Uveitis

with Dr. Raphael Rosenbaum

Uveitis

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What is Uveitis?

Uveitis is a general term that refers to inflammation of structures of the eye.  Uveitis is a conjunction of the old Latin word ‘Uva’ and ‘-itis’.  The eye is often referred to as the Uva which means grape in Latin as the eye is shaped like a grape while the suffix ‘itis’ refers to the presence of inflammation.

What are the causes of Uveitis?

There are over 90 causes of Uveitis, and while most of the time it is easy to determine an underlying cause, in about a third of patients a cause can not be identified.  In general uveitis can be broken down into 2 broad categories, infectious or autoimmune.  Within the autoimmune category the inflammation can be limited to the eye or can be part of a systemic autoimmune disease like rheumatoid arthritis, psoriasis or inflammatory bowel disease.

Are their different types of Uveitis?

Uveitis is typically classified based on the International Uveitis Study Group by the anatomical location of inflammation into anterior, intermediate, posterior and panuveitis. Approximately 66-90 % of uveitis cases are anterior, with the inflammation limited to the anterior chamber in front of the lens.  Intermediate uveitis also known as pars planitis and refers to inflammation that is predominately located in the vitreous cavity.  Posterior uveitis is inflammation of the retina and or choroid.  While panuveitis refers to inflammation of the entire eye.

Is Uveitis Dangerous?

Uveitis in and of itself can be vision and eye threatening.  Uveitis increases the risk of glaucoma, cataract formation, hypotony and retinal diseases.  More importantly, uveitis may be the tip of the iceberg and may portend a bigger systemic life threatening disease.

Who should treat Uveitis?

Ideally Uveitis should  be treated by a fellowship trained specialist in Ocular Immunology and Uveitis.  There are currently very few such training centers in the world, let alone the United States.  One of the goals of the Ocular Immunology and Uveitis foundation started by Dr. C. Stephen Foster in Cambridge, MA is to help train future Ocular Immunologists.  Dr. Raphael E. Rosenbaum was fortunate to get this specialized training under Dr. Foster’s tutelage.

How is Uveitis treated?

It depends on the cause of the inflammation.  If it is deemed to be infectious in origin the infectious etiology needs to be treated.  If it is believed to be autoimmune in nature it is best treated with an anti-inflammatory drug.  The first line treatment is typically a steroid agent. If the inflammation recurs as the steroid is tapered patients usually need to move on to steroid sparing agents.  This should be obvious as long term steroid therapy will ultimately lead to debilitating side effects including the development of elevated blood sugars and diabetes premature osteoporosis, neurological changes, cataract formation and possibly glaucoma.  Typical steroid sparing immunosuppressive agents include NSAIDs, conventional immunosuppressive therapy with drugs like methotrexate, CellCept or Cyclosporine, or more modern therapy with biologic agents like Remicade, Humira, and Rituxin.