Definition

Uveitis is an inflammation that occurs in the middle layer of the eye called the uvea. The uvea is the middle layer of the eye consisting of the eye's iris, the eye's blood vessel layer (cornea), and the connective tissue between the iris and the cornea (silar body). The uvea is located between the white part of the eye and the back of the eye that captures light. The uvea is very important because it contains many blood vessels that carry blood to other parts of the eye. If there is inflammation in this part, it can be characterized by eyes that look very red, painful, and blurred vision.

This disease is more common in the age of 20-50 years. Uveitis can affect vision quality because some cases can be chronic and cause other diseases. Other diseases are cataracts, glaucoma, as well as the risk of permanent blindness. About 10% of cases of blindness originate from uveitis.

Uveitis can be divided into several types based on the location of the inflammation, namely uveitis in the anterior area (iris), uveitis in the middle area (between the iris and the choroid), uveitis in the posterior area (choroid), and uveitis in the entire area or commonly called panuveitis (occurs in all parts of the uvea). In addition, uveitis can also be acute if symptoms improve in less than 3 months and chronic if it occurs for more than 3 months.

Cause

Approximately 50% of uveitis cases occur due to unknown causes, even healthy people can suddenly experience uveitis. However, most cases are also related to disorders of the immune system, especially when a person has an autoimmune disease. Some autoimmune diseases that are associated as triggers of uveitis are as follows:

• Psoriasis, a type of autoimmune disease that causes inflammation of the skin.
• Rheumatoid arthritis, which is an autoimmune disease that causes inflammation in the joints.
• Ankylosing spondylitis, namely an autoimmune disease that causes arthritis in the spine.
• Sarcoidosis, an autoimmune disease that causes inflammation that appears in various parts of the body such as the lungs, lymph nodes, eyes, and skin.
• Kawasaki disease, which is an autoimmune disease that causes inflammation in the walls of blood vessels.
• Ulcerative colitis, which is an autoimmune disease that causes inflammation of the colon.
• Crohn's disease, an autoimmune disease that causes inflammation in the digestive tract.
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In addition to autoimmune diseases, some cases of uveitis are also suspected to be due to infections, for example, varicella zoster virus, herpes, tuberculosis, syphilis, and so on. Causes outside of infection can also be triggers for uveitis. For example, there is an injury or history of eye surgery, malignancy or cancer in the eye, and exposure to toxins in the eye.

Risk Factors

It is known that people who have certain genetics can be more susceptible to uveitis. Likewise with people who have autoimmune diseases and a history of eye surgery. However, the exact cause of uveitis is sometimes unknown. 

The habit of smoking and age over 60 years can also increase the risk of more severe uveitis. In addition, age also plays a role in increasing the risk of complications of uveitis.

Symptoms

Uveitis can appear suddenly or develop gradually. Symptoms that may appear include:

• Red eyes
• The eyes feel painful.
• Blurred vision
• Sensitive to light
• Black spots appear or floaters in the eyes of
• Sharp decrease in vision

Diagnosis

The doctor will examine the health history and symptoms felt, after that a physical examination of the eyes is needed to establish a diagnosis. Supporting examinations are only carried out to obtain more accurate diagnosis results. Supporting examinations are not required in acute uveitis conditions that have mild/moderate symptoms without any associated diseases or conditions that can be ascertained through examination of symptoms and physical examination, such as Fuchs Uveitis Syndrome (FUS) or sarcoidosis.

The supporting examinations that may be carried out, such as:

• Sharp vision examination
• Examination of eye pressure with tonometry
• Examination of the eye structure with slit lamp
• Examination of the inside of the eye with funduscopy
• Blood examination
• As well as eye imaging to measure thickness and see if there are inflammatory cells in the eye.

Supporting examinations such as CT Scan or MRI are only needed if there are indications or want to find the cause of other diseases underlying uveitis.

Procedure

The main goal of uveitis treatment is to reduce inflammation in the eyes. Treatment of uveitis can be done with medication to surgery procedures. 

Some types of drugs that can be recommended by doctors as treatment for uveitis are as follows:

1. Corticosteroids, these drugs can reduce inflammation.
2. Antibiotics or antivirals, these drugs are given according to the type of infection that causes uveitis. These drugs need to be taken regularly and finished according to the doctor's prescription.
3. Immunosuppressive drugs are given when uveitis occurs in both eyes or is not successfully treated with corticosteroids. However, this type of medication also requires close supervision to reduce the side effects that can occur. This drug can only be consumed according to the indications and recommendations of the doctor.

If the symptoms of uveitis are severe enough and do not improve with medication, then the doctor may recommend several surgical procedures. One of them is vitrectomy, which is an eye surgery to remove fluid from the inside of the eye or also called vitreous fluid. Another surgical procedure that may be recommended is the implantation of a drug-releasing device, which is implanted to slowly deliver a corticosteroid drug to the eye. Treatment with this device is generally for 2-3 years. The type of treatment and the duration of uveitis treatment depends on the severity of the uveitis experienced.

Complications

Uveitis that is not treated properly can cause several complications such as:

• Cataract
• Glaucoma
• Ablasio retina, namely the detachment of the retina from the layer of blood vessels that provide nutrition and oxygen to the eye
• Swelling of the retina of the eye
• Inflammation that causes the iris layer to stick to the eye lens

Prevention

In general, uveitis is a disease that is difficult to prevent. This is because most cases are caused by unknown factors. However, if this condition can be detected and treated quickly and appropriately, it can reduce complications. The worst possible thing to prevent is permanent blindness.

When should you see a doctor?

If you experience symptoms that lead to uveitis, you should immediately see your nearest ophthalmologist. This is especially true if you have other accompanying diseases, such as autoimmune diseases that can trigger uveitis.

Want to know more about other diseases? Check out here, yes!