Iritis; Uveitis; Choroiditis; Chorioretinitis; Anterior uveitis; Posterior uveitis
Uveitis is an inflammation of the the uvea, the layer between the sclera and the retina, which includes the iris, ciliary body, and the choroid.
Causes, incidence, and risk factors
Uveitis is an inflammation inside the eye, affecting the uvea. The uvea provides most of the blood supply to the retina. Causes of uveitis can include autoimmune disorders, infection, or exposure to toxins. However in many cases, the cause remains unknown.
The most common form of uveitis is anterior uveitis, which involves inflammation in the front part of the eye, which is usually isolated to the iris. This condition is often called iritis. The inflammation may be associated with autoimmune diseases such as rheumatoid arthritis or ankylosing spondylitis, but most cases occur in healthy people and do not indicate an underlying disease. The disorder may affect only one eye and is most common in young and middle-aged people. A history of an autoimmune disease is a risk factor.
Pars planitis is inflammation of the pars plana, a narrow area between the iris and the choroid. Pars planitis usually occurs in young men and is generally not associated with any other disease. (There have been a few case reports of an association with Crohn’s disease and some experts suggest a possible association with multiple sclerosis. For this reason, these experts recommend that those over 25 years old diagnosed with pars planitis receive an MRI of their brain and spine.)
Posterior uveitis affects the back portion of the uveal tract and involves primarily the choroid. This is called choroiditis. If the adjacent retina is also involved it is called chorioretinitis. Posterior uveitis may follow a systemic infection or occur in association with an autoimmune disease.
The inflammation causes spotty areas of scarring on the choroid and retina that correspond to areas with vision loss. The degree of vision loss depends on the amount and location of scarring. If the central part of the retina, called the macula is involved, central vision becomes impaired.
Uveitis, affecting one or both eyes, can be associated with any of the following:
- CMV retinitis or other cytomegalovirus infection
- Sympathetic ophthalmia following trauma
- Ulcerative colitis
- Rheumatoid arthritis
- Kawasaki disease
- Herpes zoster infection
- Ankylosing spondylitis
- Behcet’s syndrome
- Reiter’s syndrome
- Redness of the eye
- Blurred vision
- Sensitivity to light
- Dark, floating spots in the vision
- Eye pain
Note: Symptoms may develop rapidly.
Signs and tests
A complete medical history and eye examination should be performed. If there is suspicion of an associated systemic disease, a physical examination and laboratory tests may be needed to look for underlying causes.
Iritis is usually mild. Pain caused by spasm of the pupil constriction muscle is relieved by drops to dilate the pupil. Dark glasses may be helpful. Steroid eye drops or ointment may be needed. More severe cases require a search for an underlying cause.
Pars planitis is often treated with steroid eye drops, but may be treated with oral steroids or another type of medication to suppress the immune system.
Choroiditis requires determination of the underlying cause, and treatment of the underlying disease. The underlying disease may be serious, and additional specialists in infectious disease or autoimmunity may be needed for such diseases as syphilis, tuberculosis, AIDS, sarcoidosis, or Behcet’s syndrome.
For systemic infectious diseases, corticosteroids are often used along with antibiotic therapy. For autoimmune diseases, various forms of suppression of the immune system may be required.
In anterior uveitis, most attacks last from a few days to weeks with treatment, but relapses are common. In posterior uveitis, the inflammation may last from months to years and may cause permanent vision damage, even with treatment.
- Fluid within the retina (cystoid macular edema)
- Retinal detachment
- Vision loss
Calling your health care provider
Call for an appointment with your health care provider if you have symptoms of uveitis. If eye pain or reduced vision are present, this condition is more urgent that if symptoms are very mild.
Treating any underlying disorders may help to prevent uveitis for some people with existing systemic diseases.
by Simon D. Mitin, M.D.
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.