Uveitis refers to inflammation of the middle layer of the eye, which is called the uvea (or uveal tract).
The uvea is made up of the iris (the coloured part of the eye), the ciliary body (a ring of muscle behind the iris), and the choroid (a vascular layer of tissue that supports the retina).
Uveitis is a rare condition, with only around 2-5 in every 10,000 people in the UK being affected by it each year.
It may be idiopathic (autoimmune) or associated with an underlying systemic disease or infection. It can also follow an injury or,rarely, ocular surgery. If uveitis is not treated, the eyesight can be seriously damaged.
Uveitis can result in further ocular complications, including cataracts and glaucoma. However, most cases recover well with treatment. Early diagnosis of uveitis is very important, as the sooner the condition is treated, the more successful the outcome is likely to be.
Uveitis usually causes a red, painful eye with cloudy vision. These symptoms may vary in intensity from mild to severe. The most typical form causes a red eye which is associated with a dull ache around the eye.
Uveitis can occur as a consequence of a multitude of causes and can affect anyone. It particularly affects people of working age, commonly those aged between 20 to 59, but can also occur in children.
The type of uveitis may be categorised according to which part of the eye is affected
Uveitis may also be categorised in accordance with the length of time that it lasts
The cause of uveitis is often unknown, with approximately 40% of patients not having a determined cause after clinical investigation. Many cases are linked to the immune system, when it becomes overactive in the eye for unknown reasons. Uveitis can also be caused by infection, injury or surgery, although this is less common.
Uveitis is broadly divided into infectious and non-infectious causes.
Increased uveitis risk factors can also be related to the following health conditions:
An inflammatory or autoimmune condition (when the body attacks its own organs). HLA B-27 positivity is the most common association. This may also be associated with rheumatoid arthritis, ankylosing spondylitis (arthritis of the lower back), psoriasis or inflammatory bowel disease. Other systemic condition associated with uveitis include Behçet’s disease, sarcoidosis and Reiters
Bacterial, viral, fungal and parasitic infection such as toxoplasmosis, Herpes Simplex, Herpes Zoster(shingles), tuberculosis (TB), Lyme disease and syphilis are all causes of uveitis. Immunodeficiency in susceptible with a known underlying condition such as leukaemia, lymphoma, HIV/AIDS may make these groups of patients vulnerable to opportunistic infections in the eye e.g. cytomegalovirus retinitis
Juvenile Idiopathic Arthritis (JIA) is the most common identifiable cause of uveitis in children
Anterior uveitis affects the front of the eye (usually the iris) and is the most common type of uveitis. It can affect one or both eyes depending on the cause.
Anterior uveitis symptoms include:
An aching, painful, red eye. The pain can range from a mild ache to intense discomfort,
Blurred or cloudy vision
A small pupil or a distortion of the shape of the pupil
An iris (the coloured part of the eye) that may have a slightly different colour
Sensitivity to light (photophobia)
Headaches.
These symptoms may develop gradually over hours or days and may gradually increase in intensity.
Intermediate uveitis is the second most common type of ocular inflammation. It predominantly affects the vitreous, a gel like structure found in the cavity just behind the ciliary body and in front of the retina in the middle part of the eye, both eyes tend to be affected and it is usually painless. Intermediate uveitis symptoms can include:
Floaters (dots that move across the field of vision)
Blurred vision due to cells and protein from the blood vessels leaking into the gel of the eye due to inflammation of the retinal blood vessel walls (retinal vasculitis)or deposits just behind the ciliary body (pars planitis)
Mild redness (although the inflamed eye may look completely normal despite having symptoms)
Posterior uveitis affects the choroid, a layer of blood vessels supplying the retina (the nerve tissue responsible for vision). The choroid forms the middle layer of the wall of the eye, with the retina comprising the inner layer and the sclera the outer layer. One or both eyes may be affected and it is usually painless. However posterior uveitis is a more serious form of ocular inflammation than anterior uveitis.
Posterior uveitis usually causes decreased vision and floaters, and sometimes retinal detachment. Posterior uveitis symptoms are slower to develop and often last longer than those of anterior uveitis. It can be more damaging to the eye than other types of uveitis and can sometimes cause visual loss.
Scleritis, is a form of inflammation affecting predominantly the sclera, or outer white coat of the eye.
Scleritis may affect the front and/or back of the eye. It causes a very red eye and intense ocular pain, which can sometimes even prevent sleep.
If you experience any uveitis symptoms, you should immediately contact your GP who may refer you to an ophthalmologist for further investigation. An optometrist may also be able to detect uveitis, if very severe and recommend referral to a uveitis expert for investigation and treatment. It is recommended that urgent attention from an ophthalmologist is sought if signs of uveitis is accompanied by sudden or pronounced blurred vision, as this may represent the severe form of uveitis.
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