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Uveitis
This is a disease process, which involves a layer of the eyeball called Uvea. The eyeball is made up of three layers-the outer layer being sclera and cornea (protective layer). The middle layer is uvea, which is a highly vascular layer, and maintains the nutrition of the eye.
The third or inner layer is the retina or neuro sensory layer. The uvea itself is divided into three parts, the choroid, which is posterior part and is in close apposition with retina. The ciliary body and the iris form the second and third part. It is because of the colour of the iris that we have different coloured eyes. Depending on the part of uvea affected we term uveitis as choroiditis or posterior uveitis, intermediate uveitis, iritis or anterior uveitis.
What are the Symptoms?
If it is intermediate uveitis Pain is not significant. It can have floaters - feeling of some dots or figures like threads moving in front of the eye and blurrness of vision, which can be mild. These symptoms can be so mild that patient may neglect this till vision gets more affected. In posterior uveitis pain is usually not a feature. If central part of eye is not affected vision can be normal. Only feature could be floaters in front of the eye. But if central part of the eye gets affected there will be significant loss of vision.
- These uveitis entities are often recurrent type, go on for months to years.
- Definite cause cannot be detected.
- Steroids are the mainstay of treatment to decrease the visual morbidity caused by uveitis. Steroid therapy is also potentially toxic, hence should be taken under medical supervision.
What we need to do in Uveitis patients?
Patient's co-operation and compliance is most important in managing these cases. Investigations are needed to rule out any systemic infections and also to know immunologically mediated disorders. Patients will be sent to physicians or immunologist for systemic evaluation as and when needed. Patients need to visit ophthalmologist more frequently for follow up.
What are steroids (USED FOR TREATING UVEITIS)?
Steroids are drugs, which decrease the inflammatory reaction, and hence decrease the tissue scarring which could occur if not treated and this scarring leads to various complications, which causes loss of vision. For anterior uveitis Steroids are given in the form of local eye drops. These are to be instilled in frequencies as directed by the ophthalmologist. Cycloplegics are given as drops, these give rest to ciliary body and dilate the pupil and there by decrease the pain, which is caused by constriction of pupil. Most cases of Anterior Uveitis can be managed well with local steroids and cycloplegics. Once acute phase passes away steroid drops are tapered slowly over few days to months depending on the clinical judgement.
As long as vision is well maintained recurrent attacks also need only local steroid drops and cycloplegics. If recurrences are frequent and vision gets chronically affected then other forms of steroid therapy can be considered like periocular steroid injection. These are steroid injection given around the eyeball for longer duration of action (2-3 weeks)
This form of treatment does well in cases of intermediate uveitis. If anterior uveitis becomes chronic or intermediate uveitis is relapsing and recalcitrant and in most cases of posterior uveitis-steroid tablets (systemic therapy) are needed. These are also long term therapy and needs to be given under close guidance by physician and ophthalmologist.