UVEITIS


   It is inflammation in the middle coat of eye comprising Iris, Ciliary body and Choroid.It can cause inflammation of adjacent eye structures as retina and vitreous.

Uveitis is divided in three types depending on its location :

  Anterior uveitis.
  Intermidiate uveitis.
  Posterior uveitis.
  Panuveitis.

Anterior Uveitis/ Iridocyclitis

This involves mainly iris and ciliary body. The condition causes painful red eye with lightsensitivity and watering. The condition when seen through slit lamp shows inflammatory cells in anterior chamber known as flare and cells. If these cells are more they deposit down in anterior chamber forming pus like material known as hypopyon.

Intermidiate uveitis / Parsplanitis

This involves the posterior part of ciliary body called pars plana. The patient usually has symptoms of seeing black spots and hazy vision. Patient may or may not have cells in Anterior chamber. Indirect Opthalmoscope shows inflammatory exudates near peripheral retina and vitreous.

Posterior Uveitis

This involves the choroid and associated with retinal involvement. The inflammation may be localised (focal), multifocal- involves multiple sites and widely spread out ( diffuse or disseminated). Symptoms are as for pars planitis but there may be marked visual loss if it involves macula. Peripheral retinal involvement may cause peripheral loss of vision.

Panuveitis

In this whole uveal tissue is involved.

Cause

In most of the cases cause is not known. However it may be associated with:
  Autoimmune diseases such as Rheumatoid arthritis, sarcoidosis.
  Infections such as Tuberculosis, Toxoplasmosis

Treatment

As the cause is not known in most of the cases there is no permanent cure for the disease. Treatment is aimed to reduce inflammation and related symptoms and complications.

Medicines commonly used are

Steroids: In form of local drops, local injections and in severe cases in form of oral tablets.

Cycloplegic drugs: Cyclopentolate and atropine: These causes temporary paralysis of iris muscles and give relief from pain.

Immunosuppresive agents: Azathioprine, cyclophosphamide etc for recurrent and non-responding cases.

Complications of Uveitis

If treated early and promptly complications are less. Important complications include:

Cataract and glaucoma it may happen because of disease and the steroids given for the treatment.

If not treated promptly iris gets adhered to the lens and blocks passage of aqueous fluid to trabecular meshwork. Iris bows forward by aqueous collection and again blocks the trabecular meshwork leading to glaucoma and untreated  may lead to blindness. So it needs urgent treatment.

Recurrent uveitis may lead to macular swelling (macular oedema) and permanent loss of vision.

 



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