Uveitis is an eye disease with multiple causes that are often difficult to pin down. It potentially threatens vision, and it certainly leads to a significant deterioration of visual acuity. Uveitis is difficult to treat and often leads to relapses and even complications such as glaucoma, cataracts, retinal detachment, and macular edema.

Uveitisis a serious eye disease that can even lead to permanent loss of vision. As soon as you notice pain in the eye or eyes, or congestion, or visual acuity disorders, do not delay the visit to an ophthalmologist - but be aware that you may also need an ENT, dentist, rheumatologist or even a gynecologist's consultation.

- Uveitis is the third cause of blindness in developed countries, says Dr. n. med. Agnieszka Kubicka-Trząska from the Department of Ophthalmology and Ophthalmic Oncology, Chair of Ophthalmology, Jagiellonian University Medical College in Krakow. - The incidence varies from 52 to 93 cases per 100,000 people per year. Unfortunately, this disease is diagnosed too late in Poland, which is associated with a delay in starting treatment - emphasizes the expert. - Uveitis is a serious medical and socioeconomic problem, as the peak incidence occurs at the productive age, between 20 and 40 years of age. The organ of sight is the most important human sense. Thanks to our eyes, we receive as much as 80% of information from the outside world. For patients with uveitis, this means exclusion from life - alerts Dr. n. med. Agnieszka Kubicka-Trząska.

Uveitis - what is the uve?

The uveal membrane is the middle layer of the eyeball wall that sits between the sclera and the retina. It consists of:

Uveitis can be mistaken for relatively harmless conjunctivitis and try to heal on your own. This is very dangerous!

  • iris (eye color), in the center of which the pupil is located - the diameter of the pupil changes depending on the amount of light and also under the influence of fear. The stroma of the iris plays a role in inflammatory processes.
  • ciliary body - is responsible for clear vision near and far, the production of aqueous humor, i.e. a substance filling the anterior chamber of the eye, and its outflow. The aqueous humor is responsible for the tension in the eyeball, it also takes part in nourishing the lens and cornea. Damage to the ciliary body can even lead to eyeball atrophy.
  • the choroid that lines the sclera from the inside. The role of the uveal membrane is to supply oxygen and nourish the retina.

Symptoms of uveitis

  • strong reddening of the eyeball
  • severe pain in the eye and surrounding area
  • photophobia
  • tearing
  • disturbed visual acuity
  • floaters

Causes of uveitis

Uveitis (ZBNO) is a condition of unclear origin. They are divided into infectious and non-infectious inflammations, i.e. autoimmune uveitis. The latter account for 70-90% of all uveitis in developed countries .¹

Factors that can cause disease, can also be generalized diseases:

  • rheumatoid arthritis
  • diabetes
  • sarcoidosis
  • bacterial diseases, such as tuberculosis, syphilis
  • infection near the eyes, e.g. sinusitis, dental disease
  • zoonoses, parasitic diseases - e.g. toxoplasmosis, toxocarosis, cryptococcosis
  • Crohn's disease
  • ulcerative colitis
  • psoriasis
  • shingles
  • Lyme disease
  • urazy
  • chemical damage
  • juvenile arthritis

Factors that increase the risk of developing uveitis:

  • foreign travels - due to contact with foreign microflora
  • eating raw meat (toxoplasmosis)
  • contact with animals
  • drugs - injected into a vein increase the risk of HIV infection, which in turn can lead to immune-compromised fungal uveitis
  • irresponsible sex life - syphilis or HIV can make you sick
Important

Juvenile idiopathic arthritis (IMZS) develops in children under 16 years of age. An ophthalmological examination reveals anterior uveitis, the course of which can vary from mild to very severe. It is very important to repeat the ophthalmological examination every 7 years after the appearance of joint symptoms, because in this disease the onset of anterior segment inflammationuveitis is always asymptomatic.

Uveitis - variants of the disease

Because the uvea has three main parts, a disease can attack any or all of them individually. And yes, we distinguish:

In diseases such as arthritis, tendonitis, and in the course of various diseases of the spine, uveitis sometimes also occurs. Uveitis is also often accompanied by unexplainable - so far - pain in the metatarsus or Achilles tendon.

  • anterior uveitis , or iris and parts of the ciliary body - is characterized by most of the symptoms listed above and may also be associated with macular edema.
  • mid-uveitis , i.e. the flat part of the ciliary body - usually only one eye is affected, and the main symptoms of this form of the disease are floaters, decreased visual acuity, but also swelling of the macula and optic nerve
  • inflammation of the posterior part of the uvea , i.e. the choroid and the retina - it can be acute (then it lasts about 6 weeks) or chronic (it lasts for months or even years). The main symptoms are also floaters and sharpness disturbances, but also defects in the visual field
  • inflammation of all uveal structures

Uveitis - diagnosis

A slit-lamp examination allows you to diagnose and begin treatment of uveitis in time, even before the development of changes that permanently deteriorate visual acuity develops.

However, the number of diagnoses of the disease is low. The multidirectional analyzes emphasize that one of the reasons for the low number of diagnoses of this disease may be the age of the patients. Over 80% of ill ophthalmic institutions are people aged 50-80, who lose their eyesight or blind as a result of eye diseases, or those whose eyesight dysfunction is related to the patient's age

Uveitis - treatment

Treatment of PBN is a major challenge due to the long diagnostic and therapeutic process. However, currently available methods of treatment allow most patients to inhibit the disease, and even to reverse its effects, provided that treatment is started early and the patient's condition is monitored regularly .²

Treatment for uveitis depends on the severity of the disease, its course, type, and whether it is associated with another underlying disease. It may happen that it will be conducted by severaldifferent specialists at the same time - e.g. by an ophthalmologist and a nephrologist, but if the cause of inflammation is a different disease, ophthalmic treatment will only be conservative.

Untreated uveitis can lead to complications such as cataracts, cystic macular edema, glaucoma, and retinal detachment, which can cause irreversible loss of vision.

In uveitis, ointments and eye drops with cortisone or additionally with an anti-inflammatory drug are often given. Antibiotic therapy is used in bacterial infections, and antiviral drugs are used for viral infections. If cataracts lead to uveitis, only surgery may be the treatment.

One of the complications that can arise from uveitis is adhesions between the iris and the lens, leading to blindness. To prevent them, eye drops are used to dilate the pupils, and in more severe inflammations of the iris, cortisone injections under the conjunctiva or cortisone tablets. Only high doses of this drug can stop progressive loss of vision.

According to an expertdr hab. n. med. Agnieszka Kubicka-Trząska, Department of Ophthalmology and Ophthalmic Oncology, Department of Ophthalmology, Jagiellonian University Medical College

The level of ophthalmic services in Poland is very good, comparable to European standards, while the main problem of our patients is the availability of these services, which is associated with a long waiting period for an appointment with a specialist. Treatment of uveitis according to world guidelines should start as soon as the first symptoms of the disease appear. The lack of treatment or its delay in patients with uveitis leads to irreversible deterioration or even loss of vision as a result of ongoing inflammation as well as serious local complications developing in its course. It should also be emphasized that steroid therapy, considered the first-line therapy in the treatment of CBN, also has a number of side effects. Recently, in many areas of medicine, the need to introduce the so-called individualization of treatment. The use of therapy tailored to the patient's needs, including biological treatment, allows to reduce the dose and duration of steroid treatment, while minimizing the risk of developing side effects and contributing to control of inflammation.

Source:

1. Agnieszka Kubicka-Trząska, Autoimmune uveitis in: Ophthalmology after graduation, 2/2016

2. Report of the Polish Association of the Blind, Uveitis (inflammation, membranesvascular eye, ZBNO) from the patient's perspective, Warsaw 2022

Category:

Eye diseases and vision disorders