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Uveitis refers to inflammation in the colored part of the eye, called the IRIS, or the layers contiguous behind it, called the ciliary body-and important part of which is the PARS PLANA--and the CHOROID. The iris, ciliary body and choroid together are the UVEA. Well known terms for inflammation in specific parts of the uvea are IRITIS, PARS PLANITIS and CHOROIDITIS. These conditions have different symptoms and are
treated somewhat differently. Patients with iritis often have pain
and find the light painful (PHOTOPHOBIA). The eye can be quite red,
tender and teary. It is generally treated with eyedrops from the
class of drugs called STEROIDS, as well as with dilating drops.
The use of steroids-even steroid eyedrops--requires close medical
attention. If not treated, iritis can cause the iris to stick to
the lens behind it, and the pupil may assume an irregular shape.
Of greater concern is the possible development of CATARACT and GLAUCOMA. Pars planitis may be painless, and most patients notice only floaters in their vision. Patients with inflammation in the choroid (CHOROIDITIS) have similar symptoms. Steroids work well as therapy, but eyedrops are generally not sufficient because the drug does not penetrate the eye deeply enough. Steroids may be administered by mouth, or by injections around the eyes or even directly into the eye so that the drug will arrive at the inflamed tissue easily. Uveitis can be vision threatening in a variety of ways. Uveitis causes CATARACTS to form more quickly than usual. GLAUCOMA (loss of the nerves in the high due to high eye pressure) can also result from both the inflammatory process itself and from the steroid drugs used to treat these diseases. The nerves in the back of the eye can also become swollen as a result of the inflammation in the eye, and this swelling (called macular edema) causes the nerves to function poorly-resulting in poor vision. The causes of uveitis are many and varied. Sometimes,
infections by various micro-organisms are the cause, and treatment
begins with determining the presence or absence of infection, (tuberculosis
and syphilis were occasional causes many years ago, but quite rare
now). Frequently, uveitis is caused by immune system dysfunction,
although the precise nature of the dysfunction is not known. Nevertheless,
often the inflammation may fit a pattern that is well recognized,
so that some types of uveitis have specific names, such as Vogt
Koyanagi Harada syndrome, Birdshot Choroidopathy or Sympathetic
Ophthalmia. Sometimes, the uveitis is clearly part of an immune
system disease affecting the whole body, such as Behcet's disease
or sarcoidosis. Children can also be affected with uveitis, due
to infection with micro-organisms, (toxoplasmosis is an important
example), or a systemic immune disease. Juvenile idiopathic arthritis,
sometimes known as juvenile
rheumatoid arthritis, is an important cause of childhood uveitis.
This uveitis is particularly problematic because it can be indolent,
such that children have no symptoms despite active ocular inflammation.
The inflammation may then go unnoticed until it has caused extensive
damage, such as cataract, glaucoma, and macular edema. It is imperative
that children with known juvenile arthritis be examined regularly
for uveitis. Similarly, children with uveitis are closely monitored
for the development of arthritic symptoms. |
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