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UVEITIS: AN EYE INFLAMMATION NOT TO BE TAKEN LIGHTLY

From Washington University Physicians, posted May 21, 2010, written by Mary Jo Blackwood, RN, MPH

Most of us don’t think too much about waking up with red eyes. We may blame our allergies, last night’s tequila, or getting too close to a child with conjunctivitis (pink eye). But ocular redness has numerous causes - some simple, some serious - from infections to chronic systemic problems.  By dismissing red eyes as simple conjunctivitis and treating it yourself  with over-the-counter drops you may put yourself in danger.

Red eyes can be the first symptom of an autoimmune disease, or even cancer. If it persists, uveitis, an inflammation of the middle layers of the eye, can cause blindness.

Washingon University ophthalmologist  Humeyra Karacal, M.D., is an expert in diagnosing and treating uveitis and other ocular inflammations. She says about one-third of uveitis is called idiopathic - occuring spontaneously - and the cause is undetermined. The other two-thirds of the cases are associated with a systemic or some other eye problem, or may be a side-effect of certain medications. Prompt treatment can prevent vision loss.

Uveitis can affect both children and adults, and is usually classified into anterior, intermediate, posterior or panuveitis (affecting both anterior and posterior segments of the eye). Anterior uveitis is more likely to present with redness, eye pain and sensitivity to light, whereas patients with intermediate/panuveitis may have those, along with decreased vision and floaters.

Says Karacal, “Anterior uveitis is often idiopathic. But it may also be caused by a systemic disease associated with autoimmune conditions such as ankylosing spondylitis, ulcerative colitis, rheumatoid arthritis, or lupus.” Infection with herpes viruses or syphilis can also cause inflammation. Anterior uveitis can be treated locally with eye drops, and only rarely requires injections around the eye or systemic treatment.

Intermediate, posterior, or panuveitis may also be idiopathic or associated with infectious diseases or autoimmune disease. Even large cell lymphoma of the central nervous system may cause posterior uveitis, so especially in the elderly this is very important to rule out. Patients with these types of uveitis have more risk to their vision than with anterior uveitis. Usually posterior uveitis requires systemic therapy in addition to topical or injections around or in the eye, as drops do not adequately penetrate the posterior segment. In 2005, the United States Food and Drug Administration approved a surgically implanted device that delivers steroids into the eye continuously for about 2.5 years. Some eligible patients may benefit from this intraocular steroid implant.

With most types of uveitis, blood vessels in the eye become inflamed and dilated, giving a red look to the sclera, the white part of the eye. Says Karacal, “It is hard to recognize it for what it is. If it’s not responsive to topical treatment or keeps coming back, that should trigger thinking about uveitis and further investigation.” With such stubborn cases, she says it’s important to do a detailed work-up. Family history should be questioned for autoimmune diseases. Sometimes eye problems may be the initial symptom of such systemic disease. She may also sample eye cells through vitreous biopsy to rule out causative bacteria, viruses, or malignancy.

Karacal says these uveitis patients should be treated by experienced ophthalmologists who can collaborate with other physicians. “Some treatments can damage the eye if not monitored closely, or have systemic side effects. For example, we can treat the eye with steroid drops to decrease the inflammation, but if the uveitis is due to infection, steroids, which weakens the immune response, can make it worse. On the other side, steroids have potential side effects on the eye like glaucoma and cataract. We also use non-steroidal anti-inflammatory medications, such as ibuprofen, some chemotherapy drugs, and lately the new biologics, which are helpful in previously hard to manage intraocular inflammations.”

The optimal therapy should begin as quickly as possible to prevent vision loss. Karacal cautions that persistent redness of the eye, especially with other symptoms and recurrence despite treatment, should be evaluated by professionals experienced in uveitis and ocular inflammation. She says each patient has a different disease course, but with timely and appropriate treatment, most patients do well and keep their sight.
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Copyright 2010 Washington University School of Medicine
Copyright 2010 Washington University School of Medicine