Uveitis

Uveitis is, broadly, inflammation of the uvea. The uvea consists of the middle, pigmented vascular structures of the eye and includes the iris, ciliary body, and choroid. Uveitis requires an urgent referral and thorough examination by an optometrist or ophthalmologist and urgent treatment to control the inflammation. Prior to the twentieth century, uveitis was typically referred to in English as "ophthalmia.

Uveitis is usually an isolated illness, but can be associated with many conditions, including diseases with major involvement of other body parts, as well as syndromes confined to the eye.

The most common form of uveitis is acute anterior uveitis (AAU). It is most commonly associated with HLA-B27, which has important features: HLA-B27 AAU can be associated with ocular inflammation alone or in association with systemic disease. HLA-B27 AAU has characteristic clinical features including male preponderance, unilateral alternating acute onset, a non-granulomatous appearance, and frequent recurrences whereas HLA-B27 negative AAU has an equivalent male to female onset, bilateral chronic course, and more frequent granulomatous appearance. Rheumatoid arthritis is not uncommon in Asian countries as a significant association of uveitis.

Uveitis is typically treated with glucocorticoid steroids, either as topical eye drops (prednisolone acetate) or as oral therapy. Prior to the administration of corticosteroids, corneal ulcers must be ruled out. This is typically done using a fluoresence dye test. In addition to corticosteroids, topical cycloplegics, such as atropine or homatropine, may be used. Successful treatment of active uveitis increases T-regulatory cells in the eye, which likely contributes to disease regression. In some cases an injection of posterior subtenon triamcinolone acetate may also be given to reduce the swelling of the eye.