Uveitis

Uveitis is inflammation of the uvea, the middle layer of the eye between the sclera (white outer coat of the eye) and the retina (the back of the eye). The uvea contains many of the blood vessels that nourish the eye. Inflammation of this area, therefore, can affect the cornea, the retina, the sclera, and other important parts of the eye. Uveitis occurs in acute and chronic forms, and affects men and women equally. It can happen at any age, but occurs primarily between the ages of 20 and 50, and most commonly in one's 20s.

Signs and Symptoms

Uveitis is often accompanied by the following signs and symptoms:

• Painful eye(s)
• Redness of the conjunctiva, the membrane covering the surface of the eyeball
• Sensitivity to light
• Blurred or decreased vision
• Tearing
• Redness
• Floaters—experienced as spots in front of your eyes; they represent the movement of protein deposits that accumulate with age on the vitreous body (a transparent substance that fills the area of the eye between the lens and the retina)

What Causes It?

Although the exact cause of uveitis is often unknown, it may result from trauma to the eye, as in the case of chemical exposure. In addition, uveitis may be caused by a viral infection (for example, cytomegalovirus, as seen in patients with AIDS), a fungal infection (such as histoplasmosis), or an infection caused by a parasite (such as toxoplasmosis; a newborn may develop uveitis if the mother was exposed to toxoplasmosis during pregnancy). Uveitis is also associated with underlying immune-related disorders, including Reiter's syndrome, multiple sclerosis, juvenile rheumatoid arthritis, Crohn's disease, and sarcoidosis. Certain diseases—including leukemia, lymphoma, and malignant melanoma—may have symptoms that resemble uveitis. Some medications, such as rifabutin, cidofovir, pamidronic acid, and sulfonamides, may cause uveitis. In many cases, an underlying cause is not identified.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing uveitis:

• History of an autoimmune disease such as ankylosing spondilitis and others mentioned in the section, What Causes It?
• Infections such as syphilis, tuberculosis, cytomegalovirus, Lyme disease, and others mentioned in the section, What Causes It?
• Other eye diseases
• Location in geographic areas that are prone to certain organisms such as histoplasmosis and Lyme disease
• In the case of toxoplasmosis, pigs and mice carry the parasite and can transmit to humans. Cat owners are at increased risk of toxoplasmosis because the litter contains spores of the parasite; pregnant women should not change cat litter.
• Those taking certain medications, such as those mentioned in the section, What Causes It?

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with uveitis, you should see your healthcare provider. He or she will do a complete physical examination and take your history, checking for signs of underlying disease such as joint problems, mouth sores, rash, and nail pitting. In addition, he or she will perform an eye examination and may order laboratory tests and imaging.

Treatment Options

Prevention

Your healthcare provider can screen for uveitis during a regular eye exam. Treatment of any of the underlying diseases discussed above may help prevent the onset of uveitis. Avoiding drugs associated with uveitis, such as rifabutin, may also help prevent this condition.

Treatment Plan

Prompt treatment is necessary to preserve your eyesight. Warm compresses may help relieve symptoms. Sunglasses can protect your eyes if they are sensitive to light.

Drug Therapies

Your provider may prescribe the following medications:

• Corticosteroids to reduce swelling and pain
• Cycloplegics (such as cyclopentolate and homatropine) to reduce pain
• Antimicrobials to treat infection
• Anti-inflammatories to reduce swelling
• Medications to suppress the immune system

Surgical and Other Procedures

Surgery may be required to repair any damage to the eyes such as cataracts, glaucoma, or a detached retina, each of which is a potential complication from uveitis.

Complementary and Alternative Therapies

CAM therapies may help reduce the severity of diseases that can lead to uveitis. Specifically, herbs and nutrients may reduce the effects of free radicals (unstable molecules that may play a role in inflammation and cell damage). In this way, these substances may prevent or slow the advance of uveitis when used together with conventional medical care.

Nutrition
Flavonoids are substances found in fruits and vegetables—particularly red grapes, blueberries, cherries, and onions—that may help prevent damage from free radicals. In our bodies, a high concentration of flavonoids is found in the eyes, and the flavonoids from berries (particularly blueberries and bilberries) tend to collect in the eye. In an animal study, quercetin, a flavonoid found in foods and available as a supplement, reduced inflammation and bleeding in the eyes of rats. Doses of quercetin supplements from 200 to 400 mg may be taken three times a day with meals. Quercetin is often used with bromelain to enhance its effects.

Carotenoids are other nutritional substances that may also protect against damage from free radicals, especially in the eye. Orange, yellow, and dark green vegetables such as spinach, carrots, and pumpkins are high in carotenoids. Supplement forms include mixed natural carotenoids (50,000 IU per day) and the carotenoid lutein (5 mg per day). Lutein is thought to be especially helpful for the eyes.

In the case of uveitis, foods that promote inflammation should be eliminated from the diet. These include saturated fats, fried foods, dairy products, and refined foods. Foods that may help fight inflammation, such as flaxseed and fatty fish, generally contain omega-3 essential fatty acids.

Other nutrients that may be useful in the treatment of uveitis include the antioxidant vitamins C and E. In at least one well-designed scientific study that evaluated whether these nutrients could be of benefit in cases of uveitis, the results suggest that taking vitamin C (1000 mg per day) and vitamin E (200 IU per day) protects the light receptors in the eyes from free radicals, thus helping to preserve visual clarity. Also, vitamin E may protect against swelling in the macula, the light-sensitive layer of the eye, that could lead to a loss of clear vision in people with uveitis.

Herbs
As noted above in the Nutrition section, flavonoids found in foods may be helpful in the treatment of uveitis. Similarly, herbs high in flavonoids, such as ginkgo (Ginkgo biloba) and bilberry (Vaccinium myrtillus), may also be useful. Herbalists have used these herbs to treat eye diseases for a long time. However, it is not yet known whether ginkgo and bilberry are of value in the treatment of uveitis specifically.

Turmeric (Curcuma longa) is another herb that may reduce inflammation. Curcumin, the main active substance in turmeric, reportedly has anti-inflammatory properties. Although it is not yet clear whether turmeric may be useful in the treatment of uveitis, results from a small 3-year study in patients with uveitis suggest that curcumin (375 mg taken orally three times daily) worked as well as corticosteroid medications but without the side effects. In addition, the rates of recurrence as well as complications from uveitis were similar to the rates of patients taking corticosteroid medications. No patients complained of side effects from the curcumin.

Homeopathy
Currently, no known scientific literature supports the use of homeopathy for uveitis; however, an experienced homeopath would consider your individual case and may recommend treatments to help relieve your specific symptoms.

Acupuncture
Acupuncture has been shown to be effective in the treatment of other eye diseases, but it has not yet been fully studied for treatment of uveitis.

Prognosis/Possible Complications

Prognosis is good with early diagnosis and treatment. Treatment may be short-term or long-term, depending on the cause. The success of treatment depends on any underlying condition you may have. Possible complications include glaucoma, cataracts, vision loss, and detached retina.

Following Up

Your healthcare provider may use a slit lamp to examine structures within the eye one layer at a time. Your provider will also measure the pressure within your eye every 1 to 7 days during the acute phase. A follow-up appointment every 1 to 6 months is generally recommended; your healthcare provider will instruct you on the exact frequency of visits.

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