Intraocular Inflammations
What is Uveitis?
The eye globe is surrounded by a casing made up of three layers, with a gel-like substance in the center. The middle layer is called the "uvea." Inflammation of the uvea is referred to as "uveitis." Uveitis can affect all or one of the layers of the eye known as the uvea, which includes the iris, choroid, and ciliary body.
Uvea is now recognized as a separate area of specialization in ophthalmology. The diagnosis and treatment of diseases related to the uvea are increasingly supported by advancements in immunology and genetics.
The key factors that enhance treatment success include early diagnosis, regular follow-up, a cooperative patient-physician relationship, and appropriate treatment. When these conditions are met, a damaged eye can often be saved.
Even after treatment is completed, patients should be monitored at least every three months. Since the disease can silently recur, there should be no breaks in check-ups. Additionally, it is essential to inform the ophthalmologist about any different symptoms related to other organs, such as mouth ulcers, skin lesions, and rheumatic symptoms.
Uveitis is a highly complex disease and can exhibit different courses in each patient. Treatment is also individualized based on the disease’s progression. The dosage of the medication to be administered must be determined by physicians specialized and experienced in uvea conditions.
Causes of Uveitis
In 30 to 40% of uveitis patients, the exact cause of the disease cannot be identified. Uveitis can occur due to factors like viruses, fungi, and parasites, or it may present as a symptom of an underlying disease in the body. Therefore, various tests are required to investigate diseases. Uveitis can also occur alongside systemic diseases that we define as collagen tissue and autoimmune-related. Examples of these include Behçet’s disease, ankylosing spondylitis, and rheumatoid arthritis.
Disorders that can lead to uveitis include:
- Behçet’s disease
- Infections (bacteria, viruses, parasites, or fungi) that can spread to the eye from other areas, such as tuberculosis, syphilis, herpes, toxoplasmosis, etc.
- Eye trauma and surgeries
- Autoimmune reactions (immune system diseases), rheumatic diseases, ulcerative colitis, sarcoidosis.
Symptoms of Uveitis
When uveitis occurs in the anterior section of the eye, it can present symptoms during severe episodes, such as redness in the eye, blurry vision, pain around the eye, sensitivity to light, and floaters. If uveitis is intense in the posterior section of the eye, the symptoms are mostly in the form of blurry vision. If the uveitis affects the macula (the central area of vision), it can lead to sudden vision loss and permanent visual impairment due to tissue damage. The primary symptoms of uveitis occurring outside the central region include:
- Eye redness
- Eye watering
- Sensitivity to light and glare
- Spotty and blurry vision or severe vision loss
- Sudden flashes of light
- Pain in the eyeball
Types of Uveitis:
- Anterior uveitis
- Intermediate uveitis
- Posterior uveitis
How is Uveitis Diagnosed?
Regardless of its severity, uveitis is an urgent condition. Delaying treatment can lead to the disease progressing and causing permanent side effects, such as deformities in the pupil, cataracts, and increased intraocular pressure. The first step when symptoms begin is to consult an ophthalmologist experienced in uveitis. Delaying the initial examination can result in permanent vision loss.
Some types of uveitis have typical appearances, allowing for immediate diagnosis. Even in these cases, if the posterior section of the eye is affected, advanced techniques like angiography, ultrasonography, and ERG may be necessary to understand the extent of the threat to vision and to monitor the effectiveness of treatment. For example, angiographies performed with a dye called ICG (indocyanine green) can provide direct diagnostic information about the disease in suspicious cases. Further joint investigations can be carried out with specialists in rheumatology, pulmonary diseases, dermatology, and neurology.
Behçet’s disease manifests as recurrent ulcers in the mouth and genital region and can cause uveitis. However, Behçet’s disease is a chronic inflammatory disorder that can affect nearly all systems in the body, leading to involvement of joints, large and small blood vessels, respiratory, central nervous system, and digestive organs. The signs and symptoms of the disease are observed as flare-ups in the affected organs, and although some symptoms may persist for a long time, there are periods when lesions are not observed, and the person does not complain, varying from individual to individual.