Learn about Uveitis
What is Uveitis?
Uveitis is inflammation of a part of the eye called the uvea. The uvea (pronounced “You-Vay-Uh”) is a layer of the eye made up of three parts. These are the iris, the ciliary body, and the choroid.
Uveitis can occur in one eye or both eyes. Inflammation of the uvea may involve other parts of the eye, or any part of the eye, including the cornea (the clear, curved front of the eye), the sclera (the white outer part of the eye), the vitreous body, the retina and the optic nerve.
The iris is the colored part of the front of the eye. It controls light that enters the eye by controlling the size of the eye’s opening (the pupil).
The ciliary body is a group of muscles and blood vessels that changes the shape of the lens so the eye can focus. It also makes a fluid called aqueous humor. Aqueous humor is a clear, watery fluid that fills and circulates through parts of the front of the eye.The choroid is a middle layer of the eye. It holds blood vessels that feed other parts of the eye, especially the retina. The retina is the inner layer of the eye. It contains nerve cells that sense color and light and send image information to the brain.
What is Inflammation?
“Inflammation” is the body’s response to injury. This injury, or trauma, may be caused by a blow or wound, eye surgery, a disease such as a virus, bacteria infection, or a parasite. It may be caused by problems with the body’s immune system or genetic disease. For many people with uveitis, the exact cause of their inflammation is unknown.
Inflammation is the body’s attempt to rid itself of the cause of trauma, and to heal any damage caused by it. Often, however, the inflammation itself can damage the body. In the case of uveitis, the inflammation can lead to problems that cause loss of vision, or even blindness.
What are the Types of Uveitis?
When doctors diagnose and treat uveitis, they may group it in different ways. Uveitis is often grouped by the part of the uvea it affects.
Anterior uveitis affects the front of the eye. It is often called iritis because it mainly affects the area around the eye’s iris. Anterior uveitis is the most common kind of uveitis in children and adults making up 40-70% of all uveitis. It is usually acute (i.e. comes on suddenly and lasts for less than six weeks) and is associated with pain, light sensitivity and redness. Although it can be caused by a number of diseases which affect the body, such as Ankylosing Spondylitis or Juvenile Rheumatoid Arthritis, most of the cases are of unknown origin.
Intermediate uveitis is inflammation of the ciliary body, the front end of the retina, and the vitreous. The vitreous body is a clear gel-like substance that fills the inside of the eyeball between the lens and the retina. Intermediate uveitis is the least common type of uveitis, making up only 7-15% of cases. It is also known as cyclitis, pars planitis or vitritis. In most of the cases, the cause is unknown. Symptoms include floaters and blurry vision. People with intermediate uveitis are more likely to have chronic inflammation. Chronic uveitis is defined as uveitis lasting longer than six weeks.
Posterior uveitis is inflammation of the choroid, retina and optic nerve. The optic nerve is the path that carries images from the retina to the brain. It can be seen in 15 to 22% of uveitis types. Generally it is chronic (long standing – can last weeks to months to years), recurrent (in which a patient has multiple flare-ups between periods of a quiet eye) and affects both eyes. The underlying cause is often a result of an abnormal immune disease. Infections caused by the organism toxoplasmosis are the most common cause of posterior uveitis.Sometimes inflammation can affect the entire uvea. This inflammation is sometimes called panuveitis. People with panuveitis may be more likely to experience vision loss from the condition. Symptoms include floaters, blurred or loss of vision.
Who is at Risk for Uveitis?
Uveitis can affect anyone at any age, but it is most commonly seen in the forth decade of life. It affects children, working adults, and senior citizens. There is a higher prevalence in women. It is a leading cause of blindness in the United States and in the world. Working age Americans are most likely to get uveitis. As we age, however, we are more likely to get uveitis in both eyes and panuveitis (uveitis that affects all of the uvea).
What Causes Uveitis?
Uveitis is inflammation of the eye’s uvea. Inflammation is the body’s response to injury, or trauma. To treat uveitis, doctors look for the cause of the trauma to the eye. Uveitis can be caused by many different kinds of trauma, including a virus, bacteria infections, or parasites.
Genes can play an important role in uveitis. Also, diseases that damage the body’s immune system, such as AIDS, can lower the body’s ability to protect itself from infections that can cause uveitis.
In many cases, perhaps as many as a third or half of all uveitis cases, the cause of the inflammation is not known.
What Causes Vision Loss from Uveitis?
Uveitis is a common cause of vision loss and blindness in the United States and in the world. Uveitis may cause blurry and reduced vision. When treated, vision may recover. In some cases, mostly in intermediate uveitis, posterior uveitis and panuveitis, where inflammation is recurrent and chronic, damage to the eye can occur, particularly to the retina and optic nerve, and cause permanent visual loss.
Cystoid Macular Edema (CME)
This is a complication seen in intermediate uveitis, posterior uveitis, and panuveitis.
The leading cause of decreased vision which may lead to permanent visual loss is the development of CME – swelling of the macula which is the most sensitive part of the eye for vision needed for driving, reading and detailed work. If the swelling does not respond to treatment and is long standing, the sensitive cells under the fluid can eventually die. Other causes are swelling of the optic nerve. With the nerve swollen, messages from the retina cannot effectively get to the brain.
This is a complication seen in intermediate uveitis, posterior uveitis, and panuveitis.
Although less serious, inflammatory cells, cellular debris and/or blood can invade the vitreous humor, which makes it cloudy. The vitreous humor is the clear gel-like substance that fills the eye. Normally, the vitreous gel is clear. This allows light through to the back of the eye. Rarely, inflammation from uveitis lets debris get into the vitreous. This may include blood and scar tissue. At first, this debris may cause floaters or flashes of light. If serious, it may block vision. Eye doctors will generally try medicines, and if the eye does not respond, the eye surgeon can remove the cloudy vitreous and replace it with a clear fluid. This procedure is called a vitrectromy.
Other Complications of Uveitis:
These are possible complications of anterior uveitis, intermediate uveitis, posterior uveitis and panuveitis.
Your eye produces a watery fluid called aqueous humor, which goes into the eye and drains out. When your eye is healthy, the fluid drains through a mesh-like pathway and into the bloodstream. Aqueous fluid is produced by the ciliary body. It flows through the pupil and behind the clear cornea. Finally, it drains away through the trabecular meshwork.
The flow of aqueous humor through the front of the eye is related to overall pressure inside the eye. Inflammation caused by uveitis can lower production of aqueous humor. Inflammation can also lead to build-up of debris in the trabecular meshwork, blocking the flow of aqueous humor. Additionally, inflammatory cells are sticky and can also lead to blockage.These problems can cause pressure in the eye to go up. This is called ocular hypertension. If the drainage is fully blocked, the pressure will rise dramatically. Severe pain, blurred vision and nausea are signs of this problem. It requires emergency room treatment. If the drainage is partly blocked, the pressure will go up – but not enough for the individual to feel it. Treatment involves the prescription of pressure-lowering eye drops. If the pressure cannot be controlled with pressure-lowering drops, it can lead to permanent vision loss – this is called glaucoma. Side vision (peripheral vision) is affected first. Many people do not notice loss of side vision until much of it is gone, so it is important to have your side vision tested regularly. Treatment includes the use of multiple eye drops; if this still does not control the damage caused by increased pressure, the eye doctor will recommend filtration surgery to let fluid drain from the eye.
Long-term corticosteroid use (a common treatment for anterior uveitis, intermediate uveitis, posterior uveitis and panuveitis) is also a risk factor in the development of secondary glaucoma. The use of steroids can increase the amount of fluid produced by the ciliary body, causing the pressure inside the eye to rise. As many as one fifth of people with uveitis can develop ocular hypertension. Some of these individuals will develop glaucoma. The best way to prevent vision loss from glaucoma is by getting your eyes checked regularly. If you have glaucoma, you will need to work closely with your eye doctor to make your treatment successful.
This is a complication of anterior uveitis, intermediate uveitis, posterior uveitis and panuveitis.
Cataracts are a common complication of uveitis. Cataracts are a clouding of the eye’s lens. In less developed countries, this can be one of the most common causes of vision loss. In industrialized nations, however, cataract surgery is a commonly performed procedure. There are few surgical complications and very few people go blind from the condition.
Eye doctors can remove the eye’s natural lens and replace it with a special plastic lens. However, if the cataracts are related to uveitis, eye doctors may not be able to perform surgery until the inflammation caused by uveitis is brought under control. In most cases, eye doctors want the eye to be free of inflammation for at least three months before performing cataract surgery. Sometimes, the artificial lens put in place by an eye doctor during cataract surgery can irritate the eye and cause anterior uveitis.
Long term use of corticosteroids used to treat uveitis can also increase the risk of developing cataracts. The type of cataract developed by long-term corticosteroid use causes the most visual disturbance.
This is a possible complication of posterior uveitis and panuveitis.
Uveitis can affect the vitreous body, the clear, gel-like substance that fills the eyeball. As we age, the vitreous may shrink and pull away from the retina. Sometimes, the retina can tear as the vitreous pulls away. If there is a break in the retina, vitreous may enter the tear and pull the retina away from the eye, requiring immediate surgery to prevent blindness. Floaters or flashes of light may be signs of vitreous detachment, a retinal tear or a retinal detachment. It’s important to see your eye doctor for a complete eye exam if you notice any signs of eye problems. For uveitis patients, the retinal detachment complication rate is generally less than 5%.
Living with Uveitis
You must work with your eye doctor if you have uveitis. Eye doctors know how to treat uveitis, but they have to work with you to find the best way to treat the condition. Stay informed, take your medicines as scheduled, and follow your treatment plan.
You and your doctor must work together to determine the best medicines for you.
- Remember to take notes about how you feel. Write down your questions so you can make the most of your eye doctor visits.
- Explain to your eye doctor how the medicines you are taking affect you.
- Tell all of your other doctors about your eye medicines and all other drugs you’re taking.
- Tell the eye doctor about any changes in your physical condition, any changes in your medicine or any side effects.
- Call your eye doctor if you notice any unusual changes in your eyes, your vision or the way you feel in general.
- Schedule regular checkups and follow through with them.
- Take care of yourself! – your eyes and the rest of you along with them.
It’s up to you to follow your treatment plan and have follow-up visits as recommended by your eye doctor. Remember to report anything you believe may be a side effect of the medicine you are taking.
Skipping doses of your medicine may put your vision in danger and mislead your doctor. Be sure to tell your doctor if you’ve missed any doses.
After evaluating your progress, your doctor may try changing your doses, switching medicines or changing other parts of your treatment to find the best results for you.
You will have many questions as your doctor diagnoses and treats your uveitis. It’s helpful to keep a list of these questions, especially if they come to mind in between your doctor appointments. Write all your questions down and bring the list with you, then discuss them with your doctor. Here are some questions many people have:
- What do the medicines do?
- How much will they cost? Will my insurance help pay for them? (These may be questions for your insurance company, not your doctor).
- What are the possible side effects of my medicines?
- Can I do anything to lower the chance of side effects or reduce the effects?
- When exactly should I take my medicine? Can you please write down a detailed schedule?
- What should I do if I miss a dose?
- Do I need to do anything special to take care of my medicines?
- Learn about the medicines you are taking and the best way to use them. Find out whether they need special handling, such as storing them in the refrigerator.
- If you take a combination of drops and ointments, always apply the drops first.
- Schedule your doses around your normal routine, such as when you wake up, when you eat meals, and when you go to bed at night.
- Keep your medicines in plain sight. It’s easier to remember to take them.
- Keep medicines in a clean place. For example, if you carry them in your purse, put them in a sealed plastic bag to keep them clean.
- Take your medicines with you when you’re away from home. If you’re checking luggage at the airport, keep your medicines with you in your carry-on or in your purse.
- If you forget a dose, do not automatically double your next dose. Instead, follow your doctor’s instructions on what to do.
- If you can’t remember whether you took your medicines, simply use one dose at your next scheduled time.
Find support and encouragement from your family, friends and others. Sometimes it helps to talk to people who have experienced the same thing. It can help you to discuss side effects, share ways to remember your medicines and celebrate getting your uveitis under control.
Unfortunately, there are a few people who will lose vision despite commitment to working with their eye doctor and following their treatment plan. The future holds great promise for uveitis. New medicines and treatments continue to be developed. In the meantime, take heart in knowing that you’re doing everything possible to treat your condition. The doctor/patient team approach, support from others and promising scientific discoveries will help you look forward toward a bright future.
Living with Low Vision
Despite treatment, uveitis can sometimes cause low vision or blindness. Low vision is vision loss that can’t be corrected with glasses or contact lenses and affects daily living.
There are many things you can do to make your daily life easier even if you have lost sight to uveitis.
Special training, called vision rehabilitation, can give you skills for living with vision loss.
Low vision aids are tools that can help you if you have vision loss. Some of these tools include:
- Magnifying lenses or special glasses
- Closed-circuit TVs
- Computers with large screens
- Bright lamps, large-print books and magazines
Stay positive about the challenges of living with low vision. You may need to develop new skills for daily living. Learn as much as you can about resources and rehabilitation services that are available.
It’s common to feel anger, grief and depression when you have vision loss. Losing even part of your vision can be devastating. But stay determined and be persistent. You can make the most of your remaining vision. Know that much of what has to be done to keep your independence and quality of life must be done by you.