Diseases
Overview
Age-Related Macular Degeneration
Diabetic Retinopathy
Retinal Vein and Artery Occlusions
Flashes of Light and Floaters
Retinal Tears and Retinal Detachments
Macular Pucker (Epiretinal Membrane)
Macular Hole
Vitreomacular Traction
Uveitis (Inflammation in the Eye)

Uveitis (Inflammation in the Eye)

What is Uveitis?
The body’s immune system is responsible for monitoring and defense against disease. When triggered, the immune system begins a process of reactions resulting in tissue inflammation. These reactions are carried out by different cell types and use many different signal molecules. Inside the eye, the inflammation is located in a vascular layer of the wall of the eye called uvea. 
 
Are there different types of Uveitis?
Uveitis is characterized by the location, the pattern of cells involved, and the severity. The uveitis can be secondary to an infection of ocular tissues or due to the immune system mistakenly attacking normal structures as part of an autoimmune disorder. The part of the eye that is inflamed helps to narrow the search of a potential cause.
  • Iritis or iridocyclitis - Inflammation to the anterior segment of the eye, the iris and ciliary body
  • Pars Planitis – Inflammation involving the central portion of the eye. 
  • Retinitis and chorioretinitis- Inflammation to the retina and the layer behind the retina, the choroid.
  • Scleritis - Inflammation to the wall of the eye
  • Panuveitis - Inflammation to all parts of the eye. 
The types of cells involved in the inflammation affects the visible pattern on examination and can be classified as granulomatous or non-granulomatous inflammation. 
 
How is Uveitis diagnosed?
Essential for diagnosis is a thorough examination of the eye and medical history. The pattern of inflammation seen greatly narrows down the numerous causes of uveitis. If the posterior structures of the eye are involved a Fluorescein Angiogram is performed to evaluate the optic nerve and retinal blood vessels for signs of inflammation. Often an Optical Coherence Tomography (OCT) scan is performed to evaluated and measure any swelling of the retina. A B-scan Ultrasound may be used to assess any inflammation and fluid in the linings of the eye. Based on the exam findings laboratory workup is undertaken to look for signs of infection or of an underlying autoimmune disorder. These lab tests are helpful but commonly to not result in a definite diagnosis. They do however eliminate certain possibilities that are the most serious.
 
Who is at risk for Uveitis?
Uveitis affects people of all ethnicities and of all ages. At highest risk are people with certain underlying autoimmune disorders.
 
What are the symptoms of Uveitis?
When the eye becomes inflamed the outside often becomes very red and painful. Typically the pain is described as an ache that is exacerbated by light and sometimes by movements of the eye. While redness and aching can be caused by other, less serious conditions, a thorough exam should be performed if these symptoms are present to check for uveitis.
 
How is Uveitis treated?
The mainstay of treating inflammation anywhere in the body is steroids. For the eye, the steroids can be given either locally or systemically. First-line steroids are in the form of topical drops and gels that are applied to the surface of the eye; these have the advantage of being able to easily adjust the dose by changing the frequency applied. The disadvantage is they poorly penetrate to deep ocular tissues and are not as strong as other steroids. If a stronger form is needed, steroids can be injected into the tissue next to the eye, called periocular or sub-tenon’s steroids. This method of delivery allows for a higher concentration to the eye and for sustained effect as the medication is slowly absorbed. Steroid can be injected inside the eye, called intravitreal injection, as well. This form results in a very high concentration directly to the eye but will not last as long as periocular steroids. A longer lasting intraocular steroid is an implant. Ozurdex is a dexamethasone implant that is injected into the eye and gives slow release steroid for up to 3 months. Retisert is a fluocinolone implant that must be inserted using surgery but can slowly release steroid for up to 3 years. While steroids work very well to control intraocular inflammation, they do have significant side effects that are proportionate to the strength and duration used. Steroids most commonly cause progression of cataract formation in the eye. The lens in the eye is clear at birth and as a natural process of aging begins to become cloudy and block light from entering the eye, this is known as cataract. With steroid use the cataract formation is accelerated. In some patients, steroid treatment can cause an increase in intraocular pressure, known as steroid induced glaucoma. Elevated intraocular pressure can damage the optic nerve in an irreversible fashion. While elevated intraocular pressure can be controlled with medications severe cases can sometimes require surgery. Most cases of steroid induced glaucoma will resolve once steroid treatment is ended. 
 
When local steroid therapy is inadequate, systemic steroids are given, mostly orally. Prednisone is the leading medication and controls the immune system throughout the body.  Similar to local steroids, prednisone is very effective at controlling inflammation but has side effects. Systemic side effects include weight gain, insulin resistance, hyperglycemia, osteoporosis, peptic ulcers. Great care must be taken when on systemic steroids to minimize the dosing to limit the side effects. In some patients, the systemic control of the immune system is necessary long-term and steroid sparing, immunomodulating medications are used. When these medications are required it is important that a thorough search for an underlying autoimmune condition is carried out and often an autoimmune specialist, a Rheumatologist, is consulted. 
Dr Kruti Dajee Dr Jawad Qureshi Dr Johnathan Warminski