Uveitis of the eye: causes, symptoms and treatment. Uveitis - what is it, how to treat acute eye disease, causes of Uveitis disease

Uveitis is a collective term for inflammatory processes in various areas of the choroid, which includes the choroid, ciliary body and retina. First of all, the pathology is characterized by irritation followed by redness of the eyeball. Then other symptoms appear.

What is uveitis?

Approximately 30-60% of cases of inflammatory processes in the eyes are due to uveitis. The pathology took its name from the uveal membrane of the eyes, where the vessels are located. This area consists of the ciliary body, choroid, and retina. Accordingly, uveitis is divided into, cyclitis, iritis, choroiditis, chorioretinitis and so on. A third of cases lead to either blindness or impaired vision.

This prevalence of uveitis is primarily associated with the branching of the vascular system in the eye, as well as with a slowdown in blood flow in the uveal membrane. This feature primarily contributes to the retention of pathogens in the membranes of blood vessels, which often provoke this disease.

Another feature of the functioning of the vascular system of the eye is the separate supply of blood to the anterior and posterior parts of the uveal membrane. Because of this structure, damage to the departments occurs separately, although there were precedents for the simultaneous development of pathology.

Important! Uveitis symptoms are similar to a number of other eye pathologies, both infectious and non-infectious types. It is important to determine the cause and type of treatment so that complications such as cataracts, glaucoma or eye problems do not develop.

They also have different innervation, which is present in the ciliary body and retina, but is absent in the choroid. Such structural features of the eye and its vascular system in individual parts, as a result of the influence of various factors, provoke the development of the disease.

Classification

In general, uveitis is divided according to the anatomical features of the eye structure:

Generalized;
Rear;
Median;
Anterior uveitis of the eyes.

Anterior uveitis is characterized by such subtypes of pathology as iritis, anterior cyclitis, iridocyclitis. Intermediate or median uveitis is manifested by posterior cyclitis, pars planitis, and peripheral uveitis. The posterior type of pathology can develop in the form of retinitis, choroiditis, chorioretinitis, neurouveitis.

Important! Using this classification, it is possible to describe as accurately as possible the course of the disease, as well as its type and the presence of complications.

In the anterior type of the disease, the ciliary body and iris are involved in pathological processes. This localization is considered the most common among all cases of pathology. The intermediate type affects the choroid and ciliary body, retina and vitreous body. The posterior type involves the optic nerve, choroid, and retina in the development of inflammation. If all parts of the uveal membrane are involved in pathological processes, then we are talking about panuveitis or a generalized type of the disease. If we divide by the nature of inflammation, the process can be:

Serous;
Purulent;
Mixed;
Hemorrhagic;
Fibrinous-lamellar.

Uveitis can also be primary and secondary, endo- and exogenous. Primary pathologies are caused by systemic diseases, but secondary pathologies are directly related to diseases of the organ of vision.

Also divided into acute, chronic recurrent uveitis and simply chronic, and depending on the morphological picture into non-granulomatous, caused by toxic-allergic factors, and granulomatous - which have a focal metastatic nature.

Acute uveitis usually develops for the first time. But chronic ones are caused either by autoimmune diseases or by untreated acute uveitis. Sluggish uveitis manifests itself as a type of chronic uveitis, manifesting itself insignificantly. May produce minor symptoms for several months.

Causes

The cause of uveitis is primarily considered to be the peculiarity of the structure of the choroid, as mentioned above. But if we talk about influencing factors, then first of all the disease is provoked by:

Injuries;
Infectious lesions;
Metabolic disorders;
Allergic reactions;
Syndromic and systemic diseases;
Violation of hormonal regulation.

The most common are infectious uveitis, which occupy a niche of 44%. In such cases, the pathogens that caused the disease are tuberculosis bacteria, toxoplasma, streptococci, cytomegalovirus, fungi, herpes virus, and so on. In this case, the focus of development will not necessarily be in the eye area. The pathogen simply needs to enter the bloodstream and reach the eye area. Most often, this pathology develops with tuberculosis, syphilis, tonsillitis, caries, sepsis, and so on.

Important! There are many causes of uveitis and it is impossible to determine them accurately without examination. For example, children are characterized by traumatic and infectious diseases, while in adults the most common are infectious and systemic diseases. But even this is not a 100% guarantee.

Allergic uveitis is not infectious in nature. In such cases, the immune system plays a major role. And her reaction to allergens - medications, food, pollen, fluff, and so on. In this case, even serum uveitis may develop, which usually occurs after the administration of vaccines and serums.

Uveitis is often caused by systemic or syndromic pathologies, for example, rheumatoid arthritis, psoriasis, Reiter's syndrome, rheumatism, sarcoidosis, colitis, and so on. In such cases, in parallel with uveitis, it is necessary to treat the underlying pathology. Rheumatoid uveitis of the eye often develops as a complication of rheumatoid arthritis.

Caused by trauma, uveitis can develop after a burn, mechanical contusion or penetrating injuries, or foreign bodies. Hormonal and metabolic dysfunction in diabetes mellitus, diseases of the circulatory system, menopause, diseases of the organ of vision and other pathologies and conditions often lead to inflammatory processes in the choroid.

Important! Sometimes the cause of uveitis cannot be determined. In such cases, a diagnosis of “unspecified ocular uveitis” is made.

Symptoms

Pathology manifests itself depending on the location, the presence of pathogenic microflora, and the reactivity of the body as a whole. In the acute form, the following appear:

Pain in the eyes;
Redness;
Irritation;
lacrimation;
Photophobia;
Constriction of the pupil;
Deterioration of visual function.

The pericorneal injection becomes purple in color, and intraocular pressure begins to increase with the acute nature of the pathology. But the chronic form often occurs either asymptomatically or with minor manifestations such as redness of the eyes, as well as the presence of moving spots in front of the eyes.

During diagnosis, an indicator of the acute phase of anterior uveitis is accumulation of precipitated cells in the area of the corneal endothelium, as well as a cellular reaction in the fluid of the anterior chamber. A complication of this type of pathology is often synechiae, which are areas of fusion between the iris and the lens, as well as keratopathy, glaucoma, and so on.

Important! The symptoms of uveitis are quite vague. Each type of pathology requires its own type of treatment. Don't self-medicate!

Peripheral uveitis affects both eyes at once. Cloudy areas appear before the eyes, and central vision decreases. With posterior uveitis, blurred vision, distortion of objects and spots in front of the eyes may appear. Complications of the posterior type of the disease include retinal detachments, macular ischemia, macular edema, and so on.

The most severe form of pathology is iridocyclochoroiditis. It develops most often due to sepsis. Accompanied by panophthalmitis or endophthalmitis. If uveitis is associated with certain pathologies, then headaches, baldness, vitiligo, enlarged lymph nodes, vasculitis, arthritis, skin rashes, shortness of breath, increased salivation, and so on may additionally make themselves felt. It all depends on what kind of disease caused inflammation in this area.

Diagnostics

Before treatment, it is necessary to conduct a diagnosis that will help determine the area of the lesion, stage and the presence of other complications and pathologies. For this purpose:

Optical coherence tomography;
and perimetry;
Ophthalmoscopy;
Biomicroscopy;
Gonioscopy;
Measuring intraocular pressure;
Ultrasound of the eye;
Retinography;
Electroretinography.

First of all, the doctor conducts an external examination to determine the condition of the conjunctiva and eyelids. The pupillary reaction is examined. Other methods for examining the eye and its parts depend on a number of factors. For example, if it is not possible to perform ophthalmoscopy due to clouding of the optical media, then ultrasound is performed.

It is necessary to understand that the cost of full diagnostics in private clinics can reach serious amounts. But if government institutions do not have the ability to carry out the necessary procedures and research, then you should turn to private institutions. In such cases, it is possible to conduct a partial diagnosis by paying only for those diagnostic methods that are not available in a free queue at a government agency.

It is also worth noting that not all treatment can be carried out in a regular hospital. For example, administering parabulbar injections involves the use of special drugs. They are introduced under the supervision of specialists, and therefore require certain experience, skills, and appropriate conditions, which not every institution can provide. Therefore, you should not save on your health, since uveitis often ends in blindness or decreased visual function.

To differentiate the pathology from other inflammatory diseases with similar symptoms, a decision may be made to perform optical CT, as well as angiography of vessels in the retinal area. Laser scanning tomography is often used. If necessary, the doctor may decide to take a biopsy sample for laboratory testing of the material. If there are suspicions of concomitant pathologies, the patient may be referred to other specialists, for example, for tuberculosis - to a phthisiatrician, for allergies - to an allergist, and so on. In addition, Mantoux reaction tests, fluorography, X-rays of the spine, MRI of the brain, and so on can be performed. It all depends on the expected pathology.

Important! It is necessary to undergo diagnostics first of all in order to differentiate uveitis from other complex pathologies.

Treatment of uveitis

After a full diagnosis with determination of the area and nature of the lesion, a course of adequate, comprehensive therapy is determined. Drug and systemic drug treatment is mainly used. Surgery may also be performed to correct complications of uveitis, but these are rare cases. Typically, classical therapy is practiced using different types of medications. Some of them involve administration in a hospital setting, but most are used either orally or topically in the form of drops, ointments, and so on.

Therapy is carried out under the careful supervision of an ophthalmologist and other specialists. When diagnosing uveitis, differential diagnosis plays an important role. Based on the diagnosis, the following is prescribed:

Substitute;
Pathogenetic;
Etiotropic;
Corrective therapy.

At the same time, treatment is being carried out for the root cause - the pathology that provoked uveitis. It is prescribed by a specialized specialist after conducting an appropriate examination.

Drug treatment

Drug therapy involves the use of a number of drugs. This largely depends on the type of pathology, the presence and type of pathogens, and so on. Mainly used:

Antiviral and antimicrobial medications;
Mydriatics - atropine, phenylephrine and so on;
Steroids - prednisolone, dexamethasone, and so on;
Systemic immunosuppressants;
NSAIDs;
Cytostatics;
Antihistamines.

Mydriatics eliminate the spastic state of the ciliary muscle. They also prevent the development of adhesions and fistulas. Also, drugs of this type help to break up already formed adhesions.

In parallel, agents that promote vasodilation are used, as well as immunostimulants and physiotherapy. For increased pressure inside the eyes, antiglaucoma medications are used. The duration of treatment is determined by the doctor.

Hormonal drugs are usually used in short courses due to their systemic effect on the body. But the doctor can extend their use if there are certain indications, for example, for psoriasis, hormonal drugs are used for a month or more. Cancellation is carried out gradually with decreasing dosages and extending the time between use of funds.

Important! Hormonal medications require a doctor's prescription. Available only by prescription. It is prohibited to use several funds from such a group at once. If side effects occur, you should consult your doctor about discontinuing or replacing the drug with another one.

Physiotherapy

To increase the effectiveness of treatment, physiotherapy is also used. Its effectiveness has been proven over time. But it is worth considering that such procedures can only be applied after the severity of the pathology has been relieved:

Electrophoresis;
Hirudotherapy;
Phonophoresis.

These are effective techniques that will help you quickly cope with the disease, and in case of a chronic type of pathology, put it into a stage of long-term remission.

Surgical intervention

Surgical intervention is practiced mainly to eliminate complications that have developed against the background of uveitis, for example, to dissect the area of fusion of the iris with the lens. Surgical treatment of glaucoma, retinal detachment, cataracts, and so on can also be performed. Depending on the type of pathology, techniques such as:

Vitrectomy for iridocyclochoroiditis;
Evisceration when it is impossible to save the eye.

The success of a particular surgical procedure depends on the type of complication. Sometimes the eye cannot be saved, and sometimes vision can be restored to 100%.

Important! Do not be afraid to go to the doctor because of the risk of prescribing a surgical procedure. This is an extremely rare phenomenon and is accepted only after attempts to cure the patient in the classical way. The longer the pathology is delayed, the greater the chances of falling under the surgeon’s knife.

Where are they treated?

This pathology can generally be treated at home, but it is necessary to first undergo a diagnosis. An accurate determination of the pathology and its causes will allow you to correctly and completely cure your eyes. Some products can only be administered by qualified healthcare professionals. In this case, it is necessary to remain under the supervision of the establishment’s specialists for some time.

Sometimes semi-inpatient treatment may be used, when the patient comes to the hospital for manipulations or medication. Modern medicine offers many different techniques and medications that will help to cope with pathology as quickly as possible.

Important! It is better to seek help from qualified ophthalmological institutions that have already proven themselves in this area. This way you will receive high-quality service and complete diagnostics.

Prognosis and prevention

With comprehensive and complete treatment in the initial stages of uveitis, recovery occurs after 4-6 weeks. Chronic uveitis can recur if the underlying disease worsens. a complicated course leads to the development of various pathologies and complications such as:

Glaucoma;
Sinechy;
Retinal detachment;
Retinal infarction;
Retinal dystrophy;
Optical disc edema;
Cataracts.

Important! The development of complications increases in the absence of treatment. Moreover, the longer the disease lasts without proper therapy, the greater the chance of losing visual function without its restoration.

As a result, vision deteriorates significantly or disappears completely, often irreversibly even with the use of surgical methods. Therefore, it is important to carry out proper prevention. Its rules are simple:

It is necessary to carry out preventive examinations in a timely manner;
Treat existing pathologies in a timely manner;
Avoid eye injuries;
Timely treatment of ophthalmological pathologies;
Eliminate allergies by taking the appropriate type of medication.

Such prevention allows you to solve several problems at once, maintain health and prevent the development of this pathology. If the disease is chronic, it is worth visiting a doctor regularly. It is also necessary to visit other specialized specialists who will help cope with general systemic diseases.

Ocular uveitis is a pathological inflammation of the vascular network of the eye. Since the uveal (choroid) membrane nourishes the entire eyeball, the development of the inflammatory process can occur anywhere in the eye or uveal tract, which includes the vessels, iris, and ciliary body.

The development of this disease always affects vision; the more advanced and severe the form, the more noticeable the consequences will be for the diseased eye. From loss of part of the visual field or acuity to complete blindness. At the slightest sign of a problem, contact your ophthalmologist immediately.

The choroid performs a number of very important functions: nutrition of the eyeball, adaptation to the level of illumination, participates in accommodation, production of intraocular fluid, restores visual pigments, etc. Protection from the general bloodstream or a kind of membrane between the vessels and the inside of the eye is the hemato- ophthalmic barrier.

The blood-ophthalmic barrier consists of endothelial cells of the retinal capillaries and is a physiological filter. Its task is to prevent large molecules from blood vessels, microorganisms, toxins, and immune cells from entering the retina. At the same time, he also does not miss many medications, which makes treatment much more difficult.

Exposure to exogenous (external) or endogenous (internal) factors leads to disruption of the permeability of this barrier, which facilitates the penetration of viruses, infections, and pathogenic microflora into the vascular network of the eye. The infectious focus can be located anywhere in the body; through the bloodstream, its toxins and antigens reach the eyeball.

Due to different branches of the blood supply for different structures of the eye, inflammation occurs locally in some part, but over time it can worsen to complete damage to the eye. Uveitis in children occurs in the same way as in adults, but is much less common. It is important to cure the cause, the focus of the process, otherwise uveitis will often recur.

Classification

The disease is not infectious, is not transmitted in any way, and it is impossible to become infected. Uveitis manifests itself as a complication, and not an independent disease. Classification depends on many factors; it is necessary to prescribe the correct etiotropic treatment.

Depending on the location of the inflammatory process:

– inflammation of the iris and ciliary body.
Posterior uveitis - affects the optic nerve, retina, choroid (choroid).
Peripheral uveitis - inflammation affects the retina, vitreous body, choroid, ciliary body.
Panuveitis (iridocyclochoroiditis) - the process affects the entire choroid of the eyeball.

According to the nature of the disease:

acute uveitis;
chronic uveitis (periodically recurrent);
indolent uveitis (Fuchs syndrome).

According to the type of inflammatory process, uveitis is:

hemorrhagic;
serous;
fibrinous;
lamellar;
purulent;
mixed.

Depending on the cause, exogenous or endogenous, uveitis is:

The causes of inflammation are varied, including pseudosymptoms of tumor-like neoplasms in the brain.

Symptoms of uveitis can be simulated by:

primary CNS lymphoma;
Richter's syndrome;
B- and T-cell lymphomas;
leukemia.

Uveitis, main causes:

Violation of the permeability of the blood-ophthalmological barrier due to hypothermia, illness, immunodeficiency states of the body.
Metabolic or hormonal disorders.
Genetic diseases such as ankylosing spondylitis, retinopathy (see).
Traumatic damage to the eyeball: physical, toxic, chemical, thermal, radiation.
Consequence of surgery.
Systemic inflammatory diseases: sarcoidosis, psoriatic arthritis, juvenile arthritis, Behcet's disease.
Diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, HIV, tuberculosis, herpes, syphilis, chlamydia, helminthiasis, toxoplasmosis, mycoplasmosis, borelliosis.
Chronic foci of infection: caries, sinusitis, tonsillitis, sinusitis.
Allergic reaction to vaccines, medications, food, pollen and other allergens.
Eye diseases: conjunctivitis, blepharitis, corneal ulcers, retinal detachment, scleritis, keratitis.
Stagnation and spasm of the vascular network due to visual strain, chronic irritation from smoke, dust, and dry eye syndrome.

Symptoms of the disease

The clinical picture of uveitis depends on the location of the lesion, the pathogen, the nature of the course, and concomitant pathologies. Symptoms can be combined or change each other. Signs of the disease are the same for adults and children.

Uveitis, main symptoms:

Hyperemia, redness of the eyes, headache.
Decreased visual acuity, partial or complete, fog, haze before the eyes, floating dots, flashes, the shape of objects may be distorted.
Photophobia, painful reaction of the pupils to light, lacrimation.
Cutting, burning of the organs of vision, sensation of a foreign body, specks in the eye.
In the anterior form of uveitis, the pupil is steadily narrowed, does not respond to light, becomes deformed over time, and loses its round shape.
Night vision deteriorates, concentration and gaze are difficult to fix.
With the development of the pathological process, color perception is impaired.
Intraocular pressure increases, which is accompanied by a feeling of fullness in the eyeball.
The shape and color of the iris changes, and a coating or tint appears on it.
The symptoms of uveitis are accompanied by the clinical picture of the underlying disease.

Diagnostics

If you find any of the symptoms, you should immediately seek help from an ophthalmologist. Don’t put it off for later, don’t wait for it to go away on its own, such tactics can lead to complete loss of vision, especially you shouldn’t experiment with the health of your children.

Determining the cause of uveitis:

Questioning the patient, collecting anamnesis and complaints.
Ophthalmological examination: ophthalmoscopy, ultrasound of the eye, paracentesis of the eye chambers, retinal angiography, measurement of visual acuity and field, refraction study, measurement of intraocular pressure.
X-ray: paranasal sinuses, spine, lungs, joints, sacroiliac joints.
Laboratory diagnostics: general blood test, general urinalysis, blood biochemistry, C-reactive protein, total blood protein and its fractions, ANF, RF.
HLA typing.
Diagnosis of chronic and trigger infections: PCR, PIF, ELISA, Wasserman reaction, Diaskin test, Quantiferon test and so on.
Additional consultations with related doctors: dentist, otolaryngologist, urologist, rheumatologist, phthisiatrician, gynecologist, neurologist and so on.
MRI or CT scan of the brain.

How to treat uveitis of the eye

Treatment of ocular uveitis is primarily aimed at eliminating the cause of the disease. Therapy is prescribed after examination, diagnosis and identification of the pathogen. Medicines are used (eye drops, injections, ointments), as well as folk remedies for complex treatment. An uncomplicated, unstarted process with timely treatment can pass without leaving a trace on the quality of vision.

General treatment plan:

Glucocorticoids: Ozurdex, Dexamethasone, Hydrocortisone, Prednisolone. They are injected into the eye, subconjunctivally, retrobulbarly, subtenonally. Eye drops – “Dexoftan”, “Prenacid”, “Dexapos”.
Non-steroidal anti-inflammatory drugs: take Ibuprofen, Indomethacin, Movalis, Butadione orally.
T-lymphocyte modulators: Cyclosporine, Tacrolimus, Sirolimus.
Antimetabolites: Methotrexate, Azathioprine, Mycophenolate.
Alkylating agents: Cyclophosphamide, Chlorambucil.
Biological agents: TNF inhibitors, Humira, infliximab, etanercept, adalimumab, golimumab, certolizumab.
For allergic inflammation, antiallergic drugs “Suprastin” or “Claritin”, “Clemastin” are prescribed.
Antibacterial agents from the group of fluoroquinolones, cephalosporins, macrolides, the drug depends on the pathogen.
Antiviral drugs, if the cause is a virus: Cycloferon, Zovirax, Acyclovir, Viferon.
Mydriatics for constriction and dilation of the pupil, which prevents the formation of adhesions: “Atropine”, “Tropicamide”, “Irifrin”, “Cyclopentolate”.
Fibrinolytics for scar resorption: “Gemaza”, “Lidaza”, “Wobenzym”.

Surgical intervention is necessary at the stage of eliminating complications or in advanced forms of uveitis, to cut adhesions.

Folk remedies

In addition to drug treatment, eye uveitis also responds effectively to folk remedies. Let's look at some of the most popular recipes.

How to treat at home:

aloe juice is squeezed through a gauze bag, diluted 1 to 10 and buried;
a weak solution of potassium permanganate, decoctions of chamomile, sage, calendula, plantain, birch leaves are used for compresses and rinsing;
tincture of marshmallow root is effective for hot compresses and lotions;
Honey is considered a natural antiseptic; a weak solution of honey and water is used as antibacterial eye drops.

Complications and prognosis

The prognosis directly depends on the cause and stage of the disease. The sooner the patient sees a doctor, the more optimistic the prognosis. The average treatment time for uncomplicated uveitis is about 3-6 weeks.

Complications:

complete or partial loss of vision;
cataract;
vasculitis;
fusion of the edge of the pupil with the lens, which disrupts the accommodation and refraction of the eye;
retinal disinsertion;
glaucoma;
optic nerve atrophy;
corneal dystrophy;
clouding of the optical media of the eye;
panuveitis;
loss of an eye.

Prevention

Prevention of uveitis is not specific, but comes down to general rules of eye hygiene, since it is impossible to predict what exactly will cause the disease. Treat all eye infections and chronic lesions in the body in a timely manner. Follow the regime of visual stress and rest, do not overwork. Light your work area properly.

Try to avoid hypothermia, irritation of the mucous membrane of the eye with dust, smoke, bright light, and ultraviolet radiation. Do not use other people's towels or cosmetics, maintain hygiene when wearing contact lenses or using false eyelashes. Eat right, add vitamins to your diet, and lead a healthy lifestyle.

Do not skip preventive examinations with an ophthalmologist.

All folk remedies and self-selected medications for treatment must be approved by your doctor. Traditional medicine is completely contraindicated for children, both in prevention and treatment. Immunity that is not fully formed and the body is still weak can only be treated under the supervision of a specialist.

Additionally, watch a video about inflammation of the ocular vasculature:

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Uveitis is called inflammation of the uveal tract - the choroid of the eye. In ICD 10 (International Classification of Diseases, 10th revision) it is coded H30-H36. The disease is not common: it affects only 0.1-0.2% of people. But it is precisely this that becomes a common cause of low vision and blindness. Let's find out what the types and symptoms of the disease are, why it occurs, and how to treat it correctly.

Uveitis is an inflammation of various parts of the uvea of the eye.

Types and causes of uveitis

Based on the reasons that caused it, uveitis is divided into:

Attention! Systemic diseases are pathological conditions in which the functioning of entire body systems, rather than just one organ, is disrupted.

An infectious disease is contagious. Adenoviral uveitis is transmitted by airborne droplets, herpetic uveitis by contact, and enteroviral uveitis by fecal-oral transmission. You can become infected with the toxoplasmosis form from infected pets and by consuming foods that have not undergone sufficient heat treatment. In fungal and bacterial types of disease, the main route of transmission is contact.

Domestic animals are carriers of the toxoplasmosis form of the disease.

Uveitis is usually caused by endogenous (internal) causes. It develops against the background of pre-existing inflammatory diseases. It can be caused by: tuberculosis infection, ear, nose and throat diseases. In such cases, pathogens are transferred to the eyes through the blood.

There is also autoimmune uveitis, which is not contagious to others. The following diseases can cause it:

psoriasis;
sarcoidosis;
Crohn's disease;
Bekhterev's disease;
juvenile rheumatoid arthritis;
nonspecific ulcerative colitis.

Ophthalmologist Elena Stanislavovna Prokhvachova says:

“Usually the cause of uveitis is an infection or a systemic disease of the body. In most cases, the patient himself does not pose a threat to others. It is easy to get infected from it only with tuberculosis. In other cases, this is only possible with very close contact with the patient, who does not follow the rules of personal hygiene.”

Poor hand hygiene is one of the causes of infection.

The disease happens:

sluggish- with mild symptoms;
with clear symptoms- begins as quickly as it ends.

If uveitis lasts less than three months, then it is called limited, if longer - persistent.

Depending on the nature of the course, the disease can be of the following types:

Spicy. Begins abruptly, duration is limited.
Recurrent. Sudden exacerbations are followed by remissions that last longer than three months without treatment.
Chronic. Persistent acute periods are replaced by short remissions (up to three months without treatment).

Based on the location of inflammation, uveitis is classified into:

front(iritis - inflammation of the iris);

Symptoms of iritis include red eyes, watery eyes, pain, and mild blurred vision.

rear(choroiditis - the choroid is inflamed - the back part of the choroid, which nourishes the retina);
peripheral(cyclitis - the ciliary body is affected - the middle part of the uveal tract, to which the lens is suspended).

Sometimes the disease affects not only the uveal tract, but also adjacent tissues. Then the following are possible: iridocyclitis (inflamed iris and ciliary body), chorioretinitis (choroid and retina) and neuroretinitis (optic nerve and retina). If the inflammation has spread to the entire choroid, then they speak of the development of panuveitis.

Symptoms of the disease

Signs of anterior uveitis:

photophobia;
lacrimation;
constricted pupils;
Pain in the eyes;
hyperemia of the sclera;
increased intraocular pressure.

Symptoms of peripheral uveitis:

blurred vision;

One of the symptoms of the peripheral form of the disease is spots before the eyes.

points before the eyes.

In the posterior form of the disease, patients complain only of blurred vision, and later of dull pain in the eyes. With panuveitis, signs of all types of uveitis are observed.

Diagnostics

In ophthalmology, two methods are used to diagnose uveitis:

Biomicroscopy of the eye(for iritis and iridocyclitis). The doctor examines the anterior structures of the eyeball under magnification using a slit lamp.

The process of eye biomicroscopy does not cause pain; the patient only observes the beam of light.

Ophthalmoscopy(for cyclitis, choroiditis and chorioretinitis and neuroretinitis). An ophthalmologist examines the condition of the fundus of the eye using an ophthalmoscope, which provides magnification from 2 to 15 times.

Additionally, the patient may be prescribed general tests, x-rays, ultrasound examinations and other diagnostic procedures to identify systemic diseases that could cause the development of uveitis.

First aid to a patient

No measures can be taken without establishing the nature of the disease, since all its types are treated differently. An exception is anterior uveitis (iritis, iridocyclitis), which can lead to fusion of the edges of the iris with the lens or their complete soldering. First aid in this case is to prescribe drugs from the mydriatic group:

In the initial forms of the disease, the doctor may prescribe Midrimax.

Irifrit;
Visofrine;

By dilating the pupil, they will prevent it from completely overgrowing, which will allow the patient to maintain visual ability. An additional effect is a decrease in intraocular pressure.

Treatment methods

For uveitis they carry out symptomatic treatment aimed at reducing the manifestations of the disease. For this, ophthalmologists prescribe the following medications:

Drugs from the NSAID group to combat mild to moderate inflammation. The drugs can be taken both topically - in the form of eye drops (Diclofenac), and systemically - in the form of tablets (Ibuprofen, Naproxen, Ketoprofen). An additional effect is pain relief.

Indocollir fights ophthalmic inflammation and relieves pain.

Glucocorticosteroids in the form of eye drops () or ointment (). They reduce inflammation in uveitis of an allergic or unknown nature, and prevent the iris from welding together.
Antihistamines for allergic forms of the disease. Eye drops - Opantanol, Allegordil, . Inside - Suprastin, Tavegil, Claritin, Xizal.
Antiviral drugs. Drops (for adenovirus infection). Ointments Acyclovir, Zovirax (for herpetic eye lesions). Sometimes antiviral drugs are prescribed orally - Acyclovir, Cycloferon tablets, Arbidol capsules.
Antibiotics with bacterial uveitis. In the form of drops: Levomycetin. In the form of an ointment: , . Inside: Amoxicillin, Ciprofloxacin, Gentamicin. It is possible to administer antibacterial drugs intramuscularly or under the conjunctiva.

For bacterial etiology of uveitis, antibiotics are prescribed, for example, Tobrex.

Combination eye drops and ointments with glucocorticosteroids and antibiotics: (tobramycin, dexamethasone), Sofradex (gramicidin, framycetin and dexamethasone).
Mydriatics(, Midrium) to prevent adhesions and eliminate spasm of the ciliary muscles of the iris, which causes pain to the patient.

For uveitis sometimes surgery is indicated. Usually prescribed:

vitrectomy;
injections under the conjunctiva;

The injections stop the inflammatory response.

filtering glaucoma surgery.

Patients may be prescribed a biopsy to clarify the diagnosis or surgery to remove pathological structures for cataracts, retinal detachment or vitreous destruction.

Attention! If the cause of the disease (possible systemic diseases) is not treated, uveitis will first become recurrent and then chronic. Then the treatment will be long and ineffective.

Egor from Murmansk writes:

“I have uveitis. The ophthalmologist said that it was caused by some disease that needed to be identified and treated. I saw an infectious disease specialist, an immunologist, an endocrinologist and a rheumatologist. Tests show an inflammatory process in the body, but no one can find anything. The doctor said that this happens in half of the cases. And I will have to limit myself to symptomatic treatment only.”

Complications and consequences

Missing or incorrect treatment of the disease is fraught with the following consequences:

10% of people who have lost their sight have become blind as a result of uveitis, which also causes low vision in 15% of cases.

Features of the course and treatment of uveitis in children

Unlike adults Diagnosing the disease in children is very difficult. In them, it develops gradually without the appearance of obvious symptoms. A sick child usually complains of worsening vision: it becomes foggy. There is no pain. With iritis and iridocyclitis, the anterior structures of the eye become filled with blood, causing the sclera to appear red. There are no other signs.

Parents who complain of deteriorating vision suspect the development of myopia. They begin to limit the time the child spends on the computer and TV, and monitor how he writes and reads. They may insist on doing eye exercises. But this is the main mistake, because Without treatment, uveitis causes retinal detachment within a few months.

Attention! The first step parents should take if their child says he has trouble seeing is to take him to an ophthalmologist.

He will see the problem after checking his vision using the Sivtsev table. With myopia, children see the top lines, and with uveitis, all letters will be blurred. Then the doctor will conduct additional diagnostics.

Only a doctor can diagnose a child.

Treatment of inflammation of the choroid in children is no different. They are also given local and systemic therapy, and in severe cases they undergo surgery. A thorough examination of the body is recommended to detect indolent infections and other hidden diseases that could cause uveitis.

Daria from Saratov writes:

“I have been suffering from tuberculous uveitis since I was 7 years old. For 5 years, she underwent 2 courses of drug therapy per year. Now I’m 24 years old, there are no relapses, but I constantly use drops. Cataracts and glaucoma have developed, the pupil is fused with the lens, and with my right eye I can only see silhouettes. They offer me surgery. I'm at a loss".

Prevention of uveitis

To prevent inflammation of the choroid, you need to maintain hygiene and promptly treat infectious, autoimmune, as well as systemic diseases and allergies.

Prevention and timely treatment of eye diseases are very important.

If you ignore the symptoms of uveitis, vision deteriorates or blindness develops. Therefore, consult a doctor at the first signs of illness. Early treatment reduces the risk of complications and consequences. To ensure that your eyes no longer become inflamed, undergo a complete examination of your body. It will help identify hidden pathologies that may be the cause of the disease.

The group of diseases of the organ of vision includes uveitis of the eye. With this pathology, the iris, ciliary body and choroid are affected. The human eye has a very complex structure. The apple is formed by 3 membranes: fibrous, choroid and retina. With uveitis, the vascular layer, which is rich in capillaries, becomes inflamed.

Uveitis is a collective term that refers to inflammation of the iris, ciliary body and choroid. This disease is very common among people under 40 years of age. Uveitis is often diagnosed in children and adolescents. A type of this disease is iridocyclitis. The following forms of uveitis are known:

front;
median;
rear;
generalized.

Iritis is an inflammation of the iris, and cyclitis is a lesion of the ciliary body. In the middle form of uveitis, the ciliary body, the choroid itself, the retina and the vitreous body are involved in the process. A feature of the posterior form of the disease is damage to the optic nerve. The greatest danger is panuveitis.

With it, all the membranes of the eye become inflamed. Depending on the nature of the exudate, serous, purulent, mixed and fibrinous-lamellar uveitis are distinguished. This pathology can be primary or secondary.

According to the nature of the course, uveitis is divided into acute, chronic and recurrent. There are also allergic, infectious, mixed, traumatic and systemic forms of the disease. Sometimes the cause of inflammation cannot be identified.

Etiological factors

With uveitis, the causes can be very different. The following etiological factors are of greatest importance:

Very often, uveitis develops against the background of influenza and ARVI. Possible causes include streptococcal diseases, gonorrhea, tuberculosis, malaria and chlamydia. Infectious anterior uveitis most often develops. Inflammation is caused by bacteria and viruses. Fungi are detected less frequently. Pathogens can enter the eye through the blood from chronic foci of infection.

Peripheral uveitis may be a manifestation of an allergic reaction. This is possible in response to the administration of immunological drugs (serums), consumption of certain foods and medications. Sluggish uveitis occurs with systemic diseases. The traumatic form most often develops from burns and penetration of foreign bodies.

Predisposing factors are the following:

endocrine disorders;
decreased immunity;
hypothermia;
keratitis;
blood diseases;
menopause

The risk of developing this pathology increases with stress, intense physical work and an improperly organized daily routine.

General clinical manifestations

With uveitis, the symptoms are numerous. The clinical picture is determined by the underlying cause and location of the lesion. The most commonly observed manifestations are:

pain in the eyes on one or both sides;
lacrimation;
redness;
fear of bright light;
presence of floating spots before the eyes.

Acute purulent uveitis is the most severe. It causes severe pain. Maybe . Often these people have increased intraocular pressure. Glaucoma may develop. Chronic uveitis occurs with scanty symptoms. The peripheral form of the disease is characterized by damage to both eyes.

The following symptoms are possible:

blurred vision;
decreased central vision;
hyperemia.

With posterior uveitis, visible objects are often distorted. The clinical picture largely depends on the underlying disease. In Vogt-Koyanagi-Harada syndrome, in addition to visual disturbances, hair loss, hearing loss, headache and psychosis are observed.

If the cause of uveitis is sarcoidosis, then the lymph nodes become enlarged and shortness of breath with cough appears.

Development of iridocyclitis in humans

The most commonly diagnosed pathology is iridocyclitis. This is anterior uveitis. Initially, only the iris or ciliary body becomes inflamed. Then the pathological process spreads to neighboring structures. The development of this pathology is based on the following disorders:

immune cytolysis;
production of inflammatory mediators;
vascular damage;
microcirculation disturbance.

The following symptoms are observed with iridocyclitis:

change in iris color to green or rusty red;
pain;
redness;
pain on palpation;
moderate vision impairment;
Availability .

A mild corneal syndrome is determined. It includes lacrimation, photophobia and blepharospasm. There may be accumulation of pus at the bottom of the anterior chamber. This condition is called hypopyon. A yellow-green stripe is visually identified. In severe cases, pupil deformation develops. It may narrow.

If uveitis is not treated, blindness is possible. The reason is pupil overgrowth. Intraocular pressure is increased or decreased. If the cause is tuberculosis, then yellowish tubercles are detected in the area of the iris. Posterior synechiae (fusions) are formed. Autoimmune uveitis is distinguished by the fact that it often recurs and is severe.

If the cause is injury, then after one eye the second is affected. This state is called. If iridocyclitis is caused by Reiter's syndrome due to chlamydia, then there are signs of damage to the conjunctiva, joints and urethra.

How does chorioretinitis occur?

Posterior uveitis can occur as chorioretinitis. With it, the choroid becomes inflamed along with the retina. The following forms of this disease are known:

peripapillary;
central;
equatorial;
peripheral.

If symptoms persist for less than 3 months, we are talking about. The peripheral form of the disease often occurs hidden. If an exacerbation occurs, the following symptoms are possible:

blurred vision;
dark spots;
distortion of objects;
violation .

Chorioretinitis develops against the background of infection, radiation, allergic reactions and autoimmune disorders. The risk group includes people with immunodeficiency.

How dangerous is uveitis for humans?

With peripheral and central uveitis, dangerous complications can develop. The following consequences of this disease are possible:

macular edema;
blindness;
significant visual impairment;
acute occlusion of retinal vessels;
optical neuropathy;
glaucoma;
cataract;
synechia;
corneal damage;
pupil overgrowth;
optic nerve atrophy;
retinal detachment.

The autoimmune form of anterior uveitis causes cataracts, scleritis, etc. Glaucoma is a common complication. It is manifested by pain in the area of the superciliary arches, decreased visual acuity of objects, blurred vision, the appearance of rainbow circles before the eyes and loss of visual fields.

Recurrent uveitis of infectious etiology can cause the spread of microbes. This leads to endophthalmitis and.

Patient examination plan

With iridocyclochoroiditis, the symptoms are similar to other eye diseases. If uveitis is suspected, the following studies are performed:

external inspection;
assessment of visual acuity using special tables;
perimetry;
biomicroscopy;
gonioscopy;
ophthalmoscopy;
tonometry;
angiography;
coherence optical tomography;
rheoophthalmography;
electroretinography.

Gonioscopy is very informative. During it, the anterior chamber of the eye is examined. The condition of the iris root, ciliary body, Schwalbe ring, Schlemm's canal and trabecula is assessed. Using gonioscopy, you can identify the presence of synechiae and exudate, as well as determine the condition of the blood vessels. Biomicroscopy is required.

A slit lamp will be needed. It allows you to examine all the structures of the eye at high magnification. The fundus, retina, and optic nerve can be visualized during ophthalmoscopy. In the infectious form of the disease, it is necessary to identify the pathogen. A bacteriological or virological study is carried out.

If necessary, consultation with a phthisiatrician, rheumatologist, infectious disease specialist and other specialists is required. A blood test is performed for sugar and rheumatoid factor. Specific antibodies are detected. Differential diagnosis is carried out with primary glaucoma, keratitis and acute conjunctivitis.

Treatment methods for uveitis

The symptoms and treatment of this pathology are not known to everyone. For this pathology, drug therapy is carried out. The following groups of drugs may be prescribed:

antiviral drugs;
NSAIDs;
mydriatics;
systemic corticosteroids;
antihistamines;
cytostatics.

To eliminate spasm of the ciliary muscle, drops are prescribed that dilate the pupil. These include Atropine. The basis of therapy for patients with uveitis is the use of corticosteroids. They are prescribed in the form of tablets, drops and ointments for the eyes.

Instillations are most often performed. Prednisolone Nycomed is used. If glaucoma develops, medications are used that reduce the accumulation of fluid in the eye. These can be adrenergic blockers and sympathomimetics.

In severe cases of infectious uveitis of the eye, treatment requires detoxification therapy. Enzymes are often prescribed to resolve exudate. After eliminating the pain syndrome, physical therapy (magnetic therapy, electrophoresis, laser correction) is carried out in the remission phase. If complications develop, surgical intervention is required. The resulting synechiae are dissected.

Radical treatment is also required in case of lens clouding, glaucoma and retinal detachment. Sometimes it is necessary to remove the vitreous. The indication is iridocyclochoroiditis. In more severe cases, evisceration is organized. It removes the internal structures of the apple.

The prognosis for uncomplicated uveitis is favorable. The duration of the disease is 3-6 weeks. Relapses are possible. When the retina is involved in the process, vision often decreases.

Prevention measures

This disease can be prevented. To do this, you must follow the following recommendations:

promptly treat infectious diseases;
Wear safety glasses when performing work that is hazardous to the eyes;
exclude injuries;
prevent eye burns;
visit an ophthalmologist periodically;
monitor hormonal levels;
do not contact with allergens;
lead a healthy lifestyle.

The most common causes of uveitis are infection, trauma, and systemic disease. They need to be prevented or treated in the early stages. Most often, uveitis is a complication of another pathology. Prevention should be carried out from a young age. To protect children from this pathology, it is necessary to prevent bacterial and viral infections.

If uveitis does develop, the goal is to prevent complications. To do this, you need to visit your doctor in a timely manner and follow all his prescriptions. Self-medication can lead to dangerous complications, including loss of an eye. Thus, uveitis is a very common ophthalmological pathology.

Video

Uveitis is a term in ophthalmology that combines the inflammatory process in various parts of the uvea of the eye, which is represented by the iris, ciliary body, and choroid. The pathology can affect one (infections) or both eyes (autoimmune diseases) and is accompanied by redness, increased sensitivity to light, blurred vision, pain, excessive tearing, and the presence of floating spots in front of the eyes. There are many causes of uveitis. The onset may be acute, or clinical symptoms develop gradually.

Table of contents:

All categories of people are susceptible to pathology, but in children and the elderly, uveitis is more often of infectious origin.

In case of systemic diseases, damage to the second eye may occur after a certain period of time.

Self-medication or inadequate therapy can lead to blindness.

Patients with uveitis are considered the most difficult to diagnose in all of ophthalmology. Because treatment and prognosis for uveitis vary, it is important to establish an accurate diagnosis. Many pathologies, including heterochromic Fuchs iridocyclitis, Behçet's disease, cytomegalovirus retinitis, ocular histoplasmosis and Vogt-Koyanagi-Harada disease are clinical diagnoses, therefore multifaceted diagnostics are carried out, and patients are treated by several specialists at once.

On the other hand, a patient with an initial episode of acute nongranulomatous anterior uveitis does not require laboratory evaluation.

One strategy used by almost all clinicians is to develop a list of potential diagnoses after interviewing the patient, followed by a focused history and physical examination, with appropriate assessment that shortens the diagnostic search.

Character of the current

Uveitis is classified as:

acute: sudden onset, limited duration;
relapsing: with periods of remission of at least 3 months, without treatment;
chronic: return of episodes of the disease, despite therapy, less than 3 months after its completion.

The treatment regimen for uveitis is individual and based on the results of a clinical and ophthalmological examination and identification of the etiological factor; Both local and systemic therapy are used. In case of complications, surgical intervention is performed.

Inflammation of the uveal tract accounts for 30-50%; in 25% of patients, the pathology is complicated by persistent visual impairment and blindness.

Forms of uveitis are associated with the involved anatomical site and are represented by choroiditis, chorioritinitis.

A developed vascular network and slower blood flow, against the background of predisposing factors, contribute to the accumulation and retention of pathogens that begin to actively multiply.

The blood supply and innervation of the anterior and posterior sections are separated, so inflammatory processes occur in isolation.

Causes and predisposing factors of uveitis

Predisposing factors include:

genetic predisposition (presence of certain genes);
a number of diseases: autoimmune diseases/spondyloarthropathy/collagenosis, / etc.);
infections (viruses:, etc., some, toxplasmosis, bacteria, fungi, rickettsia);
injuries;
burns;
allergens;
hormonal imbalance;
history of eye diseases;
taking certain medications;
chemical exposure, etc.

Uveitis often develops against the background of an underlying systemic disease; about 50% of patients have an idiopathic form. Acute nongranulomatous uveitis associated with pathologies associated with human leukocyte antigen B27 (HLA B27), including inflammatory bowel disease, reactive and psoriatic arthritis, Behçet's disease. Herpes simplex and trauma are also associated with acute nongranulomatous uveitis.

Chronic nongranulomatous uveitis diagnosed with juvenile, chronic iridocyclitis and Fuchs heterochromic iridocyclitis.

Chronic granulomatous uveitis accompanies sarcoidosis and tuberculosis.

Posterior uveitis occurs in toxoplasmosis, ocular histoplasmosis, syphilis, sarcoidosis and in immunocompromised patients with cytomegalovirus, candidal or herpetic infections.

Symptoms of uveitis

General symptoms of uveitis:

note

The above symptoms are not necessarily present simultaneously: the longer the pathological process exists, and the stronger its severity, the brighter and more diverse the clinical manifestations. Localization also matters.

The proximity of the endings of the trigeminal nerve leads to irradiation of pain in the facial area: cheeks, jaw, nose, temples, forehead.

This symptom is considered pathognomonic for herpes infection and secondary glaucoma.

Additional symptoms that are important for diagnosis:

hearing impairment/sensorineural deafness;
hair loss;
change in mental reactions;
skin manifestations;
cough, ;
joint lesions;
genital ulcers;
enlarged salivary and lacrimal glands;
aphthae in the oral cavity

Differential diagnosis includes the following:

spicy ;
corneal ulcer and ulcerative;
corneal abrasion;
herpetic keratitis;
intraocular foreign body;
scleritis;
keratitis caused by damage from ultraviolet rays.

Anterior uveitis: iridocyclitis, iritis, cyclitis

The iris and ciliary body are involved. Most often ophthalmologists encounter anterior endogenous uveitis when the etiological factor is internal: general toxic-allergic reactions or metastatic lesions.

Anterior exogenous uveitis always secondary and develops acutely during trauma, after surgery, perforation of a corneal ulcer, etc.

On palpation, the pain intensifies.

The mechanism of injury is thought to be a combination of microbial contamination and accumulation of necrotic debris at the site of injury, stimulating the body to inflammation in the anterior segment of the eye.

The accumulation of inflammatory elements causes clouding of the aqueous humor of the anterior chamber (hypopyon); in case of hemorrhage (hyphema) against the background of injury, the exudate acquires a reddish tint due to blood. Precipitates are localized in the lower part of the cornea and resemble a triangle, but can cover the entire posterior surface.

Pathologically dilated vessels and swelling against the background of inflammation change the color and pattern of the iris. Deformation of the pupil is a consequence of the adhesive process between the pupillary edge and the anterior surface of the lens, up to complete fusion of the pupil. Communication between the anterior and posterior chambers of the eye is disrupted, leading to increased intraocular pressure or secondary glaucoma. Nutrients and oxygen are supplied in limited quantities, and the developed cataract is accompanied by a decrease in visual acuity.

Iridocyclitis changes the structure of the vitreous body, clouding occurs, and the replacement of normal tissue with connective tissue sharply disrupts the functions of the eye. If it spreads to the retina, retinal detachment may develop.

note

Anterior uveitis, unlike posterior uveitis, is sterile in most cases: the infectious nature of the disease is absent.

More often, the pathology regresses within 1.5 months, but the cause cannot be determined.

Chronic uveitis represented by blurred vision and slight redness. The patient experiences mild pain and photophobia, except during an acute episode.

Posterior uveitis (choroiditis)

Inflammatory areas with perifocal inflammation (edema and hyperemia) in the fundus can be single or multiple, with variable shape and color. The process involves the retina or choroid: choroiditis, chorioretinitis, retinochoroiditis, retinitis, neuroretinitis. The patient's general condition does not suffer.

The pathology is visualized by ophthalmoscopy; the diagnostic method allows one to examine granulomatous lesions through a transparent or cloudy retina.

In advanced cases, the retina and optic nerve head are affected.

Choroiditis is characterized by loss of visual fields/blind areas, depending on the location of pathological formations: with central localization, visual acuity decreases, complaints of image curvature, the presence of dark spots when examining white objects, photopsia (moving dots, flashes, spots, figures, etc.) .).

Soreness and redness are not typical, the main complaint is blurred vision.

Posterior uveitis symptoms and pain indicate anterior chamber involvement, bacterial endophthalmitis, or posterior scleritis.

Intermediate (medium) uveitis

The process affects the vitreous body (posterior cyclitis, hyalitis) and is bilateral in nature.

Pain and hyperemia are less pronounced than with anterior uveitis, but opacities in the vitreous and visual impairment are more significant.

Moderate uveitis in children and adolescents is difficult to treat and has a high risk of complications.

Diagnosis is difficult, since the anatomical zone is inaccessible to standard ophthalmological diagnostics.

Generalized uveitis (panuveitis)

The most serious form, the entire vascular tract of the eye is involved in the process: the anterior chamber, the vitreous body and/or the choroid.

The infection enters the uveal tract hematogenously, or toxic damage occurs. With severe hypersensitivity reactions and general allergization, conditions accompanied by immunosuppression, panuveitis can also develop.

Clinical manifestations are varied: panuveitis can be present with any symptoms.

Treatment of uveitis

Uveitis has no standard treatment regimen.

Therapy includes a number of drugs from different groups; their action is aimed at eliminating the etiological factor and relieving pathological symptoms, they use:

vasodilators;
non-steroidal anti-inflammatory drugs (NSAIDs);
hormones: topical and systemic corticosteroids;
immunosuppressants;
antihistamines;
mydriatics and cytoplegics;
vitamins;
enzymes, etc.

Additionally, physiotherapy is used.

Cycloplegic and corticosteroid drops are initially prescribed to relieve pain and reduce inflammation.

Before treatment, intraocular pressure must be assessed and the herpetic nature of uveitis excluded.

In patients with severe cases who do not respond to steroids or who have complications with conventional therapy, immunosuppressants may be used. They are also considered as first-line therapy for the treatment of uveitis in Behçet's disease, Wegener's granulomatosis and necrotizing scleritis. These diseases are often associated with life-threatening systemic vasculitis.

Necrosis factor inhibitors

Immunomodulatory therapy is used in situations where long-term treatment with systemic corticosteroids is necessary. New treatment approaches are drugs that target specific mediators of the immune response. Although these drugs have been studied primarily in patients with rheumatoid arthritis, psoriasis, and Crohn's disease, the similarities in disease pathogenesis have stimulated interest in using these drugs to treat various inflammatory eye diseases. Tumor necrosis factor alpha blocking molecules (eg, adalimumab, infliximab) have been found to effectively modulate the immune response in patients with uveitis.

In June 2016, the FDA approved adalimumab (Humira) for the treatment of non-infectious intermediate uveitis, posterior uveitis and panuveitis in adults. The basis is the results of two pivotal phase 3 studies: VISUAL-I and VISUAL-II, which showed that adult patients with active and controlled non-infectious intermediate uveitis, posterior uveitis and panuveitis had a significantly lower risk of treatment failure with adalimumab.

Intraocular implants and intravitreal injections

Another new treatment option is the use of intraocular pharmacotherapy through injections and surgical placement of implants. Cataract formation and increased intraocular pressure are common side effects, and the risk of endophthalmitis (usually sterile) is approximately 0.1%.

Cycloplegics

Symptoms and complications of inflammation can be reduced by topical cycloplegic agents. Short-acting drops (cyclopentalate) and long-acting drops (atropine) can be used to reduce photophobia caused by ciliary spasm and to break up or prevent the formation of posterior synechiae (adhesions).

Cyclopentolate causes mydriasis after 30-60 minutes and cycloplugia after 25-75 minutes. The effect lasts up to 24 hours.

Corticosteroids

Corticosteroids slow the release of arachidonic acid from phospholipids, inhibit transcription and cytokine action, and limit the activity of B and T cells. They are indicated for inflammatory diseases of non-infectious causes. Three routes of administration are available: local, periocular and systemic, which is determined individually in each case. Because of serious side effects, especially with high doses and long-term use, immunosuppressants are commonly used for chronic or sight-threatening uveitis.

note

For anterior uveitis, steroid drops are used. Prednisolone acetate 1% is preferred. Sometimes steroids can cause ocular hypertension; therefore, you need to monitor intraocular pressure once a month.

Intravitreal implants of dexamethasone and fluocinolone may be considered as an option to provide prolonged treatment.

Periocular corticosteroids are used to treat posterior uveitis.

In the presence of a systemic disease that additionally requires ophthalmological treatment; For uveitis that does not respond well to other treatments, systemic oral or intravenous therapy is necessary. Prednisone is the most used oral corticosteroid.

Prednisolone ophthalmic (Pred Forte) treats acute inflammation after ophthalmic surgery or other types of eye damage. It reduces inflammation and neovascularization of the cornea, inhibits the migration of polymorphonuclear leukocytes and reduces capillary permeability. In cases of bacterial infections, the use of antibacterial agents is mandatory.

Other drugs:

Dexamethasone (Ozurdex implant for chronic non-infectious uveitis),
Fluocinolone ophthalmic (Retisert implant),
Triamcinolone for intravitreal administration,
Prednisone, etc.

Immunosuppressive agents

Immunosuppressants: antimetabolites, T-cell suppressors and cytotoxic agents. Antimetabolites include azathioprine, methotrexate, and mycophenolate mofetil. T-cell inhibitors include cyclosporine and tacrolimus. Cytotoxic agents: cyclophosphamide and chlorambucil. Most drugs take several weeks to be effective and are initially given in combination with oral corticosteroids.

Prevention

Preventive measures include:

Mishina Victoria, doctor, medical columnist