Uveitis and eye damage
Uveitis is a generic inflammation of the uveal tract, the thin vascular membrane composed of three ocular sheets (choroid, ciliary and crystalline body) that separate the cornea and sclera from the retina.
Uveitis constitutes an optical eye emergency in all respects: when not treated properly, the disease can spread to other neighboring ocular structures - such as cornea, iris and retina - causing exaggerated and sometimes irreversible damage, first of all compromising the vision and blindness.
Mild and apparently insignificant symptoms such as light intolerance, abundant tearing and eye redness require a diagnostic assessment precisely because they could represent a clear signal of uveitis.
Diagnosis
The approach to the patient suffering from uveitis requires a meticulous and precise diagnostic examination, as well as a correct interpretation of the causes and the recognition of specific symptoms.
- Only after the medical history and the clinical evaluation of the patient can the doctor formulate a diagnostic hypothesis because only then will he have all the necessary information.
The diagnosis therefore begins with the patient's medical history: here, the doctor analyzes the symptoms exposed by the patient and evaluates his clinical history.
We proceed with the objective analysis of the eye to assess the health status of the different internal ocular structures. Often the onset symptoms of uveitis are almost the same as those of conjunctivitis: for this reason, the two conditions are often confused. Differential diagnosis is therefore indispensable for assessing adequate therapy.
If the doctor deems it appropriate, in support of the physical examination - performed with eye instruments such as slit lamp, ophthalmoscope and tonometer for ocular pressure - the patient can undergo more precise diagnostic tests, such as blood tests, tests skin and radiographs.
In case of suspected infectious uveitis, the doctor performs an ocular biopsy, in which a sample of tissue is taken from the patient's eye for a subsequent cytological (cellular) laboratory investigation.
Therapy
To learn more: Uveitis treatment drugs
Objectives of treatment for uveitis
Although uveitis variants are more than one, therapy is always performed for at least three common reasons:
- Relieve the painful and annoying symptoms experienced by the patient
- Remove the cause (when possible)
- Prevent complications that could compromise vision, such as in particular glaucoma, cataract, retinal detachment and blindness
The most suitable drugs for the symptomatological treatment (only of the symptoms) of uveitis are the mydriatics and corticosteroids, able to exert a powerful anti-inflammatory action. By dilating the pupil, the mydriatics (such as Atropine, Cyclopentolateo and Omatropina) are indicated both for treating eye inflammation in general (including uveitis) and for preventing the formation of posterior synechiae. Corticosteroid drugs are indicated to reduce ocular inflammation, especially when associated with an uveitis of uncertain etiology.
If the infectious origin of the uveitis is ascertained, a specific treatment is carried out against the pathogen:
- Antibiotics (eg Sulfasalazine) are the first line drugs for the treatment of bacterial uveitis. To accelerate healing, acting on both the cause and the symptom, many eye drops for the treatment of uveitis are prepared with a mixture of antibiotics and corticosteroids: for example, the medicinal product Mixotone is an eye drop consisting of hydrocortisone (corticosteroid drug) and two antibiotics (neomycin and polymyxin B). Pre-G is a combined ophthalmic ointment, specifically indicated for the treatment of bacterial uveitis (and conjunctivitis): this drug consists of gentamicin (antibiotic) and prednisolone (corticosteroid drug).
- Antimalarials (eg. Pyrimethamine) are useful for the treatment of protozoan uveitis, supported for example by Toxoplasma gondii.
- Antivirals can be prescribed in the presence of a proven viral uveitis. It is recommended not to use corticosteroid drugs (eye drops / ophthalmic ointments) at the same time to avoid damaging the internal ocular structures.
- Antifungals are drugs indicated for the treatment of fungus-supported uveitis such as Fusarium and Candida.
When uveitis depends on an autoimmune disease, the most indicated drugs are suppressors of the immune system such as: Methotrexate, Adalimumab and Infliximab.
Prognosis
Generally, in front of an immediate treatment for anterior uveitis, the prognosis is excellent: the symptoms regress in a few days and the eye regains full health.
Bacterial uveitis is probably the simplest variant to treat: in these cases, however, the promptness of intervention with antibiotic drugs is decisive for the prognosis. If the infection is treated properly, the risk of recurrence is minimal.
The above is independent of the simultaneous presence of uveitis and autoimmune diseases: this category of patients, in fact, is extremely at risk of recurrences, even if the previous uveitis has been treated with the right drugs.
Other times, unfortunately, anterior uveitis can become chronic even when treated early.
The intermediate and posterior uveites, on the other hand, are more difficult to eradicate: in such circumstances, care must be continued for longer periods or, when necessary, for life.
Patients with chronic uveitis must undergo regular routine checks by the ophthalmologist to ensure that the disease remains confined to a particular site, without involving other eye structures.
