Anterior uveitis

Definition

Uveitis is an inflammation (swelling and irritation) of the the uvea. The uvea is the layer of the eye between the sclera and the retina. This layer includes the iris, ciliary body, and the choroid.

Alternative Names

Causes

Uveitis is an inflammation inside the eye, affecting the uvea. The uvea provides most of the blood supply to the retina. Causes of uveitis can include autoimmune disorders, infection, or exposure to toxins. However, in many cases the cause remains unknown.

The most common form of uveitis is anterior uveitis, which involves inflammation in the front part of the eye. This form of uveitis is usually limited to the iris. Therefore, this condition is often called iritis (inflammation of the iris). The inflammation may be associated with autoimmune diseases such as rheumatoid arthritis or ankylosing spondylitis

Pars planitis is inflammation of the pars plana, a narrow area between the iris and the choroid. Pars planitis usually occurs in young men and is generally not associated with any other disease. However, there have been a few case reports of an association with Crohn's disease, and some experts suggest a possible association with multiple sclerosis. For this reason, these experts recommend that those over 25 years old diagnosed with pars planitis receive an MRI of their brain and spine.

Posterior uveitis affects the back portion of the uveal tract, and involves primarily the choroid. This is called choroiditis. If the adjacent retina is also involved it is called chorioretinitis. Posterior uveitis may follow a systemic infection or occur in association with an autoimmune disease.

The inflammation causes spotty areas of scarring on the choroid and retina that result in areas of vision loss. The degree of vision loss depends on the amount and location of scarring. If the central part of the retina, called the macula, is involved, central vision becomes impaired.

Uveitis, affecting one or both eyes, can be associated with any of the following:

• Toxoplasmosis
• Histoplasmosis
• Tuberculosis
• Sarcoidosis
• Syphilis
• AIDS
• CMV retinitis or other cytomegalovirus infection
• Trauma
• Ulcerative colitis
• Rheumatoid arthritis
• Kawasaki disease
• Herpes zoster infection
• Ankylosing spondylitis
• Behcet syndrome
• Psoriasis
• Reiter syndrome

Symptoms

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

Note: Symptoms may develop rapidly.

Exams and Tests

A complete medical history and eye examination should be performed. If there is suspicion of an associated systemic disease, a physical examination and laboratory tests may be needed to look for underlying causes.

Treatment

Iritis is usually mild. Pain caused by spasm of the pupil constriction muscle is relieved by drops to dilate the pupil. Dark glasses may be helpful. Steroid eye drops or ointment may be needed. More severe cases require a search for an underlying cause.

Pars planitis is often treated with steroid eye drops, but may be treated with oral steroids or another type of medication to suppress the immune system.

Choroiditis requires determination of the underlying cause, and treatment of the underlying disease. The underlying disease may be serious. Additional specialists in infectious disease or autoimmunity may be needed for such diseases as syphilis, tuberculosis, AIDS, sarcoidosis, or Behcet's syndrome.

For systemic infectious diseases, corticosteroids are often used along with antibiotic therapy. For autoimmune diseases, various forms of suppression of the immune system may be required.

Outlook (Prognosis)

In anterior uveitis, most attacks last from a few days to weeks with treatment, but relapses are common. In posterior uveitis, the inflammation may last from months to years and may cause permanent vision damage, even with treatment.

Possible Complications

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

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms of uveitis. If eye pain or reduced vision are present, this condition is more urgent than if symptoms are very mild.

Prevention

Treating any underlying disorders may help to prevent uveitis for some people with existing systemic diseases.