Uveitis

What is uveitis?

Uveitis is an eye disease in which the vascular membrane is inflamed. This middle eye membrane is located between the retina and the sclera in the eye. The uvea is made up of three parts:

• iris (iris)
• Ciliary or ray body (corpus ciliare)
• Choroid (choroid)

Each of the different sections of the uvea can be inflamed. Doctors therefore differentiate between anterior, middle and posterior uveitis. If all sections are affected, this is referred to as panuveitis.

• Anterior uveitis (anterior uveitis) – the most common form: The iris (iris) is inflamed. The disease is therefore also called iritis. If the ciliary body is affected by the inflammation, doctors refer to it as cyclitis. Because the iris and ciliary body are anatomically close to each other, both structures can be inflamed (iridocyclitis).
• Intermediate uveitis (uveitis intermedia, intermediate uveitis): The inflammation affects the middle area of the uvea. The inflammatory cells are mainly located in the vitreous body. Doctors speak of vitritis.
• Posterior uveitis (posterior uveitis or postereorectal uveitis): The areas of the posterior vitreous body are inflamed. In chorioditis, the inflammation mainly affects the choroid; in chorioretinitis, the choroid and parts of the retina are inflamed.
• Panuveitis: Inflammation of the anterior, middle and posterior segments of the eye together.

Ophthalmologists treat uveitis by alleviating the symptoms and reducing the inflammation in the eye. Sometimes the eye inflammation is also associated with another underlying disease or an infection – then doctors treat this, often in collaboration with other specialists from rheumatology and other disciplines. Without treatment, uveitis can progress and, in the worst case, lead to blindness.

Uveitis – frequency and age

Uveitis is a very common inflammatory eye disease and a major cause of severe visual impairment or blindness. Ophthalmologists estimate that between 17 and 52 out of 100,000 people are newly diagnosed with the disease every year. In the western world, around ten percent of visual impairments are caused by uveitis. And up to 35 percent of patients with uveitis experience a significant reduction in their vision or even go blind.
Uveitis usually affects both sexes equally. Anterior uveitis is most common in the western world. It is also the most common form in adults. In principle, uveitis can occur at any age. However, it often affects people between the ages of 20 and 60. Uveitis is relatively rare in adolescents under the age of 16 and children. It often accompanies juvenile idiopathic arthritis.

Uveitis: causes often remain unknown

Uveitis can have various causes. In over 50 percent of cases, however, doctors are unable to identify a trigger for the eye inflammation.
In addition to the anatomical classification mentioned above, the distinction between infectious and non-infectious uveitis is of the utmost importance for the correct treatment.

• Infectious uveitis – pathogens are at work here, such as bacteria, viruses, fungi or parasites. They can, for example, penetrate as part of an eye injury and cause inflammation. Infectious diseases such as toxoplasmosis, syphilis, tuberculosis, herpes, Lyme disease or HIV/Aids can also be associated with uveitis.
• Non-infectious uveitis: Certain underlying diseases can play a role. These include inflammatory diseases that can also affect other organs or parts of the body, such as juvenile idiopathic arthritis, ankylosing spondylitis, Behçet’s syndrome, sarcoidosis, chronic inflammatory bowel disease and others. If no cause or concomitant disease is found, it is referred to as idiopathic uveitis.

Symptoms: Uveitis can start acutely or gradually

Uveitis can be recognized by various symptoms. They can affect one or both eyes. The most important signs are

• reddened eyes
• Pain
• Increased sensitivity to light, increased sensation of glare
• Reduced vision: blurred and out-of-focus vision – some see as if through a veil
• Flying midges (mouches volantes) – you see “black dots”
• Restrictions of the visual field

The symptoms of uveitis can start suddenly (acute uveitis) and worsen quickly. However, the symptoms can also develop slowly and insidiously – in which case the uveitis often goes unnoticed for a long time (chronic uveitis). Uveitis can also recur in episodes (recurrent uveitis).

Always consult your ophthalmologist if you experience symptoms such as worsening vision or eye pain.

Uveitis: Diagnosis with us

The diagnosis of uveitis always begins with a discussion of the patient’s medical history between doctor and patient (anamnesis). Ophthalmologists can draw initial conclusions about the cause of the symptoms from the information you provide. The following questions are of interest to the doctor:

• What exactly are your symptoms?
• How long have the complaints existed?
• How severe are the symptoms?
• Did the symptoms start quickly or develop gradually?
• Do you suffer from an eye disease?
• Do you have any other symptoms (e.g. breathing or joint problems)?
• Do you have any known underlying illnesses? For example, rheumatic diseases, autoimmune diseases or infectious diseases?
• Are you taking any medications? If yes: Which ones and since when?
• Are you at risk of contracting a sexually transmitted disease?

This is followed by an eye examination. The following methods are used, for example:

• Eye test: Ophthalmologists determine your eyesight and can detect any deterioration.
• Slit lamp: This is a type of microscope with a powerful light source. Doctors can magnify the eye and thus recognize changes and abnormalities in the eye. The slit lamp examination is the most important diagnostic tool for ophthalmologists.
• Ophthalmoscopy (ophthalmoscopy): This allows the back of the eye to be examined. Doctors can detect pathological changes, for example in the retina or choroid, which would otherwise not be visible.
• Intraocular pressure measurement (tonometry)

Uveitis can be associated with other underlying diseases, such as autoimmune diseases, infections or rheumatic diseases. If the ophthalmologist suspects this, further examinations by another specialist will follow. For example, a blood test, urine test and imaging procedures are used. In some cases, a computer tomography or magnetic resonance imaging examination is carried out.

Uveitis: prevention, early detection, prognosis

There are no special measures you can take to prevent uveitis. In general, make sure you have good protection for your eyes, for example if your eyes are in danger at work (safety goggles) and in everyday life (sunglasses with UV protection). There are also no special measures for the early detection of uveitis in the doctor’s office. Therefore, always consult your ophthalmologist if you experience symptoms such as a deterioration in vision or increased sensitivity to light. He or she can find out the cause behind the symptoms.

Course and prognosis of uveitis

Uveitis can be acute, chronic and recurrent (relapsing). In an acute course, the symptoms set in suddenly and worsen rapidly. However, the symptoms do not last longer than three months. In the chronic course of uveitis, many people initially experience hardly any symptoms. It lasts longer than three months, often several years. In recurrent uveitis, sufferers experience symptom-free phases and acute flare-ups with symptoms.

Adequate treatment of uveitis is important for the course and prognosis. If another underlying disease is the cause, doctors must also treat this sufficiently so that the symptoms subside and the uveitis does not develop further.

Without treatment, vision continues to deteriorate – in the worst case, there is a risk of blindness. Untreated uveitis can generally have these consequences:

• Glaucoma – the intraocular pressure is greatly increased
• Cataracts – the lens of the eye becomes increasingly cloudy
• Vitreous opacity
• Damage to the optic nerve
• Retinal detachment
• Fluid retention in the retina (macular edema)
• Loss of vision and blindness

Uveitis: treatment slows down inflammation

The treatment of uveitis is aimed at slowing down the inflammation in the eye and alleviating the symptoms. If the uveitis is associated with an underlying disease, doctors will also treat this sufficiently.