The uvea is the layer between the tough white outer coat of the eye and the retina. It is made-up of the coloured iris at the front with the cilary body in the middle and the choroid at the back of the eye. It’s a very important layer as it serves many functions including supplying the retina with oxygen as well as helping control the pressure of the eye and controlling the amount of light that enters through the pupil. The uvea is very prone to inflammation because it has an excellent blood supply which means that white blood cells from the body are able to enter the eye through this and cause inflammation.
There are many types of uveiits tests but a good way to split the different types includes categorising uveitis as anterior intermediate or posterior uveitis. Anterior uveitis is the most common type and is generally the least serious of the three types. Intermediate uveitis involves the vitreous gel at the centre of the eye and can be a little bit more serious. Posterior uveitis is the least common type but can be the most serious as it involves the retina of the eye and this is a very sensitive tissue.
Uveitis has many causes but broadly speaking it can be grouped as being caused by infections such as viruses, bacteria or parasites or through autoimmune disease where the immune system incorrectly targets the eye. Sometimes autoimmune disease can target the eye alone in which case the uveitis will be called idiopathic. Sometimes the autoimmune disease can target the eye alongside other organs in which case it may have names such as sarcoidosis or HLA B27 disease or rheumatoid arthritis. Uveitis can happen after trauma or surgery.
Anterior uveitis is the most common type of uveitis and typically present with red eye and pain particularly when looking at bright lights. Patients with intermediate uveitis will generally notice floaters as a primary feature. Those with posterior uveitis may have blurred vision. Patients with scleritis will generally have pain in their eye and this typically keeps them up at night.
Most patients with uveitis will need drops particularly steroid drops to help ease inflammation in the eyes. Common drops for this include Maxidex or Pred Forte. Sometimes patients will need to take tablets such as steroid tablets or antibiotics to fight infections. Sometimes patients will also need steroid injections into the eye to help provide long term control of inflammation. And some forms of uveitis patients benefit from taking special medication called biologics and this can be very effective indeed.
In the early stages of disease some patients benefit from having dilating drops to dilate the pupil and reduce the risk of the iris getting stuck down to the lens of the eye. These are rarely used long term as they affect a patient’s ability to drive.
The ophthalmologist will generally have a long term management plan for the patient. If they have chronic uveitis they will need to have long term treatment to prevent relapses of the condition and these treatment modalities may involve drops or tablets or further treatment such as biologics.
Uveitis is a serious condition and if untreated it can cause complications. One common complication is glaucoma due to high pressure of the eye causing damage to the optic nerve thus affecting vision. Another common complication is cataract where the lens of the eye becomes hazy and this can be treated with cataract surgery. A common problem with uveitis is swelling in the retina and this is termed macular edoema. This condition is generally treated with drops or injections or tablets but if left untreated can cause permanent visual loss. To prevent all these complications early treatment and follow up are vital.
Patients with uveitis can lead a perfectly normal life and take treatment alongside their normal daily activities. Many patients will need to take eye drops regularly to control inflammation or pressure in the eye. It is important that patients have a good supply of this medication and that it is placed on a repeat prescription by the GP so that there is no break from treatment. It’s also essential that patients attend their follow up appointments regularly and move these when they are unable to attend.
Having uveitis can naturally cause an emotional and psychological impact on a patient. It is a very good idea for patients to seek out support from societies and charities particularly those involved in supporting patients with eye conditions or with uveitis specifically. Knowing that other patients are living with the condition successfully can be a huge support for patients.
Uveitis is a very common condition and generally patients with the disease can do very well and can lead very full independent lives. When the condition is well managed and well-treated the vision can remain good for a very long period of time. A small minority of patients are unlucky enough to have very severe disease and sometimes this can affect vision. Nevertheless the advances in treatment today mean that we are increasingly able to diagnose disease well and to treat it very effectively.
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