Uveitis and You: The Essential Guide to Symptoms and Care

What do you know about Uveitis? 

Uveitis is a complex and heterogeneous condition requiring a multidisciplinary approach for optimal management. Advances in diagnostic modalities and targeted immunotherapy have improved patient outcomes. However, further research is necessary to elucidate its pathogenesis and develop novel treatments.

Uveitis and You: The Essential Guide to Symptoms and Care

         Anatomical Classification

Uveitis is classified based on the primary site of inflammation:

• Anterior Uveitis: Inflammation of the iris and anterior part of the ciliary body. This is the most common form and may present as acute or chronic.
• Intermediate Uveitis: Involves the vitreous humor and peripheral retina.
• Posterior Uveitis: Affects the choroid and/or retina.
• Panuveitis: Involves inflammation across all layers of the uvea.

Etiology of uveitis

The etiology of uveitis is multifactorial and includes:

• Infectious Causes:

• Bacterial: Tuberculosis, syphilis.
• Viral: Herpes simplex virus (HSV), cytomegalovirus (CMV).
• Fungal: Histoplasmosis, candida infections.
• Parasitic: Toxoplasmosis, onchocerciasis.

• Autoimmune and Systemic Inflammatory Diseases:

• Ankylosing spondylitis.
• Rheumatoid arthritis.
• Sarcoidosis.
• Behçet's disease.

• Idiopathic:

In many cases, the cause remains unidentified.

• Trauma and Post-Surgical: 

 Ocular injuries or surgeries can precipitate inflammation.

Pathophysiology

Uveitis results from an immune-mediated process, either due to an infection triggering an inflammatory response or a dysregulated autoimmune reaction. Inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), play a pivotal role in mediating tissue damage.

Clinical Manifestations

Symptoms vary depending on the type and severity of uveitis:

• Anterior Uveitis:

• Redness, pain, and photophobia.
• Decreased visual acuity.
• A hypopyon (pus in the anterior chamber) may be visible in severe cases.

• Intermediate Uveitis:

• Floaters.
• Blurred vision.
• Minimal redness or pain.

• Posterior Uveitis:

• Loss of central vision or scotomas.
• Floaters.
• Retinal vasculitis and choroiditis on examination.

• Panuveitis:

• Combines symptoms of all forms, with widespread inflammation.

Diagnostic Workup

The evaluation of uveitis involves:

• Clinical History and Examination:

• History of systemic diseases, infections, or trauma.
• Slit-lamp biomicroscopy to assess anterior chamber inflammation.
• Fundus examination for retinal and choroidal involvement.

• Laboratory Tests:

• Complete blood count, ESR, CRP.
• Serological tests for infectious causes (e.g., VDRL for syphilis, Mantoux test for TB).
• Autoimmune markers such as HLA-B27.

• Imaging Studies:

• Optical coherence tomography (OCT) for retinal assessment.
• Fluorescein angiography for vascular leakage.
• MRI or CT for systemic evaluation if sarcoidosis or malignancy is suspected.

Management

The treatment of uveitis focuses on controlling inflammation, relieving symptoms, and addressing the underlying cause:

• Corticosteroids:

• Topical corticosteroids (e.g., prednisolone acetate) for anterior uveitis.
• Systemic or periocular injections for posterior or severe uveitis.

• Immunomodulatory Therapy:

• TNF-α inhibitors (e.g., adalimumab) or methotrexate for autoimmune-related uveitis.

• Antimicrobial Agents:

• Specific antibiotics, antivirals, or antifungals for infectious etiologies.

• Adjunctive Therapies:

• Cycloplegics (e.g., atropine) to relieve pain and prevent synechiae.
• Surgery may be required for complications like cataracts or glaucoma.

Prognosis and Complications

The prognosis depends on timely diagnosis and treatment. While anterior uveitis often resolves with appropriate therapy, posterior and panuveitis carry a higher risk of vision impairment. Complications include:

• Chronic glaucoma.

• Retinal detachment.

• Cystoid macular edema.

Conclusion: Uveitis is a complex and heterogeneous condition requiring a multidisciplinary approach for optimal management. Advances in diagnostic modalities and targeted immunotherapy have improved patient outcomes. However, further research is necessary to elucidate its pathogenesis and develop novel treatments.