Uveitis - Treating Chronic Eye Inflammation
Uveitis – Statistics are alarming
Uveitis is a common but serious eye problem that affects over 300,000 patients in the United States, with European prevalence estimated at about 200,000. Experts estimate that uveitis causes 10% of new cases of blindness in the United States each year. Therefore, uveitis is the fourth leading cause of blindness among the working age population in the Western world. If left untreated, uveitis can cause irreversible sight loss in just three years.
What is Uveitis?
By simple definition, uveitis is an eye disease that often results in chronic (long-term) inflammation of several parts of your eye.
Patients may suffer single acute (sudden and severe) episodes of uveitis but the resulting the inflammation may be chronic, lasting three or more months, or they may also suffer recurrent (repetitive) episodes of inflammation.
Who is at risk?
While uveitis can occur in any race, gender and age, it is particularly prevalent in younger people. The mean age of uveitis patients is 39. Similarly, those who already have some preexisting chronic autoimmune conditions such as AIDS, psoriasis or rheumatoid arthritis are also at increased risk of developing uveitis.
What causes uveitis?
Uveitis is an autoimmune disease involving the eye i.e. it occurs when, somehow, your own immune system begins to work against your own body. In about 50% cases, uveitis is often associated with other autoimmune diseases, such as psoriasis or rheumatoid arthritis, and often precedes these. Uveitis can also result from infection or injury to the eye but in up to 50% of patients, the cause of uveitis is unknown.
What are the types of uveitis?
Based on where it occurs, uveitis can be of 4 types:
Anterior Uveitis: Occurs in the front of the eye, mainly in the area around the iris. This is the most common and easiest to treat type.
Intermediate Uveitis: Occurs around the front end of the retina, and the vitreous (a clear gel like substance that fills the inside of the eyeball between the lens and the retina).
Posterior Uveitis: Occurs in the rear portion of the eye including the retina and optic nerve. It is also sometimes called as choroiditis, retinitis or vasculitis.
Pan-Uveitis: Occurs when the at least two of the above types are developed simultaneously.
What are the symptoms of uveitis?
Symptoms of uveitis include:
- Redness of the eye
- Light sensitivity
- Pain in the eye
- Blurred vision
- Floaters (particles in the eye that cause cloudiness and the sensation of flickering objects whenever and wherever you move your eyes)
- In some cases, tearing, lid puffiness, and some drooping of the eyelid may also be present.
How is uveitis diagnosed?
All patients with Uveitis should provide their doctor with a thorough medical history which is the cornerstone of the diagnosis along with a detailed physical exam of your eye. The eye doctor may then opt to obtain laboratory tests and/or x-rays.
How is uveitis treated?
The main objective of any uveitis treatment is to rid the eye of any inflammation which is the main culprit.
Steroids: These are the only drugs that are currently approved by the Food and Drug Administration (FDA) in the United States for the treatment of uveitis. Steroids are available to uveitis patients in the form of eye drops, pills, implants, and injection.
If inflammation occurs in the front of the eye (as in case of anterior uveitis), eye drops are sufficient to treat the disease in most patients. However, if inflammation occurs in the back of the eye (as in posterior uveitis), patients require injections or pills for therapeutic levels of medication to reach the disease location. The therapy is typically specific, individualized and requires regular monitoring.
However, you must remember that like many other medications, long-term use of local steroids (eye drops, implant, and injection) can also cause side effects and the eye itself is at risk of serious undesirable effects such as glaucoma (increased pressure in the eye, one of the top reasons for blindness in the United States) and cataracts (clouding of the lens in the age, commonly associated with aging). Other general side effects include bone loss and increase in cardiovascular risks (high blood pressure, high blood cholesterol, diabetes, and weight gain).
Finally, even after successful treatment, some forms of uveitis have a tendency to recur. Prompt initiation of treatment at the time of recurrence may shorten the duration of the attack or improve the prognosis, but treatment should always be guided by a physician who should confirm the patient’s suspected diagnosis at the earliest possible time. Most importantly, as the loss of vision is correlated with the severity, frequency and duration of inflammatory episodes, early detection and continued control of the disease are crucial.
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