Summary about Disease
Posterior uveitis is an inflammation of the uvea, specifically affecting the back portion of the eye. The uvea is the middle layer of the eye between the retina and the sclera, comprised of the choroid, ciliary body, and iris. When inflammation occurs in the choroid and/or retina, it is categorized as posterior uveitis. It can affect one or both eyes and may lead to vision loss if not treated promptly.
Symptoms
Common symptoms of posterior uveitis include:
Blurred vision
Floaters (spots in vision)
Decreased vision
Eye pain (less common than in anterior uveitis)
Photophobia (sensitivity to light, less common than in anterior uveitis)
Redness of the eye (less common than in anterior uveitis)
Causes
The causes of posterior uveitis can be varied and sometimes unknown. Potential causes include:
Infections: Viral (e.g., herpes simplex, herpes zoster, cytomegalovirus), bacterial (e.g., tuberculosis, syphilis), fungal (e.g., histoplasmosis), or parasitic (e.g., toxoplasmosis).
Autoimmune diseases: Sarcoidosis, Behçet's disease, Vogt-Koyanagi-Harada syndrome, systemic lupus erythematosus (SLE), rheumatoid arthritis, ankylosing spondylitis.
Inflammatory conditions: Inflammatory bowel disease (IBD)
Trauma: Eye injury
Idiopathic: In many cases, the cause cannot be identified.
Medicine Used
Treatment options for posterior uveitis depend on the underlying cause and severity of the inflammation. Common medications include:
Corticosteroids: Prednisolone (oral or intravenous), dexamethasone (eye drops, injections, or implants). These reduce inflammation but have potential side effects.
Immunosuppressants: Methotrexate, azathioprine, mycophenolate mofetil, cyclosporine. Used to suppress the immune system in autoimmune-related uveitis.
Antiviral medications: Acyclovir, valacyclovir, ganciclovir (for viral infections like herpes).
Antibiotics or antifungals: Used to treat bacterial or fungal infections.
Biologic therapies: Adalimumab, infliximab (TNF-alpha inhibitors), or other biologics targeting specific parts of the immune system. These are often used for autoimmune-related uveitis that doesn't respond well to other treatments.
Mydriatic eye drops: Dilate the pupil to prevent or treat the formation of adhesions (synechiae) between the iris and lens.
Is Communicable
Posterior uveitis itself is generally not communicable. However, if the underlying cause is an infection (e.g., tuberculosis, syphilis, herpes virus), the infection itself may be communicable, but the uveitis is a result of the infection, not directly contagious itself.
Precautions
Precautions depend on the underlying cause of the posterior uveitis. General precautions may include:
Follow treatment plan: Adhere strictly to the prescribed medication regimen.
Regular eye exams: Attend all scheduled follow-up appointments with an ophthalmologist to monitor the condition and treatment effectiveness.
Manage underlying conditions: If the uveitis is related to an autoimmune disease, work with a rheumatologist or other specialist to manage the underlying condition.
Protect your eyes: Wear sunglasses to reduce glare and protect your eyes from UV rays.
Avoid rubbing your eyes: This can worsen inflammation.
If infectious, take precautions: If the underlying cause is an infection (like herpes), follow guidelines to prevent its spread.
How long does an outbreak last?
The duration of a posterior uveitis outbreak can vary widely, depending on the cause, severity, and response to treatment. It can range from a few weeks to several months or even become chronic (long-lasting or recurring). With prompt and effective treatment, an acute episode may resolve in weeks to months. Chronic uveitis may require long-term management.
How is it diagnosed?
Diagnosis typically involves a comprehensive eye exam by an ophthalmologist, which may include:
Visual acuity testing: Measures how well you can see.
Slit-lamp examination: Allows the doctor to examine the front and back structures of the eye under magnification.
Dilated eye exam: Eye drops are used to widen the pupil, allowing the doctor to view the retina and other structures in the back of the eye.
Fundoscopy: Direct examination of the retina and optic nerve.
Optical Coherence Tomography (OCT): Imaging test that provides detailed cross-sectional images of the retina.
Fluorescein angiography: Dye is injected into a vein, and pictures are taken as it travels through the blood vessels in the retina. This can help identify areas of inflammation or leakage.
Indocyanine green angiography (ICGA): Similar to fluorescein angiography but uses a different dye that penetrates deeper tissues, useful for visualizing the choroid.
Blood tests: To look for underlying infections or autoimmune diseases (e.g., testing for syphilis, tuberculosis, rheumatoid factor, antinuclear antibody).
Chest X-ray or CT scan: To look for signs of sarcoidosis or other systemic diseases.
Timeline of Symptoms
The onset of symptoms can vary depending on the cause and severity.
Acute onset: Symptoms develop relatively quickly, over a few days to weeks. This might involve a sudden increase in floaters, blurred vision, or decreased vision.
Gradual onset: Symptoms develop more slowly, over weeks to months. The changes in vision may be subtle at first and gradually worsen.
Recurrent: Symptoms may come and go, with periods of remission followed by flare-ups.
Important Considerations
Prompt diagnosis and treatment are crucial to prevent vision loss and other complications.
Posterior uveitis can be a sign of an underlying systemic disease, so it's important to identify and manage any associated conditions.
Long-term monitoring is often necessary, even after the inflammation has subsided, to watch for recurrence or complications.
Side effects of treatment (particularly corticosteroids and immunosuppressants) need to be carefully monitored.
Patient education about the disease, treatment options, and potential complications is essential for successful management.