Uveitis

Definition
Uveitis is inflammation of the uveal tract of the eye, which includes the iris, ciliary body, and choroid. It can be acute or chronic and may threaten vision if not promptly treated.

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Classification (by anatomical location)

1. Anterior uveitis – affects iris and anterior part of ciliary body (iritis, iridocyclitis)

2. Intermediate uveitis – affects vitreous, peripheral retina, and pars plana (pars planitis)

3. Posterior uveitis – affects choroid and retina (choroiditis, retinochoroiditis)

4. Panuveitis – inflammation of all parts of the uveal tract

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Causes

A. Non-infectious (often autoimmune)

• HLA-B27–associated conditions (ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease)

• Sarcoidosis

• Behçet’s disease

• Vogt–Koyanagi–Harada (VKH) syndrome

B. Infectious

• Viral: herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV)

• Bacterial: syphilis, tuberculosis, Lyme disease, leptospirosis

• Parasitic: toxoplasmosis (common cause of posterior uveitis)

• Fungal: candidiasis

C. Other

• Post-surgical or post-traumatic inflammation

• Idiopathic (no identifiable cause)

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Risk Factors

• Autoimmune diseases

• Recent ocular trauma or surgery

• Immunosuppression

• Certain genetic markers (e.g., HLA-B27 positivity)

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Clinical Features

Anterior uveitis

• Eye pain and redness (especially circumcorneal/limbal flush)

• Photophobia

• Blurred vision

• Excessive tearing

• Small or irregular pupil due to posterior synechiae

Intermediate uveitis

• Floaters

• Blurred vision

• Usually painless

Posterior uveitis

• Painless blurred vision

• Floaters

• Scotomas (visual field defects)

Panuveitis

• Combination of anterior and posterior segment symptoms

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Complications

• Posterior synechiae (iris adhesion to lens)

• Cataract

• Glaucoma

• Cystoid macular oedema

• Retinal detachment

• Permanent vision loss if untreated

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Diagnosis

• Ophthalmic examination: slit-lamp exam (cells and flare in anterior chamber), fundoscopy (retinal/choroidal lesions)

• Intraocular pressure measurement

• Laboratory work-up (based on suspicion): ESR, CRP, ANA, HLA-B27, syphilis serology, TB screening, ACE levels (sarcoidosis), toxoplasma serology

• Imaging: Optical coherence tomography (OCT) for macular oedema, fluorescein angiography for retinal vasculitis

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Treatment

General principles:

• Prompt referral to an ophthalmologist

• Treat underlying cause where identified

• Reduce inflammation, relieve pain, and prevent complications

Anterior uveitis

• Topical corticosteroids (e.g., prednisolone acetate 1%) – reduce inflammation

• Cycloplegic agents (e.g., cyclopentolate, homatropine) – relieve ciliary spasm pain and prevent synechiae

• If severe or resistant: periocular or systemic corticosteroids

Intermediate / Posterior / Panuveitis

• Systemic corticosteroids (oral prednisone)

• Immunosuppressive agents (methotrexate, azathioprine, mycophenolate mofetil) for chronic/recurrent non-infectious cases

• Biologic agents (adalimumab, infliximab) in selected autoimmune cases

• Antimicrobial therapy for infectious uveitis (e.g., antibiotics for syphilis, antitubercular drugs for TB, antiparasitic for toxoplasmosis)

Adjunctive

• Treat elevated intraocular pressure if present

• Monitor for cataract and macular oedema

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Prognosis

• Early diagnosis and treatment usually preserve vision

• Chronic or recurrent cases require long-term monitoring

• Poor prognosis if associated with severe systemic disease or delayed treatment