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Ophthalmology: Uveitis

Diagnostic Procedures

A complete medical history and eye examination will be conducted to determine what type of uveitis you have and if there is any evidence of an underlying condition. This may involve a variety of tests, such as blood work, X-rays of your back, scans, etc.

The eyes will be thoroughly examined. This usually involves the placement of eye drops to make the pupils wider so that the doctor can see into your eye more easily. You may also have a fluorescein angiogram. A small amount of yellow dye will be injected into your arm while photos are taken of your eyes. Because the drops used affect your eyesight for a short period of time, you will not be able to drive or read for a couple of hours after your appointment


Treatment Options

Prompt treatment is necessary to minimize any loss of vision. Eye drops, especially steroids and pupil dilators, are medications used to reduce inflammation and pain. For deeper inflammation, oral medication or injections may be necessary. Complications such as glaucoma, cataracts or new blood vessel formation (neovascularization) also may need treatment in the course of the disease. If complications are advanced, conventional or laser surgery may be necessary.

Uveitis in the front and middle part of the eye usually can be controlled by the frequent use of drops. Uveitis in the back part of the eye often is more difficult to treat.

What to Expect

The part of your eye affected by uveitis will determine the duration of the condition. With proper treatment, anterior uveitis can clear up in a matter of days to weeks. Posterior uveitis, on the other hand, may last several months or years and could permanently alter your vision.

If your uveitis responds poorly to corticosteroids or becomes severe enough to threaten your vision, you may need a different kind of medication, such as an immunosuppressive or cytotoxic agent. Vitrectomy—surgery to remove the jelly-like material in your eye (vitreous)—may sometimes be necessary for diagnosis and treatment of uveitis.

Uveitis can recur, so it's important to see your doctor if your symptoms reappear after successful treatment.


Frequently Asked Questions

How did I get uveitis?
It is unknown why most people get uveitis. There is an association with some infections (such as toxoplasmosis) and certain diseases (sarcoidosis and Behcet's disease) in some patients. Some patients have an increased likelihood due to the genes they carry (HLA B27 and HLA A29). But in many patients, a cause cannot be identified. Uveitis is classified as an autoimmune disease, meaning the body reacts against itself. The trigger for this is unknown, but it might be an infection in susceptible individuals. Treating for infection is unlikely to help, though, as the immune system is already activated and causes the damage.

What types of uveitis are there?
Uveitis is divided initially into anterior, in which only the front part of the eye is involved (this is also sometimes called iritis and iridocylitis), posterior, in which the back of the eye is involved, and panuveitis, in which the front and the back of the eye are both involved. Within each type, there are several subtypes. Anterior uveitis can be subdivided into acute disease, which lasts a few weeks, and chronic disease, which is defined as lasting more than three months. Posterior uveitis is usually chronic and can last a long time except in patients with toxoplasmosis, when it may settle in a few weeks. It is important to know which type of uveitis you have as this determines the type of investigations and treatment you need, as well as complications associated with the condition.

Can uveitis be cured?
No. Treatment only suppresses the harmful inflammation until the disease process is stopped by your body's own healing process. The treatment needs to be continued as long as the inflammation is active. In any patient, it is not possible to know how long the disease will last.

Is it caused by stress?
A lot of patients tell us that stress can bring on an attack or cause a relapse. There is a relationship between stress and the immune system, but it not an easy one to understand. Unfortunately, removing stress does not guarantee the disease will go away.

Why do I have to use drops?
Anterior uveitis can be treated with drops as the drugs penetrate well into the front of the eye. Steroid drops come in a variety of types and strengths and are given to suppress the inflammation until it goes away. The more intense the inflammation, the stronger the steroid drops and the more frequently you have use them. As the inflammation is brought under control, the frequency and strength of the steroid drops can be reduced. Steroids can also be given as an ointment used at night. This releases the needed steroid into the eye on a constant, low level. Dilating drops are prescribed to stop the iris, which becomes sticky when it is inflamed, from sticking to the lens. Often, the pain of acute inflammation is helped by dilating the pupil as spasm of the iris can contribute to the discomfort.

Are steroid drops dangerous? Can they cause cataracts?
It is true that steroid drops can cause cataracts; however, uncontrolled inflammation can also cause them and will do more harm to the eyes. It is best to get the inflammation under control with the lowest amount of steroid required.

Will I have to take an oral medication?
Patients who have inflammation at the back of the eye cannot use drops to control it as the drops do not get to the back of the eye. Sometimes, steroids can be given by injection under the eye in a slow-release form. But this is only useful if only one eye is involved. Most patients who have inflammation in both eyes take oral steroids to control the condition. It is not necessary for someone to stay on high doses of steroids long term. Other drugs such as cyclosporin, azathioprine and mycophenolate can work with the steroids, enabling them to be effective at a lower dose.

How will I know when I no longer have uveitis?
It is only possible to know that uveitis is gone by decreasing your medication. If your symptoms are gone, the uveitis is in remission although it may come back later. If the symptoms of uveitis increase as the medication is decreased, the disease process is still active and treatment needs to be continued.

Will I go blind?
Most patients treated for acute uveitis do not lose their vision. The main causes of visual loss in patients with chronic uveitis are cataracts, glaucoma or damage to the back of the eye from pressure inside the eye, and macular edema of the retina. The two most important factors in preventing permanent loss of vision are to control the inflammation and ensure that the intraocular pressure is not elevated.

Should I worry if a cause cannot be found for my uveitis?
In many people, no obvious cause is found for their uveitis. In many diseases associated with inflammation, no underlying cause can be found; the most common example being rheumatoid arthritis. In others, inflammation can be detected elsewhere (i.e., the lung) and sarcoidosis may be the cause. Infectious causes may be due to toxoplasma or toxocara.

How can uveitis and the medications used to treat it affect my pregnancy and subsequent breast-feeding?
Drops are the most frequent type of therapy used to treat uveitis and are not a threat as very little, if any, of the drug gets into the bloodstream. Drugs taken by mouth are used less commonly, and include steroids, azathioprine, cyclosporin, methotrexate, mycophenolate, tacrolimus and Diamox. Of these, Diamox is contraindicated in pregnancy. If you are considering getting pregnant or become pregnant while taking these types of drugs, it is very important that you talk to your ophthalmologist and obstetrician as soon as possible.