Uveitis is characterized by inflammation of the uveal tract, encompassing the ciliary body, iris, and choroid. In Pakistan, according to some estimates the prevalence rates of uveitis may range from 17 to 52 per 100000 people, with tuberculosis as a significant potential cause of the condition.
Classification Of Uveitis
Anatomical Classification
- Anterior uveitis is the most common type affecting the iris
- Intermediate uveitis affects the middle region of the eye including the peripheral retina, vitreous humor and pars plana
- Posterior uveitis causes the inflammation of the choroid and may involve the retina and optic nerve
- Panuveitis involves the entire uvea
Classification Based On Disease Duration
- Acute uveitis is characterized by sudden onset of symptoms and can last for up to 3 months
- Subacute uveitis persists for typically between three to six months
- Chronic uveitis persists for more than six months to as long as several years
Causes
- Autoimmune disorder, such as lupus, ankylosing spondylitis, multiple sclerosis, juvenile arthritis
- Inflammatory conditions like inflammatory bowel disease
- Infections, including syphilis, varicella virus, herpes, tuberculosis, toxoplasmosis
- Previous eye surgery or trauma
- Idiopathic cases such glaucomatocyclitic crisis
Symptoms
- Discomfort in the eye exacerbated by focusing
- Eye redness
- Photophobia ( sensitivity to the light)
- Blurring of the vision
- Floaters ( spots, specks, threads or cobwebs) in the vision
- Loss of peripheral vision
- Increased lacrimation
- Systemic signs, such as, fever, arthralgia, myalgia, and joint stiffness
Diagnosis
Examination
- Altered visual acuity on exaimination
- Tonometry may show normal elevated or low intraocular pressure
- Slit-lamp examination may show keratitic precipitates, aqueous flare, aqueous cells and/or posterior synechiae
- Fundoscopy is usually unremarkable but may show poor red reflex
Clinical Tests
- Blood tests, imaging and serological assays to determine the underlying cause
Management
Lifestyle Modifications
- Protective glasses to relive eye discomfort
- Eat fruits and vegetables rich in antioxidants such as cherries, tomatoes and leafy vegetables. Avoid sugar, processed food and excessive salt intake
- Turmeric supplements has anti-inflammatory properties and is rich in antioxidants may boost the immune system to combat chronic uveitis
- Take supplements containing Vitamin A, lutein, omega 3 fatty acids and other minerals which may improve your general and ocular health after consultation with a doctor
- Avoid smoking and reduce stress
Pharmacological therapies
- Topical cycloplegic agents
- Corticosteroid agents administered orally, or via intraocular or periocular route
- Immunomodulatory agents, such as, azathioprine, methotrexate or mycophenolate are given to reduce inflammation
- Biological therapies, for instance, rituximab, or adalimumab may be used in case of refractory cases
- Non-steroidal inflammatory drugs
- Antibiotics or antivirals are given in case of bacterial or viral infection
Surgery
- Vitrectomy is done in case of severe and persistent infectious uveitis
- Surgical interventions can be employed to treat complications such as, cataracts, glaucoma or retinal detachment.
