Uveitis in adults
Uveitis is a rather serious eye disease that can even lead to blindness if not treated on time. We learned from experts what causes uveitis, what symptoms should be alerted, whether it is possible to do without surgery, and how to prevent uveitis at home

Uveitis in adults and children is a serious problem of modern ophthalmology. The disease is dangerous because it often occurs in a latent form.1. This hinders timely diagnosis and treatment and often leads to the development of complications, the most severe of which is irreversible blindness.1. According to statistics, vision loss occurs in 10-15% of patients with uveitis.1.

We asked our experts about the causes of uveitis in adults. They also learned about modern methods of treating uveitis and preventive measures that will help reduce the likelihood of developing the disease.

What is uveitis

Uveitis is an inflammation of the choroid or uveal membrane of the eye.1. The inflammatory process can also affect the retina, its vessels and the optic nerve.1.

Depending on where the inflammation develops, there are anterior, posterior, median and generalized uveitis. With anterior uveitis, the inflammatory process affects the ciliary body and iris, with median uveitis, the vitreous body, retina, and ciliary body suffer, while with posterior uveitis, the retina, choroid, and optic nerve suffer. In the generalized form of the disease, inflammation captures all the vascular structures of the eye.

Most often, uveitis affects people of working age from 20 to 40 years. The disease can occur in acute, chronic and chronic relapsing form. Acute inflammatory process lasts less than 3 months, chronic – more than 3 months. In the relapsing form, periods of exacerbations alternate with periods of remission.

Causes of uveitis in adults

Uveitis in adults can be caused by infections, trauma, allergic reactions, and hormonal imbalances. In almost half of the cases, the disease has an infectious origin.1. The causative agents of the disease can be tubercle bacillus, streptococci, herpesvirus, toxoplasma, various fungi1.

Infectious pathogens can enter the choroid of the eye from the external environment and any infectious focus in the body2. Therefore, uveitis can develop against the background of caries, infectious diseases of the urogenital area and ENT pathologies, such as otitis media, sinusitis and tonsillitis.2. Inflammatory processes in the maxillofacial zone are very dangerous, from where the infection easily penetrates into the choroid2.

Allergic reactions are another cause of uveitis in adults. Allergies can begin due to the use of certain foods and medications. Sometimes vaccines cause an allergic reaction.

The cause of uveitis in adults can be an autoimmune and rheumatoid disease:

  • psoriatic, rheumatoid and reactive arthritis;
  • Behcet’s disease;
  • ankylosing spondylitis;
  • systemic scleroderma and systemic lupus erythematosus3.

Non-infectious uveitis occurs against the background of diabetes mellitus, thyroid disease, hepatitis B and C3. Post-traumatic uveitis develops after a foreign body enters the eye, chemical and thermal burns, and other injuries.

Symptoms of uveitis in adults

The symptoms of uveitis are very similar to those of other eye diseases. And some signs of pathology can be detected only with the help of diagnostic devices. Therefore, doctors advise to carefully monitor the condition of their eyes and, with the slightest deviation, seek medical help.

Symptoms of uveitis in adults depend on which part of the eye is affected by the inflammatory process. With anterior uveitis, visual acuity decreases, “fogging”, photophobia and lacrimation appear, and the eye becomes painful. Unpleasant sensations are aggravated by palpation1.

With posterior uveitis, pain in the eye is usually not observed, but vision may deteriorate. “Fog” and floating muddy fragments appear before the eyes, the outlines of objects are distorted, a person notices a weakening of twilight vision1. Posterior uveitis in an asymptomatic form may not manifest itself in any way and is often detected during a routine examination by an ophthalmologist, who reveals a degenerative lesion of the retina2.

The diagnosis of uveitis is made after the examination. For diagnosis use:

  • external eye examination;
  • viziometriya – checking visual acuity;
  • perimetry – determination of visual fields;
  • tonometry – measurement of intraocular pressure;
  • biomicroscopy – microscopic examination of the conjunctiva, lens, iris, vitreous body;
  • ophthalmoscopy – a detailed examination of the fundus of the eye.

According to indications, additional examinations are prescribed, among which may be X-ray of the lungs and spine, CT and MRI of the brain, PCR tests to detect infectious pathogens.

Treatment of uveitis in adults

For the treatment of uveitis in adults, conservative methods are most often used. In the early stages of the disease, most patients are prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and mydriatics, drugs that relieve spasm of the ciliary muscle and dilate the pupil. The choice of drugs depends on the cause of the disease:

  • with infectious uveitis, antibacterial and antiviral agents are prescribed;
  • antihistamines prescribed for allergies3;
  • in systemic autoimmune diseases, cytostatics, NSAIDs are recommended3.

Glucocorticosteroids play an important role in the treatment of uveitis in adults. These drugs have an anti-inflammatory effect, reduce pain and swelling. For therapy, local glucocorticosteroids are used in the form of eye drops and ointments, and systemic action – in the form of tablets and injections.

Surgical treatment of uveitis in adults is required if complications arise: retinal detachment, secondary glaucoma, vitreous fibrosis, complicated cataract1. Surgery can be urgent or planned. A planned operation is done during a period of remission, which lasts at least 3 months1.

Prevention of uveitis in adults at home

To prevent uveitis in adults, doctors recommend timely treatment of general and ophthalmic diseases, protecting the eyes from injuries, and avoiding contact with allergens if they are prone to allergic reactions. Regular (at least once a year) examination by an ophthalmologist will not be superfluous.

Popular questions and answers

Our experts answer popular questions: ophthalmologist Tatyana Sotnikova и ophthalmic surgeon Natalya Koval.

How does uveitis start?

– At the initial stage, the inflammatory process manifests itself with the symptoms mentioned above. This may be photophobia, lacrimation, soreness of the eye on palpation, blepharospasm – difficulty opening the eyelid.

Why is uveitis dangerous in adults?

The main danger is complications, among which there may be secondary glaucoma, complicated cataract, retinal edema, vitreous opacity. Perhaps a significant deterioration in visual function and complete loss of vision.

How long does it take to treat uveitis?

– The duration of treatment depends on the form of the disease, the presence or absence of relapses. The duration of therapy averages from 10 days to 6 months.

Which doctor should I contact with signs of uveitis?

Uveitis is treated by an ophthalmologist. Depending on the cause and clinical picture of the disease, other specialists may be involved in therapy – infectious disease specialists, endocrinologists and rheumatologists. The intervention of a surgeon may be required, for example, if the vitreous body of the eye has been affected by the disease.

Sources:

  1. Diagnosis and treatment of uveitis associated with juvenile idiopathic arthritis. Russian Association of Ophthalmologists. 2015 Clinical guidelines. https://disk.yandex.ru/i/FyEt5gya9eMiew
  2. Inflammatory diseases of the vascular tract of the eyes (uveitis). Tutorial. Irkutsk State Medical University. Department of Eye Diseases. 2015 https://clck.ru/dYKfw
  3. Uveitis is non-infectious. All-Russian public organization “Society of Ophthalmologists of Russia”, “Association of Ophthalmologists”. Clinical guidelines. https://clck.ru/dYKyJ

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