Uveitis

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Uveitis, which can be separated into anterior uveitis, intermediate uveitis, posterior uveitis, and pan-uveitis, is inflammation of the uvea or the middle layer of the eye.  The uvea consists of the iris (the colored part of the eye), the ciliary body, (a thin, vascular layer of the eye located between the white of the eye and the retina (responsible for producing eye fluid) and the choroid (a layer of blood vessels between the white of the eye and the retina that nourishes the back of the eye).  Uveitis is caused by a number of factors including infection, inflammatory diseases, eye injury and exposure to toxic chemicals and acids, but often the cause is unknown.  Many cases of uveitis are chronic and when not properly treated, may lead to other eye conditions including cataracts, retinal swelling, scarring, glaucoma and retinal detachment, which may result in vision loss. 

What are the symptoms of Uveitis?
Symptoms of uveitis are dependent upon the location of the inflammation. Anterior uveitis (inflammation of the iris and the front chamber of the eye) is the most common form and often presents with eye pain, light sensitivity and blurred vision.  Intermediate uveitis (inflammation of the ciliary body) and posterior uveitis (inflammation of the choroid) have similar symptoms that include blurred vision and floaters, yet are not normally associated with pain.   Pan-uveitis is the diagnosis when inflammation occurs in the iris, ciliary body and choroid of the uvea, thus symptoms of the other forms of uveitis may be present. 

How is Uveitis treated?
The treatment for uveitis depends upon the cause and the location of the inflammation.  If an underlying infection is responsible, then an anti-infective agent will be prescribed along with corticosteroids to bring the inflammation under control quickly.  Whether the steroid is in eye drop, injection or oral form depends upon the type of uveitis diagnosed.  Because anterior uveitis occurs in the front of the eye, steroid eye drops are often an effective treatment option.  If intraocular pressure (IOP) is elevated as a result of anterior uveitis, then pressure lowering agents may be prescribed as well to prevent damage to the optic nerve while the inflammation is being treated with steroids.    Also, pupil-dilating drops may be prescribed to manage pain associated with anterior uveitis.

Treatment of intermediate and posterior uveitis requires different techniques because steroid eye drops will not reach the location of the inflammation. If the inflammation is in one eye, then a steroid injection to the outside of the eyeball may be used to bring the inflammation under control.  If uveitis is present in both eyes, then high-dose oral steroids may be necessary.   
Because long-term, systemic steroid use may result in side effects, some patients with chronic, uveitis may need oral non-steroidal anti-inflammatory drugs known as anti-metabolites to manage the disease.  As a result, occasionally diagnosis and management of uveitis is performed in conjunction with a rheumatologist.  

Patients with noninfectious posterior uveitis may also benefit from Retisert™, a long-acting drug implant.  Retisert™ is surgically implanted into the eye and consists of a tiny drug reservoir designed to deliver sustained levels of a well-known corticosteroid for approximately two-and-a-half years.  The implant releases the steroid directly to the back of the eye, thus reducing or eliminating many of the systemic side effects commonly caused by oral steroids.  

Uveitis is a common disease that the doctors of Fifth Avenue Associates diagnose and treat.  A systematic approach is taken to manage acute and chronic uveitis and prevent damage to other structures of the eye.