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Uveitis
Uveitis is an inflammatory reaction within the vascular coats of the eye (iris, ciliary body and choroid). This reaction releases a cascade of inflammatory cells and proteins into the adjacent media (aqueous, vitreous and retina) causing pain, redness and a variable intensity of visual disability - haze, floaters, scotomata or blindspots. This inflammatory reaction may be the result of infection, autoimmunity (where the immune system erroneously attacks oneself) or a combination of both.
The distinction of uveitis as a disease, as opposed to a normal reaction to clear an infection, is that the inflammatory reaction is excessive and prolonged and may not have an identifiable trigger. This excessive reaction may scar the eye causing permanent blindspots in the film of the eye (retina), corneal haze and distortion, iris synechiae (pupil distortion) which may in turn increase the risk of glaucoma and cataract.
The aim of treatment is to terminate the inflammatory reaction and return the local immune system to a state of rest. Therapy is initially intensive followed by a gradual taper. Stopping therapy rapidly risks rebound of the inflammatory reaction. Treatment may include local therapy - drops (corticosteroids and dilating agents) or regional injections of steroids, or systemic therapy - oral or intravenous steroids and immunosuppressive drugs. Specific antimicrobial therapy will be used if an infectious cause is identified.
Importantly, disease may recur even if antimicrobial therapy has been used, as it is difficult to eradicate microbes from the eye. If the symptoms of the first attack recur, urgent review with an eye doctor is essential to limit attack duration and possible scarring.
