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uveitis

 
Medical Encyclopedia: Uveitis
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Definition

Uveitis is an inflammation of the uveal tract, which lines the inside of the eye behind the cornea. Much of the uvea lies between the retina and tough, outer sclera. The uveal tract has three parts: the iris, the ciliary body, and the choroid. Uveitis is categorized according to the part of the uveal tract that is affected. Anterior uveitis is an inflammation of the front part of the uveal tract; it includes inflammation of the iris (iritis) and inflammation of the iris and the ciliary body (iridocyclitis). Posterior uveitis is an inflammation of the part of the uveal tract behind the lens of the eye. It includes inflammation of the choroid (choroiditis) and inflammation of the choroid and retina (chorioretinitis). Uveitis that affects the entire uveal tract is called panuveitis or diffuse uveitis.

Description

The uveal tract is made up of the iris, ciliary body, and choroid. The iris is the colored part of the eye. The ciliary body is inside the eye and produces a fluid called aqueous humor. Ciliary muscles aid in accommodation, the process of changing the shape of the lens in the eye to see things at various distances. The choroid lines the back of the eye and has many blood vessels. It helps nourish part of the retina. The choroid lies between the retina and outermost sclera.

Uveitis may either persist for a long time (chronic) or have a short-term duration (acute). Anterior uveitis is classified as either granulomatous or nongranulomatous. The distinction is based on the disease agents that were considered responsible for the condition. At one time, it was thought that granulomatous uveitis was caused by tuberculosis bacilli whereas nongranulomatous uveitis was thought to be caused by streptococci. The distinction is still used even though the causes of uveitis are now understood differently.

In most cases, uveitis affects only one eye, although posterior uveitis sometimes involves both eyes. About 60% of cases develop within the eye itself, but 40% are associated with systemic diseases or disorders ranging from toxoplasmosis to syphilis. Many of these are diseases of childhood and adolescence. Uveitis does not appear to run in families or to be associated with lifestyle choices, occupational history, geographical location, or environmental factors.

Uveitis is a serious condition that may develop rapidly and cause lasting damage to the eye. Patients who think they may have chronic uveitis should seek evaluation and treatment by an ophthalmologist (a physician who specializes in diseases of the eye) as soon as possible. If the patient has a sudden loss of vision and the eye looks inflamed, the patient should go immediately to the doctor for emergency treatment.

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Dictionary: u·ve·i·tis   (yū'vē-ī'tĭs) pronunciation
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n.
Inflammation of the uvea.

[UVE(A) + -ITIS.]


Britannica Concise Encyclopedia: uveitis
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Inflammation of the uvea, the middle coat of the eyeball. Anterior uveitis, involving the iris or ciliary body (containing the muscle that adjusts the lens) or both, can lead to glaucoma and blindness. Posterior uveitis, involving the choroid (which contains the eye's blood supply), can cause bleeding, lens clouding, and eyeball atrophy. Granulomatous uveitis (persistent inflammation with a grainy surface) causes vision impairment, pain, watery eyes, and sensitivity to light; nongranulomatous uveitis causes less pain and sensitivity, with a better chance of recovery. Causes include generalized infections and other diseases, allergic reactions, and injury. Rarely, the uninjured eye also has symptoms, with a risk of blindness in both eyes. Treatment aims to eliminate infection, reduce inflammation, and preserve vision.

For more information on uveitis, visit Britannica.com.

Dental Dictionary: uveitis
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n

Inflammation of the uveal tract: the iris, ciliary body, and choroid of the eye.

Veterinary Dictionary: uveitis
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Inflammation of the uvea.

  • anterior u. — inflammation of the anterior uveal tract, i.e. iridocyclitis. Signs include pain, blepharospasm, tearing, conjunctivitis, constricted pupil, reduced intraocular pressure, aqueous flare, and sometimes keratic precipitates and hypopyon.
  • endogenous u. — arising from causes within the body.
  • equine recurrent u. — see periodic ophthalmia.
  • exogenous u. — arising from causes external to the body.
  • granulomatous u. — associated with toxoplasmosis and systemic mycotic infections such as cryptococcosis, blastomycosis, coccidioidomycosis and candidiasis.
  • heterochromic u. — see heterochromic iridocyclitis.
  • lens-induced u. — caused by escape of lens protein into the aqueous, initiating an immune response.
  • phacolytic u. — associated with resorption of hypermature cataracts in which there is rupture of the lens capsule and release of lens proteins.
  • phacoclastic u. — caused by disruption of the anterior lens capsule and leakage of lens proteins.
  • posterior u. — inflammation of the ciliary body and choroid.
  • recurrent equine u. — see periodic ophthalmia.
  • sympathetic u. — see sympathetic ophthalmia.
Wikipedia: Uveitis
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Uveitis
Classification and external resources

Hypopyon in anterior uveitis, seen as yellowish exudate in lower part of anterior chamber of eye
ICD-10 H20.
ICD-9 364
DiseasesDB 13676
eMedicine oph/580 emerg/284
MeSH D014605

Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye.

Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States.[1] Uveitis requires an urgent referral and thorough examination by an ophthalmologist or optometrist along with urgent treatment to control the inflammation.

Contents

Anatomical Classification

Uveitis may be classified anatomically into anterior, intermediate, posterior and panuveitic forms, based on which part of the eye is primarily affected by the inflammation.

  • Anywhere from two-thirds to 90% of uveitis cases are anterior in location (anterior uveitis), frequently termed iritis - or inflammation of the iris and anterior chamber. This condition can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature. Symptoms include red eye, injected conjunctiva, pain and decreased vision. Signs include dilated ciliary vessels, presence of cells and flare in the anterior chamber, and keratic precipitates ("KP") on the posterior surface of the cornea.
  • Intermediate uveitis (pars planitis) consists of vitritis - inflammatory cells in the vitreous cavity, sometimes with snowbanking, or deposition of inflammatory material on the pars plana.
  • Posterior uveitis is the inflammation of the retina and choroid.
  • Pan-uveitis is the inflammation of all the layers of the uvea.

In 2004, a group of international uveitis specialists convened in Baltimore, MD, to standardize the method of reporting data in uveitis clinical trials, including anatomical classification. The results of this meeting were published in the American Journal of Ophthalmology in 2005.[2]

Conditions associated with uveitis and uveitis syndromes

Myriad conditions can be associated with uveitis, including diseases with major extra-ocular involvement, as well as syndromes confined to the eye. In anterior uveitis, no associated condition or syndrome is found in approximately one-half of cases. However, anterior uveitis is often one of the syndromes associated with HLA-B27. Presence this type of HLA allele has a relative risk of evolving this disease by approximately 15%.[3]

Systemic disorders associated with uveitis

Systemic disorders that can be associated with uveitis include: [4]

Infectious causes

Uveitis may be a (normal) immune response to fight an infection inside the eye. While representing the minority of patients with uveitis, such possible infections include:

Uveitis Syndromes

In many cases, uveitis is not associated with a systemic (i.e. extraocular) condition: the inflammation is confined to the eye. In some of these cases, the presentation in the eye is characteristic of a described syndrome, and include the following diagnoses:

  • Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)
  • Birdshot retinochoroidopathy
  • Fuchs Heterochromic Iridocyclitis
  • Multifocal Choroiditis and Panuveitis Syndrome
  • Multiple Evanescent White Dot Syndrome (MWEDS)
  • Punctate Inner Choroidopathy (PIC)
  • Serpiginous Choroiditis

Masquerade syndromes

Masquerade syndromes are ophthalmic disorders that clinically present as either an anterior or posterior uveitis, but are not primarily inflammatory. The following are some of the most common:

  • Anterior segment
  • Posterior segment

Symptoms

  • Redness of the eye
  • Blurred vision
  • Sensitivity to light (photophobia)
  • Dark, floating spots along the visual field
  • Eye pain

Treatment

The prognosis is generally good for those who receive prompt diagnosis and treatment, but serious complication (including cataracts, glaucoma, band keratopathy, retinal edema and permanent vision loss) may result if left untreated. The type of uveitis, as well as its severity, duration, and responsiveness to treatment or any associated illnesses, all factor in to the outlook.[1]

Uveitis is typically treated with glucocorticoid steroids, either as topical eye drops (prednisolone acetate) or oral therapy with corticosteroids. But before giving corticosteroids, rule out corneal ulcers by Florescence Dye test. In addition to corticosteroids, topical cycloplegics, such as atropine or homatropine, may be used. In some cases an injection of PSTTA can also be given to reduce the swelling of the eye. [6]

Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatment with Infliximab or other anti-TNFs' infusions may prove helpful.

See also

Footnotes

  1. ^ Sergio Schwartzman. Inflammatory eye disease: an expert interview with Sergio Schwartzman,MD Medscape Rheumatology 2007.
  2. ^ Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005;140:509-516.
  3. ^ Table 5-7 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7.  8th edition.
  4. ^ White G. "Uveitis." AllAboutVision.com. Retrieved August 20, 2006.
  5. ^ McGonagle D, McDermott MF (2006) A proposed classifi cation of the immunological diseases. PLoS Med 3(8): e297. DOI: 10.1371/journal. pmed.0030297
  6. ^ BNF 45 March 2003

External links

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Inflammation
Acute
Chronic
Processes
Specific types

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Medical Encyclopedia. © 2006 through a partnership of Answers Corporation. All rights reserved.  Read more
Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.  Read more
Britannica Concise Encyclopedia. Britannica Concise Encyclopedia. © 2006 Encyclopædia Britannica, Inc. All rights reserved.  Read more
Dental Dictionary. Mosby's Dental Dictionary. Copyright © 2004 by Elsevier, Inc. All rights reserved.  Read more
Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved.  Read more
Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Uveitis".  Read more