Uveitis and Iritis

Uveitis is inflammation, redness, and/or swelling of the middle layer of the eyeball, that left untreated can cause damage to eye tissues. The uvea is a blood vessel network that is comprised of three main areas including the iris, ciliary body, and choroid. These blood vessels are one way that inflammatory cells can enter the eye. The iris is the colored muscle at the front of the eye that controls how much light enters our eye through the size of your pupil. The ciliary body controls the production of fluid and the eye focus by changing the shape of the lens. The choroid is the vascular layer inside the eye that supplies blood and nutrients to the retina.  

Uveitis can last for a short (acute) or long (chronic) time, often with multiple recurrences of the disease with severe complications. It may occur suddenly in one or both eyes. There are 4 main classifications of uveitis depending on where the swelling occurs in the eye: 

• Anterior Uveitis (iritis) – swelling of the front part of the eye. Symptoms include eye pain, redness, tearing, light sensitivity, a small pupil, and blurred vision and can last up to 8 weeks. Some forms of anterior uveitis are ongoing, while others go away, but keep coming back. 
• Intermediate Uveitis (cyclitis) – swelling of middle of the eye; the ciliary body. Symptoms can last for a few weeks to many years, going through cycles of getting better, then worse. Symptoms include floaters and blurred vision. 
• Posterior Uveitis (choroiditis and reitinits) – swelling of the choroid and the back of the eye. Symptoms of blurriness and floaters can develop gradually and last for many years. 
• Panuveitis (diffuse uveitis) – swelling of all areas in the eye, with generally more severe symptoms stated previously. 

It usually affects people 20-50 years of age and accounts for 10-15% of cases of legal blindness in developed countries. It’s caused by an inflammatory response from the eye. Inflammation is the body’s natural response to tissue damage, germs, or toxins. It produces swelling, heat, redness, and destroys certain cells while white blood cells rush to contain the damage. Doctors don’t always know the cause of uveitis, but they include: 

• An autoimmune disorder 
  • Sarcoidosis, ankylosing spondylitis, rheumatoid arthritis, lupus, AIDS, multiple sclerosis, psoriasis, etc.
• An inflammatory disorder
  • Chron’s disease, ulcerative colitis, Reiter’s syndrome, Bechet’s disease, Vogt Koyanagi Harada Disease, Kawasaki disease, sarcoidosis, etc.
• Infections occurring within the eye or in other parts of the body
  • Shingles virus, herpes simplex virus, cytomegalovirus, West Nile Virus, syphilis, Lyme disease, toxoplasmosis, histoplasmosis, tuberculosis,  etc.
• Cancer that affects the eye
  • Lymphoma, choroidal melanoma, choroidal hemangioma, iris cyst, etc.
• Injury to the eye or surgery. 
• Toxins that may penetrate the eye. 

Diagnostic tests may include lab tests, fluorescein angiography, and OCT scan. Your doctor will try to categorize it into infectious uveitis, and non-infectious uveitis. Left untreated, complications include glaucoma, cataracts, optic nerve damage, macular edema, retinal detachment, and permanent vision loss. If uveitis is caused by an underlying condition, treatment will focus on that condition.  

• Drugs that reduce inflammation – you may be prescribed steroid eyedrops. If these are not enough, you may need corticosteroid pills or injections. 
• Drugs that fight bacteria, fungi, or viruses – if uveitis is caused by an infection, you may need antibiotics, antiviral, or antifungal drugs to stop the infection. You may also need corticosteroids as well to treat the inflammation. 
• Drugs that suppress the immune system – You may need immunosuppressive or cytotoxic medication if your uveitis affects both eyes, doesn’t respond well to corticosteroids, or severe enough to threaten your vision. 

These medications may have serious side effects and may involve the help of a rheumatologist to help manage your inflammation. The speed of your recovery will depend on the type of uveitis that you have and the severity of your symptoms. Uveitis can be a recurrent condition, so make sure to give us a call at (616) 954-2020 if any symptoms reappear.