Symptoms, Causes and Treatment of Uveitis

Uveitis is one of the leading causes of irreversible blindness. The problem is rampant in developing countries like India. It becomes important for the patients and their relatives to know what Uveitis is and what they can really do about it.

1. What is Uveitis?

There is a vascular layer sandwiched between the light-sensitive nerve layer (retina) and outer white coat of the eye (sclera) which is called uvea. Inflammation of this vascular layer (which also often affects adjacent structures) is called uveitis. Uveitis is a broad term and includes: scleritis (inflammation of the outer white coat of the eye), anterior uveitis (inflammation in the front part of the eye), intermediate uveitis (inflammation within the gel inside the eye- vitritis), retinal vasculitis (inflammation of the retinal blood vessels), retinitis (inflammation of the retina), choroiditis (inflammation of the choroid which is a part of uvea itself). Uveitis may be an isolated eye problem or more often may be associated with an underlying systemic disease.

2. What are the causes of Uveitis?

Uveitis is most often than not an ocular manifestation of an underlying systemic disease. It is caused by an immune-mediated reaction against an offending antigen (protein) which may be internal or external. This offending antigen could be infectious (bacteria, virus, parasites) or non-infectious /autoimmune (genetic, environmental).

3. What are the most recognisable symptoms of uveitis?

Symptoms depend on the part of the eye affected and include redness, pain, intolerance to light (anterior uveitis), floaters (intermediate uveitis), blurred vision (posterior uveitis). There is significant overlap of symptoms in the different types of uveitis.

4. How is Uveitis diagnosed?

The diagnosis of Uveitis involves eye scans, blood work-up, urine tests and body scans to identify the underlying systemic illness. Patients and their families need to cooperate with the doctor while she is getting the tests done because the accurate diagnosis of the underlying disease is crucial for the correct treatment and restoration of vision. Moreover, treatment of one type of uveitis may actually be contraindicated in another type of uveitis. This makes an accurate diagnosis of the condition all the more important.

5. How is Uveitis treated?

Most cases of uveitis can be managed medically, with eye drops and pills. Treatment involves steroids, but at Neoretina, we believe in the safe use of steroids, and we do not prescribe more than one course of oral steroids. Beyond that, the disease control is maintained with systemic immunosuppression.

6. What is systemic immunosuppression?

Systemic immunosuppression is selective suppression of a constituent type of white blood cells in the body which helps in maintaining the control of inflammation achieved by steroids. These drugs act slowly so they cannot be used in the initial phase for control of inflammation.

7. Is it safe to take immunosuppressive drugs?

Steroids are not safe for long-term (more than six months) use. They can cause side effects like reduced bone density, increase in blood sugar, increased blood pressure, skin changes, weight gain, abnormal fat deposition, etc. Systemic immunosuppression begins to weigh-down the benefits of the treatment. At Neoretina, we take a written informed consent for immunosuppression, i.e., inform the patients about the possible side effects, how we propose to manage them and what alternative treatments are available before starting the treatment. We start at the lowest dose of the immunosuppressive drug and increase stepwise based on objective response to therapy. The lowest dose at which response is achieved is continued, and treatment is monitored by way of regular blood counts.

8. What is the duration of immunosuppressive therapy?

Systemic immunosuppressive therapy is generally long term. Once control of inflammation is achieved, treatment is continued for a year, and if there is no recurrence, immunosuppressive therapy is tapered very slowly over a period of a year. Before stopping immunosuppressive therapy, the severity of uveitis at presentation, duration of disease, type of disease, the extent of damage caused, the risk of recurrence etc. need to be considered.

9. What are the contraindications of immunosuppressive therapy?

Pregnancy and lactation are two situations where immunosuppressive therapy is contraindicated.

10. What are the other modes of treatment for uveitis?

Uveitis may also be treated with local steroid injections especially in unilateral cases or in cases of isolated eye involvement where systemic therapy may not be required. Local steroids are given as periocular steroids (steroid injection near the outer coat of the eye) or inside the eye. Inside the eye, we prefer giving steroid implant (Ozurdex) which is a low dose dexamethasone biodegradable implant and releases the drug slowly over a period of 3-4 months.

11. Is uveitis curable?

Infectious uveitis is curable, and treatment duration depends on the type of infection. Non-infectious uveitis is also curable, but treatment takes longer to prevent recurrence.

12. What are the complications of uveitis?

Irreversible complications of uveitis arise mostly because of delayed or inadequate or inappropriate treatment. Complications include glaucoma (optic nerve damage due to increased eye pressure), optic disc pallor, macular scarring (scarring in the central part of the retina).

Reversible complications are cataract, transient increase in eye pressure without optic nerve damage, epiretinal membrane (membrane over the retina).

13. How are complications of uveitis treated?

Complications of uveitis may require additional procedures or surgery. Increased eye pressure due to bowing forward of the iris needs laser treatment; cataract requires surgery and opacification of the vitreous gel requires vitrectomy surgery (removal of the vitreous gel) and the epiretinal membrane may require removal by vitreo-retinal surgery.

Timely consultation can help prevent complications.