision.

Additional Info

American Academy of Ophthalmology

P.O. Box 7424

San Francisco, CA 94120-7424

Phone: (415) 561-8500

http://www.eyenet.org/

National Eye Institute

2020 Vision Place

Bethesda, MD 20892-3655

http://www.nei.nih.gov/