Uveitis
Uveitis is inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascularstructures of the eye and includes the iris, ciliary body, and choroid. As Uveitis is an ophthalmic emergency and requires a thorough examination, urgent treatment to control the inflammation is offered at SEH by our Uveitis surgeon in Nagpur.
Classification
Uveitis is classified anatomically into anterior, intermediate, posterior, and panuveitic forms—based on the part of the eye primarily affected. Prior to the twentieth century, uveitis was typically referred to in English as "ophthalmia".
- Anterior uveitis includes iridocyclitis and iritis. Iritis is the inflammation of the anterior chamber and iris. Iridocyclitis presents the same symptoms as iritis, but also includes inflammation in the ciliary body. Anywhere from two-thirds to 90% of uveitis cases are anterior in location. This condition can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature.
- Intermediate uveitis, also known as pars planitis, consists of vitritis—which is inflammation of cells in the vitreous cavity, sometimes with snowbanking, or deposition of inflammatory material on the pars plana. There are also "snowballs," which are inflammatory cells in the vitreous.
- Posterior uveitis or chorioretinitis is the inflammation of the retina and choroid.
- Pan-uveitis is the inflammation of all layers of the uvea.
- Redness of the eye
- Blurred vision
- Photophobia or sensitivity to light
- Irregular pupil
- Eye pain
- Floaters, which are dark spots that float in the visual field
- Headaches
- synechia
- Signs of anterior uveitis include dilated ciliary vessels, presence of cells and flare in the anterior chamber, and keratic precipitates ("KP") on the posterior surface of the cornea. In severe inflammation there may be evidence of a hypopyon. Old episodes of uveitis are identified by pigment deposits on lens, KPs, and festooned pupil on dilation of pupil.
- Busacca nodules, inflammatory nodules located on the surface of the iris in granulomatous forms of anterior uveitis such as Fuchs heterochromic iridocyclitis (FHI).
- Floaters
- Blurred vision
Intermediate uveitis normally only affects one eye. Less common is the presence of pain and photophobia.
Inflammation in the back of the eye is commonly characterized by:
- Floaters
- Blurred vision
- Photopsia or seeing flashing lights
Uveitis is usually an isolated illness, but can be associated with many other medical conditions. In anterior uveitis, no associated condition or syndrome is found in approximately one-half of cases. However, anterior uveitis is often one of the syndromes associated with HLA-B27. Presence this type of HLA allele has a relative risk of evolving this disease by approximately 15%.The most common form of uveitis is acute anterior uveitis (AAU). It is most commonly associated with HLA-B27, which has important features :
- Noninfectious or autoimmune causes
- Infectious causes
- Associated with systemic diseases
- Drug related side effects
- Rifabutin, a derivative of Rifampin has been shown to cause uveitis.
- Several reports suggest the use of quinolones especially Moxifloxacin may lead to uveitis.
- White Dot syndromes
- Occasionally, uveitis is not associated with a systemic condition: the inflammation is confined to the eye and has unknown etiology. In some of these cases, the presentation in the eye is characteristic of a described syndrome, which are called white dot syndromes, and include the following diagnoses:
- Masquerade syndromes are those conditions that include the presence of intraocular cells but are not due to immune-mediated uveitis entities. These may be divided into neoplastic and non-neoplastic conditions.
Treatment
- Uveitis treatment in Nagpur at our medical centre typically consists of glucocorticoid steroids, either as topical eye drops (prednisolone acetate) or as oral therapy. Prior to the administration of corticosteroids, corneal ulcers must be ruled out. This is typically done using a fluorescence dye test. In addition to corticosteroids, topical cycloplegics, such as atropine or homatropine, may also be used by our uveitis surgeon in Nagpur. Successful treatment of active uveitis increases T-regulatory cells in the eye, which likely contributes to disease regression. In some cases an injection of posterior subtenon triamcinolone acetate may also be given to reduce the swelling of the eye.
- Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis. As a part of Uveitis treatment in Nagpur at our hospital, Infliximab or other anti-TNF infusions are also used. The anti-diabetic drug metformin is reported to inhibit the process that causes the inflammation in uveitis. In the case of herpetic uveitis, anti-viral medications, such as valaciclovir or aciclovir, may be administered to treat the causative viral infection.
The prognosis is generally good for those who receive prompt diagnosis and treatment, but serious complication including cataracts, glaucoma, band keratopathy, macular edema and permanent vision loss may result if left untreated. The type of uveitis, as well as its severity, duration, and responsiveness to treatment or any associated illnesses, are all factored by SEH, the best eye hospital in Nagpur.
