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Uveitis

Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye. more...

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Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States. Uveitis requires a thorough examination by an ophthalmologist.

Types

Uveitis is usually categorized anatomically into anterior, intermediate, posterior and panuveitic forms.

  • Anywhere from two-thirds to 90% of uveitis cases are anterior in location (anterior uveitis), frequently termed iritis - or inflammation of the iris and anterior chamber. This condition can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature. Symptoms include red eye, injected conjunctiva, pain and decreased vision. Signs include dilated ciliary vessels, presence of cells and flare in the anterior chamber, and keratic precipitates ("KP") on the posterior surface of the cornea.
  • Intermediate uveitis consists of vitritis - inflammatory cells in the vitreous cavity, sometimes with snowbanking, or deposition of inflammatory material on the pars plana.
  • Posterior uveitis is the inflammation of the retina and choroid.
  • Pan-uveitis is the inflammation of all the layers of the uvea.

Causes

A myriad of conditions can lead to the development of uveitis, including systemic diseases as well as syndromes confined to the eye. In anterior uveitis, no specific diagnosis is made in approximately one-half of cases. However, anterior uveitis is often one of the syndromes associated with HLA-B27.

Systemic disorders causing uveitis

Systemic disorders that can cause uveitis include:

  • Acute posterior multifocal placoid pigment epitheliopathy
  • Ankylosing spondylitis
  • Behçet's disease
  • Birdshot retinochoroidopathy
  • Brucellosis
  • Herpes simplex
  • Herpes zoster
  • Inflammatory bowel disease
  • Juvenile rheumatoid arthritis
  • Kawasaki's disease
  • Leptospirosis
  • Lyme disease
  • Multiple sclerosis
  • Presumed ocular histoplasmosis syndrome
  • Psoriatic arthritis
  • Reiter's syndrome
  • Sarcoidosis
  • Syphilis
  • Systemic lupus erythematosus
  • Toxocariasis
  • Toxoplasmosis
  • Tuberculosis
  • Vogt-Koyanagi-Harada syndrome

Masquerade syndromes

Masquerade syndromes are ophthalmic disorders that clinically present as either an anterior or posterior uveitis, but are not primarily inflammatory. The following are some of the most common:

  • Anterior segment
  • Intraocular foreign body
  • Juvenile xanthogranuloma
  • Leukemia
  • Malignant melanoma
  • Retinoblastoma
  • Retinal detachment
  • Posterior segment
  • Lymphoma
  • Malignant melanoma
  • Multiple sclerosis
  • Reticulum cell sarcoma
  • Retinitis pigmentosa
  • Retinoblastoma

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Cow protein may help eye inflammation - retinal S antigen used to wean people with uveitis from steroids - Biomedicine - Brief Article
From Science News, 6/21/97 by Nathan Seppa

Uveitis, an eye inflammation, is responsible for about 10 percent of all cases of severe vision impairment and blindness in the United States. It can arise from injury or infection, but it sometimes attacks mysteriously via an autoimmune reaction--the body turning against itself. To suppress the immune system in such cases, patients need to take powerful steroids for long periods, a treatment that can cause harmful side effects, including kidney damage, glaucoma, cataracts, and brittle bones.

Scientists at the National Eye Institute in Bethesda, Md., report in the May American Journal of Ophthalmology that retinal S antigen, a purified protein derived from cow eyes, may enable physicians to wean some patients off steroids without their uveitis flaring up.

Of 45 people whose autoimmune-based uveitis was being held in check with steroids and other medication, 10 received pure retinal S antigen orally, 10 got a mixture of other cow retinal constituents, 10 took a combination of the S antigen and the bovine mixture, and 15 received a placebo. Over 11 weeks, doctors tried to taper off the patients' steroid dosage while keeping inflammation at bay. The 10 patients receiving pure retinal S antigen fared markedly better than those in the other groups. Some were able to stop taking steroids. Surprisingly, the 10 patients who received the mixture without the S antigen. flied badly, even worse than the placebo group, says Robert Nussenblatt, leader of the research team.

How S antigen works is unclear, Nussenblatt says. It may produce substances that "turn off" the immune response in the eye, he says, or it may paralyze T cells, the immune system's roving soldiers.

Uveitis can lead to glaucoma or irreversible destruction of the retina. Although the study population was small, the researchers consider the findings promising and are preparing for a larger clinical trial. S antigen may also prove useful in preventing rejection of corneal grafts, they suggest.

COPYRIGHT 1997 Science Service, Inc.
COPYRIGHT 2004 Gale Group

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