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Uveitis & Eye Inflammation at The Eye Care & Surgery Center in New Jersey

By Milton Kahn, M.D.

About Eye Anatomy & Uveitis
The term uveitis refers to inflammation of the middle layer of the eye but is often used to describe any inflammatory process involving the interior of the eye. The middle layer of the eye is called the uvea or uveal tract. The uvea consists of a number of ocular structures including the iris, the ciliary body and the choroid. The uvea lines the inner eye like a tunic and the only visible element of the uvea is the iris or the colored part of the eye.The uvea provides most of the blood supply to the retina. Inflammation in any of the parts of the uveal tract is called Uveitis

Inflammation Inside the Eye is a Medical Emergency Because If Untreated It Will Lead to Vision Loss
Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States. Uveitis requires an urgent and thorough examination along with urgent treatment to control the inflammation. Uveitis is classified into Anterior, Intermediate, Posterior and Panuveitic forms, based on which part of the eye is primarily affected by the inflammation.

Anterior Uveitis
The most common type of Uveitis is Anterior Uveitis. In fact, between 65-90% of Uveitis is Anterior Uveitis, affecting the Iris and/or Anterior Chamber of the eye and thus called Iritis. Iritis can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature. Signs and symptoms of Iritis may include a red eye and conjunctiva, light sensitivity, blurred vision, pain, floating spots and upon examination of the eye, inflammatory cells in the front chamber of the eye-called the anterior chamber-and possibly precipitates or inflammatory deposits on the back surface of the cornea. Anterior Uveitis or Iritis may be associated with autoimmune diseases such as rheumatoid arthritis, but often occurs in healthy people. The disorder may affect only one eye. It is most common in young and middle-aged people.

Intermediate Uveitis
Intermediate Uveitis affects the pars plana and/or the back chamber of the eye-called the vitreous cavity- with the presence of inflammatory cells causing vitritis, an inflammation of the vitreous body and sometimes what is referred to as “snowbanking” as a result of inflammatory cells and material on the pars plana structure. Pars Planitis affects the narrow area between the colored part of the eye (Iris) and the choroid. Pars Planitis usually occurs in young men and is generally not associated with any other disease. However, some evidence suggests it may be linked to Crohn's disease and possibly Multiple Sclerosis.

Posterior Uveitis
Posterior Uveitis is an inflammation of the back part of the eye and affects either the choroid and/or retina. Often it involves primarily the choroidchoroid, the layer of blood vessels and connective tissue in the middle part of the eye. This type of Uveitis is called Choroiditis. If the retina is also involved it is called Chorioretinitis. You may develop this condition if you have had a body-wide or systemic infection or if you have an Autoimmune Disease such as Rheumatoid Arthritis, Inflammatory Bowel Disease or Sarcoidosis.

Panuveitis
Panuveitis is the inflammation of all of the layers and structures of the Uvea.

Causes of Eye Inflammation & Uveitis
Eye Inflammation and Uveitis can be caused by a number of infectious diseases, non-infectious causes including autoimmune diseases, trauma or injury, malignancies and even induced by certain drugs or medications. Some of the infectious causes may include bacteria, parasites, fungus, viruses such as rubella, HIV-AIDS, sexually transmitted diseases such as syphilis, chlamydia or gonorrhea and unusual infections, such as tuberculosis, toxoplasmosis or Lyme Disease. Of the non-infectious causes, autoimmune disease-such a Rheumatoid Arthritis, Lupus Erythematosis, Crohn’s & Inflammatory Bowel Disease and Behcet’s Disease-are possible causes of eye inflammation.

Certain drugs and medications can cause ocular inflammatory disease including bisphosphonates, a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases, Cidofovir, an antiviral medication for the treatment of Cytomegalovirus (CMV) Retinitis in patients with AIDS, Rifabutin, an antibiotic used in HIV and Tuberculosis, and sulfonamides-a common antibacterial-or topical corticosteroids. In addition, certain vaccines and even skin tattoos can cause ocular inflammatory disease and eye inflammation.

Finally, certain cancers can cause eye inflammation such as lymphoma, lung cancer and breast cancer.

Treatment of Eye Inflammation & Uveitis
Generally, the prognosis for those who are diagnosed and treated quickly is good but guarded. Most attacks of Anterior Uveitis go away in a few days to weeks. However, relapses are common. Inflammation related to Posterior Uveitis may last from months to years and may cause permanent vision damage, even with treatment. Even with prompt clinical care serious complications such as cataracts, glaucoma, retinal edema and corneal band keratopathy may occur. Specifically, the type of Uveitis, as well as its severity, duration, and responsiveness to treatment or any associated illnesses, all play a role in to the outlook.

Typically the treatment of eye inflammation or Uveitis is approached in a stepwise manner. The first step is steroid medication.  A steroid is an anti-inflammatory immunosuppressive medication that can be administered in many forms: drops, oral, injection, or intravenous infusion.  The form of steroid that is prescribed depends on the severity and type of ocular inflammatory disease being treated. Steroid medication can be effective in rapidly stopping acute inflammation. However, when steroids are used for long term treatment they often result in their own set of complications and side effects such as stomach ulcers, osteoporosis (bone thinning), diabetes, cataract, glaucoma, cardiovascular disease, weight gain, fluid retention, and possibly even Cushing’s syndrome.

If the inflammation continues after slowly discontinuing the steroid medication, Retina Specialist Milton Kahn, M.D. may prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) such as Motrin®, Celebrex® or Naprosyn. NSAIDS are another type of medication that works to suppress inflammation. Oral NSAIDS require monitoring of your liver and kidney function and if used for long periods of time may require some additional medication to prevent stomach ulcers.

If the inflammation persists even after the use of NSAIDs, it is possible that Dr. Kahn will prescribe immunosuppressive chemotherapy medications or Immunomodulatory Therapy (IMT) including such medications as Methotrexate, CellCept, Imuran, Cytoxan, Leukeran and Cyclosporin. The use of such medication requires special, regular monitoring and blood tests in order to avoid side effects.

A newer category of medications employed for the treatment of autoimmune diseases called biologic response modifiers (BRM). This category of medications may more effectively target components of the immune system and thus avoid some of the potential risks of the more conventional IMT medications. Such medications include Humira® and Remicade®.

The use of most, if not all of the medication mentioned here as being used for treatment of ocular inflammatory disease is considered “Off Label” by the United States Food and Drug Administration (FDA). This means that the pharmaceutical companies who manufacture these medications have never conducted the randomized clinical trials required by the FDA in order for the companies to include treatment of ocular inflammatory disease in the package insert or “label” for the medication. Therefore, physicians who employ such medications for treating eye inflammation do so “off-label.”  Off-label use is perfectly legal and appropriate, if, in the physician’s opinion, it is in the patient’s best interest to proceed with such treatment.  One can find numerous clinical reports and studies in the medical literature that demonstrate the success of the use of these types of medications for treating eye inflammation.

In conjunction with immunosuppressant medication and/or antibiotics, additional medications may be used as well. These may include eye drops that dilate the pupil and reduce spasm of the ciliary body if inflammation is in the iris. By preventing ciliary body contraction and spasm it will reduce the pain or discomfort you might otherwise experience. However, with a dilated pupil, it may be necessary to wear sunglasses because bright light may cause discomfort.

If you or someone you know would like to learn more about uveitis, eye inflammation or ocular inflammatory disease, please call The Eye Care & Surgery Center at 908-789-8999 to schedule an appointment.