If there is a persistent decrease in visual acuity accompanied by tearing as well as redness of one or both eyes, an ophthalmologist should be consulted to rule out uveitis. This inflammation of the vascular membrane can affect patients regardless of age and should be treated promptly to prevent permanent damage to the eye.
What is uveitis?
Uveitis is an inflammation of the vascular membrane of the eye. The eyeball is a structure lined with three layers of tissue, with the layer in the middle called the vascular membrane (uvea). Inflammation can affect specific areas of the uvea. This results in a distinction between anterior, intermediate, and posterior uveitis, with anterior uveitis being the most common form of inflammation of the vascular membrane and also referred to as irititis or inflammation of the iris. The disease can be a one-time occurrence or chronic. There are no age limits for affected patients. The symptoms include dull pain in the eye, which may radiate to the forehead. The eye is red and watery. Visual acuity is usually reduced and there is sensitivity to light. In chronic uveitis, there is often less discomfort. The disease can occur in one eye or bilaterally.
Causes
Causes of uveitis can be bacilli as well as viruses, fungi, and parasites. Viruses include herpes or varicella. The inflammation can also occur during tuberculosis or Lyme disease. It is often a consequence of another disease that has already been overcome, such as a diarrheal disease caused by bacteria from Yersinia. Various autoimmune diseases also promote uvetitis. These include the chronic intestinal diseases Crohn’s disease and ulcerative colitis as well as rheumatic diseases such as juvenile arthritis, ankylosing spondylitis and sarcoidosis, multiple sclerosis or certain kidney inflammations. Often, however, no causes can be found for the occurrence of the disease. In these cases, it is thought to be an immune reaction of the body to certain protein structures of the eye that are considered foreign to the body, thus triggering uvetitis.
Symptoms, complaints, and signs
Uveitis can be acute or chronic. However, acute episodes with symptom-free intervals are possible in the chronic forms of the disease. The most important sign is a sudden or slowly developing deterioration of vision. The vision of those affected becomes increasingly blurred. The visual acuity decreases. In addition, severe pain often occurs. Very rarely, the iris may be differently colored. Depending on where the vascular membrane is inflamed, there may also be a marked redness of the eye with heavy tearing and increased sensitivity to light (glare). This is especially true if the anterior part of the [eye inflammation|eye is inflamed]]. Basically, three forms of uveitis are distinguished. Thus, there is anterior, middle and posterior uveitis. Posterior uveitis is usually characterized only by blurred and unclear vision. Pain, redness of the eyes and tearing usually do not occur here. In most cases, uveitis is very treatable. In some cases, however, it can become chronic. Then recurrences occur more often later. Sometimes adhesions of the iris with the lens or the chamber angle are possible. Impaired vision due to vitreous opacities, cataracts or glaucoma also occur. If retina or choroid are involved, the retina may be destroyed, leading to night blindness or even total blindness.
Diagnosis and course
The ophthalmologist makes the diagnosis of uvetitis. By questioning the patient, he already receives the first indications of a possible vasculitis. The diagnosis can be confirmed by a thorough examination of the fundus of the eye. Blood tests may also be necessary to detect other infections that may underlie the vasculitis. A single case of uveitis usually heals without further consequences for the patient. However, if the infection recurs and a chronic inflammation develops, damage to the eye that permanently limits visual acuity is to be expected.
Complications
Depending on the type of uveitis, various complications may occur.A typical complication of anterior uveitis is inflammation in the anterior segment of the vascular membrane, which is associated with visual disturbances and occasionally with scarring and permanent impairment of vision. In addition, the iris and lens may become adherent. As a result of an increase in intraocular pressure, so-called glaucoma occurs. In moderate uveitis, fluid can collect on the retina and sometimes lead to retinal tearing. Cataracts or glaucoma may also occur. In posterior uveitis inflammation, the retina is often damaged as well – resulting in vision problems that can become chronic. Other possible complications include clouding of the lens of the eye (cataract) and deposition of calcium in the cornea. In infants and young children, uveitis often takes a severe course and causes permanent damage to the eye. Surgery may result in injury to the eye. In addition, infections may occur or the eye may not heal properly after surgery and become inflamed again. Laser therapy carries similar risks.
When should you see a doctor?
A doctor should be consulted if symptoms around the eyes persist or increase. Watery eyes, redness and irritation indicate discrepancies that need to be checked and treated. If there is impairment of vision, pain or an increased risk of accidents, a doctor is needed to determine the cause. If the affected person suffers from sensitivity to light, blurred vision or dizziness, a visit to the doctor is advisable. If night blindness is noticed or if headaches occur regularly, research into the cause should be carried out. Sudden changes in usual vision are considered worrisome. They should be examined by a doctor as soon as possible. Disorders of the tear duct, swelling around the eyes or itching should also be presented to a doctor. Since complete blindness can result if left untreated, a visit to the doctor should be made at the first signs of irregularity. In addition, a check-up visit to a doctor is always recommended if a difference in vision is noticed in everyday life in direct comparison to people from the social environment. Uncertainty of gait, abnormal behavior or mood swings indicate health impairments that should be discussed with a doctor. Often, psychological irregularities occur in parallel due to the dysfunction of the eye, as the emotional burden on the affected person is very strong.
Treatment and therapy
Treatment of uvetitis depends on the cause of the disease. The ophthalmologist selects medications to relieve the inflammation and prevent long-term damage to the eye. If the cause is bacterial, antibiotics are prescribed; if the cause is fungal, antifungal medication is prescribed. Most often, a cortisone ointment is prescribed to reduce inflammation. It is also important to avoid adhesions to the iris. For this purpose, the pupil must be dilated with appropriate eye drops (cycloplegics or mydriatics). If the immune system is disturbed, the immune reaction is dampened with cortisone. Depending on the type of inflammation, the drugs are administered as eye drops, in tablet form or as an injection. In most patients, administration of cortisone cures uvetitis. If the inflammation does not recede sufficiently, other medications are available that can intervene in the inflammatory process of the vasculitis and thus achieve its healing. Only in particularly severe cases, uvetitis requires surgery on the vitreous body of the eye.
Prevention
There is no effective prevention of uvetitis, as this inflammatory reaction can have many causes. However, it is necessary to see an ophthalmologist immediately if discomfort occurs in the eye that is associated with a decrease in visual acuity so that uvetitis can be quickly diagnosed and treated. This is especially important for patients with underlying chronic diseases.
Follow-up
To prevent the development of secondary diseases, the treatment of uveitis should be followed by comprehensive follow-up care. This consists of regular follow-up examinations by an ophthalmologist.He measures the visual acuity, examines the fundus of the eye, as well as the eye skin, choroid, ray body and iris and checks the intraocular pressure and takes timely countermeasures in case of a secondary disease that has developed or a renewed uveitis. If visual acuity is permanently impaired as a result of uveitis, glasses or contact lenses may be necessary. If the uveitis results in a clouding of the lens, this must also be treated. If the intraocular pressure has increased as a result of the uveitis or its treatment, it must be lowered with medication. For this purpose, special water tablets (Glaupax, Azemid) are used, which lower the intraocular pressure. If an infection with viruses, bacteria, fungi or parasites was the trigger for uveitis, increased personal hygiene should also be observed. In particular, rubbing the eyes with uncleaned or undisinfected hands should be avoided. If an autoimmune disease is present, as a result of which the uveitis has developed, this must be treated separately to prevent the re-emergence of uveitis, as well as the development of secondary diseases of the eyes.
What you can do yourself
To relieve itching and redness of the affected eye, home remedies are also good. Cold or warm compresses are proven as an immediate measure. For this purpose, a clean cloth should be soaked with cold or lukewarm water. Then this compress should be carefully placed on the closed eye. The compress helps to relax the affected eye. However, it will not fight the infection. Eye rinses can help better. In this way, pus can be washed out of the eye. One method of eye rinsing is rinsing with a syringe without a needle, which has been drawn up with lukewarm water. Here, however, the water should be dripped slowly into the eye with only slight pressure, so that no damage is done to the cornea. Also compresses with chamomile tea are a proven means of symptom relief in uveitis. For this purpose, water should be boiled and steeped with chamomile tea for five to ten minutes. However, it is important that it is not chamomile tea from the supermarket, but pure chamomile from the pharmacy or a health food store. For the overlay, a clean cloth should be soaked with the lukewarm or even cold chamomile brew. This moist overlay should then be placed on the affected eye. This allows the chamomile compress to exert its healing and soothing effects.
