Summary about Disease
Granulomatous uveitis is a type of uveitis (inflammation inside the eye) characterized by the presence of granulomas. Granulomas are small collections of immune cells that form in response to infection or inflammation. This form of uveitis can affect any part of the uvea (iris, ciliary body, and choroid) and can lead to significant visual impairment if left untreated. It is frequently associated with systemic diseases.
Symptoms
Symptoms can vary depending on which part of the uvea is affected and the underlying cause, but commonly include:
Eye pain or discomfort
Redness of the eye
Blurred vision
Light sensitivity (photophobia)
Floaters (spots in vision)
Watering of the eye
Decreased vision
Small pupils
Causes
Granulomatous uveitis is frequently associated with systemic conditions including:
Infections: Tuberculosis (TB), Sarcoidosis, Syphilis, Herpes viruses (simplex, zoster), Lyme disease, Toxoplasmosis, Histoplasmosis.
Autoimmune Diseases: Sarcoidosis, Behcet's disease, Vogt-Koyanagi-Harada (VKH) syndrome.
Idiopathic: In some cases, the cause cannot be identified.
Medicine Used
Treatment typically involves medications to reduce inflammation and address the underlying cause, including:
Corticosteroids: Topical eye drops (prednisolone, dexamethasone), oral prednisone, or intravenous methylprednisolone to reduce inflammation.
Cycloplegics/Mydriatics: Eye drops (atropine, cyclopentolate) to dilate the pupil, reduce pain, and prevent adhesions.
Immunosuppressants: Methotrexate, azathioprine, mycophenolate mofetil, adalimumab, infliximab, or other immunosuppressants may be used to control inflammation, especially if corticosteroids are ineffective or for long-term management.
Anti-infective medications: Antibiotics, antivirals, or antifungals are used to treat infections when a specific infectious cause is identified (e.g., anti-TB medications for tuberculosis).
Is Communicable
Granulomatous uveitis itself is not directly communicable. However, if it is caused by an infectious agent (like tuberculosis or syphilis), the underlying infection is communicable.
Precautions
Precautions depend on the underlying cause. If the cause is infectious:
Standard precautions: Hygiene practices to prevent the spread of infection.
Specific precautions: Isolation or treatment protocols related to the identified infection. If the cause is non-infectious:
Monitor for side effects of medications: Regular check-ups with the doctor.
Protect eyes: Wear sunglasses to reduce light sensitivity.
Attend all follow-up appointments: Essential for monitoring the condition and treatment effectiveness.
How long does an outbreak last?
The duration of an outbreak varies significantly depending on the cause, severity, and response to treatment. It can range from weeks to months, and chronic cases may require long-term management. With effective treatment, the inflammation can be controlled, but relapses are possible.
How is it diagnosed?
Diagnosis involves a comprehensive eye examination and medical history. Key diagnostic procedures include:
Slit-lamp examination: Examination of the eye under magnification to visualize inflammation.
Dilated fundus examination: Examination of the retina and choroid after pupil dilation.
Intraocular pressure measurement: To check for glaucoma.
Optical coherence tomography (OCT): Imaging to evaluate retinal layers and detect complications.
Fluorescein angiography: To visualize blood vessel inflammation and leakage.
Blood tests: To identify underlying infections (TB test, syphilis test, Lyme test) or autoimmune conditions (ANA, ACE levels).
Chest X-ray or CT scan: To evaluate for systemic diseases like sarcoidosis or tuberculosis.
Anterior chamber tap (aqueous humor analysis): To identify infectious agents via PCR.
Vitreous biopsy: in rare cases to diagnose an infection
Timeline of Symptoms
The timeline of symptoms can vary, but generally:
Onset: Can be gradual or sudden, depending on the cause.
Progression: Symptoms may worsen over days or weeks if untreated.
Treatment: With treatment, symptoms should improve within days to weeks.
Relapses: Possible, especially if the underlying cause is not controlled or if treatment is stopped prematurely.
Important Considerations
Prompt diagnosis and treatment are crucial: Untreated uveitis can lead to permanent vision loss, glaucoma, cataracts, and other complications.
Compliance with treatment is essential: Follow the doctor's instructions carefully regarding medications and follow-up appointments.
Management of underlying conditions is key: Addressing any underlying infections or autoimmune diseases is important for controlling the uveitis.
Long-term monitoring: Regular eye exams are necessary to monitor for recurrence or complications.
Multidisciplinary approach: Collaboration between ophthalmologists, rheumatologists, infectious disease specialists, and other healthcare providers may be needed for optimal care.