What types of uveitis are there?
The classification is based on which part of the choroid is inflamed. Anterior uveitis - iritis and iridocyclitis - occurs most often and gives vivid symptoms: pain, photophobia, redness. Middle uveitis manifests itself predominantly as floating opacities, posterior uveitis affects the choroid and retina and primarily reduces vision, panuveitis affects all parts. According to the course, uveitis can be acute, chronic and recurrent. Both examination and treatment depend on the form, so self-diagnosis is impossible here.
- Anterior uveitis - iritis, iridocyclitis
- Intermediate uveitis - inflammation of the vitreous body
- Posterior uveitis - chorioretinitis
- Panuveitis - damage to all departments
- Acute, chronic and recurrent course
Causes and connections with common diseases
In approximately half of cases, uveitis is associated with systemic diseases. A classic example is acute anterior uveitis in carriers of the HLA-B27 antigen, often associated with ankylosing spondylitis or reactive arthritis. In children, uveitis occurs with juvenile idiopathic arthritis and is dangerous because it occurs almost without complaints. Infectious causes - herpes viruses, tuberculosis, syphilis, toxoplasmosis. Separately, uveitis is distinguished after injury and eye surgery. Often, after examination, the cause remains unknown, and such uveitis is called idiopathic.
- Ankylosing spondylitis and HLA-B27
- Juvenile idiopathic arthritis
- Sarcoidosis
- Behçet's disease
- Tuberculosis, syphilis, herpes, toxoplasmosis
- Eye injuries and surgeries
- Inflammatory bowel diseases
Symptoms
With anterior uveitis, the eye hurts, turns red mainly around the cornea, reacts sharply to light, and vision becomes blurred. The pupil on the diseased eye may be narrower than on the healthy eye, and react less well to light, and when adhesions form, it may change shape. Posterior uveitis usually does not cause pain, but floating spots, a veil and decreased visual acuity appear. In a child with arthritis, uveitis is often asymptomatic, so such children need regular preventive examinations by an ophthalmologist.
- Pain and aching in the eye
- Photophobia and lacrimation
- Redness around the cornea
- Fog and decreased vision
- Floaters
- Changes in pupil shape and reaction
Diagnostics
The diagnosis is made by an ophthalmologist during examination at a slit lamp: inflammatory cells in the anterior chamber, deposits on the posterior surface of the cornea, and adhesions of the iris are visible. Intraocular pressure must be measured, because with uveitis it can either decrease or increase. The fundus is examined with a dilated pupil; in case of cloudy media, ultrasound of the eye helps. The search for the cause is carried out in a targeted manner: tests for inflammation, examination for tuberculosis and other infections, consultation with a rheumatologist, if necessary, HLA-B27 typing and x-rays of the joints.
- Slit lamp biomicroscopy
- Measuring intraocular pressure
- Fundus examination with pupil dilation
- Ultrasound of the eye in B-mode
- Complete blood count, CRP, rheumatoid factor
- Testing for tuberculosis and infections
- Consultation with a rheumatologist
Treatment and observation
The basis of treatment for anterior uveitis is drops with glucocorticosteroids according to the regimen prescribed by the doctor and drops that dilate the pupil: they relieve pain from spasm and prevent the iris from fusing with the lens. In case of severe inflammation, injections are added under the conjunctiva or parabulbar. If the uveitis is infectious, antiviral or antibacterial drugs are prescribed, and in case of a systemic disease, the rheumatologist selects basic therapy. Treatment cannot be stopped independently at the first improvement: abrupt withdrawal of hormonal drops often causes an exacerbation. Monitoring intraocular pressure is mandatory.
- Glucocorticosteroids in drops according to the doctor’s regimen
- Drops that dilate the pupil against adhesions
- Injections under the conjunctiva and parabulbar
- Anti-infective treatment for identified pathogens
- Basic therapy for systemic disease
- Monitoring intraocular pressure
- Regular check-ups for children with arthritis
