What is Uveitis?
Uveitis is a field of ophthalmology that focuses on inflammatory diseases of the eye. The term uveitis comes from “uvea”, which initially referred to conditions affecting the iris, ciliary body, and choroid. Over the years, it has evolved to refer to any disease that create inflammation in or around the eye.
Uveitis occurs in about 1 in 1,000 people in the general population. It is also the 3rd leading cause of preventable blindness in the United States, and there are currently 12 fellowship training programs for uveitis specialists around the country. RMU is proud to be an active participant in the University of Colorado uveitis fellowship program.
What are the causes of Uveitis?
About 90% of cases of uveitis are autoimmune, or inflammatory. These arise from the immune system attacking normal tissues in the eye. Uveitis can be isolated to the eye, or it can exist in association with inflammation in the rest of the body. A lab workup is often required to determine if uveitis is localized or part of a systemic condition.
10% of uveitis can be due to other causes, including so-called masquerade syndromes, including tuberculosis and syphilis, viral uveitis, and more rare conditions such as intraocular lymphoma.
What are the different types of Uveitis?
There are a number of terms that refer to different subtypes of uveitis. Anterior uveitis, or iritis, describes inflammation in the front of the eye, between the cornea and the lens, and is usually symptomatic with pain, redness, and light sensitivity. Intermediate uveitis, also referred to as pars planitis, affects the middle of the eye, and presents with floaters and blurred vision. Posterior uveitis affects the retina and the choroid in the back of the eye, and patients often experience flashes, floaters, and dark patches within their vision. Finally, panuveitis has elements of anterior, intermediate, and posterior uveitis, and can have symptoms that associate with all of the conditions.
What conditions are treated by Uveitis Specialists?
- Outside of the eye: ocular cicatricial pemphigoid, orbital pseudotumor, orbital myositis.
- Front of the eye: iritis, anterior uveitis, peripheral ulcerative keratitis, anterior scleritis.
- Middle of the eye: pars planitis, intermediate uveitis.
- Back of the eye: birdshot chorioretinopathy, VKH (Vogt-Koyanagi-Harada) syndrome, retinal vasculitis, white dot syndromes, infectious retinitis (syphilis, acute retinal necrosis, toxoplasmosis), intraocular lymphoma.
What evaluations can be expected in approaching Uveitis?
Most patients will undergo a thorough laboratory evaluation, including looking for potential infectious, autoimmune, and genetic causes for uveitis.
In the office, RMU is equipped with state-of-the-art technology, including OCT, wide field fluorescein and ICG angiography, ERG (electroretinogram), and visual fields testing. Occasionally, additional imaging, including CT scans, MRI imaging, and PET scans may be ordered as well.
How is Uveitis treated?
It depends on where the inflammation is within the eye, and how frequent and severe the episodes of uveitis are. We utilize a step-ladder approach, starting with the simplest and most benign treatments, and increasing until the disease is quiescent. Topical steroids are often employed first, but many patients require local therapies around the eye, including periocular and intravitreal injections. A number of patients may benefit from oral Prednisone in the acute phase of uveitis.
For patients with more frequent or recurrent episodes, or vision-threatening disease, we utilize a number of steroid-sparing immunomodulatory therapies in an effort to prevent additional flares of uveitis. These include oral medications (Methotrexate, CellCept), injectable medications (Humira), and intravenous infusions (Remicade, Rituximab, Actemra and others). The team at RMU will work with your insurance and your other specialists to obtain authorizations and monitor these medications, in an effort to work towards a long-term remission.
Why is important to prevent Uveitis?
The inflammation associated with uveitis can create a number of issues within the eye, including macular edema, floaters, corneal and retinal scarring, and retinal detachment.
Local steroid drops and injections, when used long-term, can also create cataracts and glaucoma. Glaucoma, in particular, is a leading cause of vision loss in uveitis patients.
Systemic steroids are historically overused by ophthalmologists in treating uveitis. Prednisone causes high rates of diabetes, hypertension, heart attack, stroke, weight gain and osteoporosis. Steroid-sparing agents help to prevent these complications of both local and systemic steroids, with the goal of achieving a steroid-free remission.