In my previous article, I discussed the basis of uveitis and how important the part of the eye affected can be in making an accurate diagnosis.
Anterior uveitis is the most common form of uveitis. Most of the time, people have red, painful eyes (one or both), are sensitive to light and have blurry vision. There are a few sources of the inflammation that physicians commonly check for, including systemic infections like TB or syphilis, genetic factors such as HLA-B27 disease, and systemic inflammatory diseases such as sarcoidosis, Behcetâ€™s disease, or juvenile idiopathic arthritis. However, about 50% of the time, we do not find a systemic source. The disease can still be treated, but the cause is often not identified. Eyedrops commonly work well for anterior uveitis, though shots or pills are sometimes needed. Systemic disease is treated systemically and occasionally a rheumatologist or infectious disease specialist is involved.
Intermediate and posterior uveitis
Intermediate uveitis and posterior uveitis are much less common than anterior uveitis, rarely causing pain. However, they can cause significantly more damage to your vision if left untreated. Most patients will have floaters (aging floaters are exceedingly common. Floaters in a 14-year-olds should be investigated), central vision blurriness or blind spots, or trouble seeing at night. While drops sometimes work for these types of inflammation, systemic medications are often necessary. Infections also can cause this disease, but systemic inflammatory disease is much more likely.
Panuveitis is inflammation affecting all parts of the eye. Most commonly, these are infections within the eye (caused by trauma, surgery or systemic infection) or significant inflammation from an underlying disease. Panuveitis is fortunately rare, but it is very serious and must be treated aggressively to prevent visual deterioration.
Scleritis is inflammation in the eye wall and causes red, painful eyes that are often tender to the touch and can wake people from a deep sleep. Out of all the types of uveitis, this is the only type caused by diseases like lupus and rheumatoid arthritis. Drops rarely work for scleritis and shots or oral therapy is often needed to ensure remission. Evaluation for common causes is also important as we do not want to miss a systemic disease that may be causing the eye symptoms.
90% of all red painful eyes are most likely caused by conjunctivitis, foreign bodies in the eye or a scratched cornea. But occasionally, your eye doctor may find inflammation in the eye that will need further investigation. Fortunately, treatment with a variety of anti-inflammatory medications is available as long as the disease is appropriately diagnosed.