Uveitis is inflammation of part or all of the uveal tract, the layer under the white part of the eye. The uveal tract is made up of 3 parts:
- Iris – the colored part of the eye
- Ciliary body
There are several different types of uveitis. The types get their names based on the part of the uveal tract that is affected.
- Anterior uveitis – Inflammation of the iris and/or ciliary body. It is also known as iritis or iridocyclitis.
- Intermediate uveitis – Inflammation of the ciliary body and may extend to the nearby vitreous humor. This type of uveitis is also known as pars planitis.
- Posterior uveitis – Inflammation of the choroid and may extend to the nearby retina and/or vitreous humor.
- Panuveitis – Inflammation of all parts of the uveal tract.
The above types of uveitis can also be labeled as granulomatous or non-granulomatous. Granulomas refer to the kind of inflammatory cells that are present. These can be identified with the eye exam by your eye doctor, or by a biopsy of the tissue in the eye.
The causes of uveitis include:
- Autoimmune disease – Juvenile Rheumatoid Arthritis or psoriasis
- Infection – Tuberculosis or toxoplasmosis
- Idiopathic – unknown causes
The symptoms of uveitis can vary depending on the type of uveitis. Some forms of uveitis have no symptoms. Other forms of uveitis may have symptoms including:
- Light sensitivity
- A decrease in vision
The uveitis associated with juvenile idiopathic arthritis (JIA) is an anterior uveitis that has no symptoms initially. This type of uveitis is more common in:
- Patients with a positive ANA (antinuclear antibody) test
- Patients whose age at onset of JIA is less than 6 years old
- Patients with oligoarticular form of JIA
However, everyone with JIA needs to get periodic exams to check for uveitis. The eye inflammation can also occur when the joint disease is inactive. The frequency of eye exams will depend on your child’s risk of developing eye problems. Your doctor will tell you how often your child should get eye exams.
Uveitis is diagnosed by a slit lamp exam. The slit lamp exam is a very quick, easy and painless test. It is done by shining a light through a microscope to look for inflammation in the eye.
If your child is diagnosed with uveitis, the eye doctor will likely recommend further tests to look into the cause of your child’s uveitis. The exact tests that are ordered will be based on the part of the eye that is inflamed and whether the inflammation is granulomatous or non-granulomatous. Your child’s eye doctor may recommend your child be evaluated by a rheumatologist to look for an associated autoimmune disease. Rheumatologists and eye doctors often work together to determine the best treatment for your child.
The treatment of uveitis depends on the type seen. Uveitis caused by an infection may require antibiotics or may even get better on its own. Uveitis of unknown cause or that is associated with an autoimmune disease usually requires treatment with medications. Medications to treat the inflammation can be given locally in the eye or systemically by mouth or by injection.
Local treatment with eye drops is usually tried first. Steroid eye drops are typically used for treatment of anterior uveitis. Steroids help to reduce the inflammation. Depending on how much inflammation is present, the steroid eye drops may need to be given several times a day. Drops that dilate the eye are also an important part of treatment. These dilating drops help to prevent adhesions from forming. Adhesions are like bands of scar tissue that can occur as a result of inflammation. If present, the adhesions can prevent the pupil from getting larger or smaller.
Steroid eye drops do not work as well for the treatment of intermediate or posterior uveitis (inflammation in the middle or back of the eye), as it is difficult for the drops to get deeper into the eye. Therefore, a local injection (shot in the eye) of steroids may be used to treat intermediate or posterior uveitis.
If local treatment is not effective, then your eye doctor may recommend systemic treatment. Systemic treatment is medication given by mouth, injection, or infusion that travels throughout the whole body. Systemic treatment usually consists of stronger anti-inflammatory medications. This therapy is usually managed by a rheumatologist instead of the eye doctor. Rheumatologists are doctors that specialize in the treatment of different types of inflammation.
Complications may occur due to the inflammation or sometimes from the medications. Following is a list of possible complications that may occur:
- Cataracts – clouding of the lens in the eye
- Glaucoma – increased pressure in the eye
- Posterior synechiae – adhesions or bands of scar tissue
All of the complications could possibly lead to an element of visual loss. However, your child’s eye doctor will closely monitor for any problems. If complications do occur, different treatments are available.