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Iritis & Uveitis

What is uveitis?

Uveitis is an inflammation of the uveal tissue within the eye. The uvea consists of the pigmented iris, ciliary body (the tissue around the lens that produces the liquid aqueous), and the choroid (the vascular supply under the retina). Anterior uveitis (iridocyclitis, iritis) affects the anterior chamber. This condition can occur in a single episode or may be recurrent or chronic. Intermediate uveitis (pars planitis) is an inflammation localized to the vitreous (the middle clear gel). Finally, posterior uveitis (chorioretinitis) is inflammation of the retina and the choroid.

If left untreated, uveitis can cause permanent eye damage and vision loss from various problems including glaucoma, cataracts and retinal edema.

What causes uveitis?

Uveitis is actually a name for a large group of various disorders. Anterior uveitis can occur in any healthy patient and most develop without any obvious cause. Some common causes of anterior uveitis include ulcerative colitis, Crohn’s disease, Behcet’s disease, ankylosing spondylitis, reactive arthritis, and herpes simplex virus.

Posterior uveitis is often associated with systemic conditions that can cause inflammation in the eye. Some common causes of posterior uveitis include herpes zoster virus, systemic lupus erythematosus, sarcoidosis, syphilis, cytomegalovirus, toxoplasmosis, and Lyme disease.

There are numerous laboratory and radiologic tests that can be ordered for a patient with uveitis. Appropriate testing is often used to search for a systemic cause.

What are the symptoms of uveitis?

If the uveitis involves the front of the eye, symptoms include sensitivity to light and eye pain. The eye is red but unlike conjunctivitis, there is usually no discharge. The pupil is often small and irregularly shaped. Uveitis in the vitreous, retina or choroid usually causes painless floaters or vision loss. The eye itself usually looks normal.

How is uveitis treated?

Anterior uveitis is usually treated with anti-inflammatory steroid drops. A medication that dilates the pupil is often used to help for pain caused by pupillary spasm. Treatment usually lasts for several days to weeks until the inflammation is completely resolved. At that point, the steroid drops are slowly tapered down. Some patients will require chronic treatment if inflammation recurs.

Posterior uveitis can’t be treated with drops since they don’t penetrate into the back of the eye. It is therefore usually treated with steroid injections around or into the eye. In some cases, oral steroids, antivirals, or antibiotics are prescribed as well.