Do your eyes feel this way too? Let's talk about Uveitis!

Have you ever experienced red, painful, and slightly blurry eyes? Or have you ever felt like things were floating in front of your eyes? These are symptoms that we sometimes don't pay much attention to, but they can be signs of some other inflammatory condition inside the eye. That's the condition we're going to talk about today, called uveitis. This can be quite serious, so it's important to be aware of it.

What is Uveitis? Let's understand it simply!

Simply put, uveitis is an inflammation, or swelling, of the uvea, the middle layer of the eye. Think of it like a camera. The uvea is a very important part of the camera. Sometimes, this inflammation can be idiopathic, meaning it can be caused by a number of known conditions. This condition can affect only one area of ​​the eye , or it can affect several areas. The symptoms vary depending on where it is affected. You may experience eye pain, redness, or inflammation. Or your vision may be affected. It can affect just one eye, or both eyes at once. Now, look, there is not much room for swelling inside our eyes. So even a small amount of swelling can change the shape of the inside of the eye. Did you know that the shape of the inside of the eye is very important for our vision? So even a small change due to this swelling can have a big impact on vision.

In some severe cases, uveitis can lead to permanent vision loss or even blindness. So this is not something to take lightly.

How common is Uveitis?

This is actually a fairly common condition. Worldwide, about 4 million new cases, or about 4 million people, are diagnosed with this disease each year. Even in a country like the United States, between 80,000 and 168,000 cases are reported each year. This is most common among adults. The risk of developing this condition increases with age. It is a little less common among young children, with children accounting for between 2% and 20% of all patients.

What are the symptoms of uveitis?

The symptoms of uveitis really depend on which part of the eye is affected by the inflammation. Specialists divide it into three main parts: anterior, intermediate, and posterior. Sometimes all three parts are affected, and this is called panuveitis.

Symptoms of Anterior Uveitis

Of these three , anterior uveitis is the most common.This affects the iris and ciliary body of the eye. Often, you or others can see the symptoms. These symptoms include:

• Eye pain: Can be severe.
• Redness or burning of the eyes: The eyes may feel red, itchy, and burning.
• Blurred vision: A condition in which you cannot see clearly.
• Sensitivity to light (photophobia): Difficulty looking at light, feeling as if the eyes are turning blue.
• Swelling of the white membrane of the eye (swollen conjunctiva).
• Changes in the shape of the black ring: The black ring, which is usually round, can take on an irregular shape.
• A white fluid collection in the front of the eye (hypopyon) or a white ring around the black eye.

Characteristics of Intermediate and Posterior Uveitis

In cases of middle and posterior uveitis, symptoms are usually not easily visible to you or others. Instead, symptoms mostly affect what you see and how well you can see. Symptoms of these conditions may include:

• The appearance of small objects floating in front of the eyes ( floaters or myodesopsias) increases, or they become more prominent than before.
• Visual field defects: Some areas of the eye become invisible when viewed from the affected eye.
• Decreased vision .

What are the causes of Uveitis?

There are many possible causes of uveitis. Surprisingly, in 50% to 70% of cases, an ophthalmologist cannot find a cause. This means it is an ``idiopathic`` condition. However, the main causes that can be found are:

• Infections
• Disease conditions that affect the entire body (Systemic causes)
• Eye Injuries
• Some medications

1. Infections

Infection is when something, such as a germ, enters the body and causes damage. Uveitis caused by an infection usually affects only one eye. It can be caused by different types of germs:

• Viruses: Viruses such as Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV), which causes chickenpox and herpes zoster, and Cytomegalovirus (CMV). They can also be caused by vaccine-preventable diseases such as rubella.
• Bacteria:Bacteria that cause diseases like syphilis and tuberculosis.
• Fungi: Molds such as Candida (which causes candidiasis) and Aspergillus (which causes aspergillosis).
• Parasites: These can be transmitted to you from pets, especially cats (toxoplasmosis, which is transmitted through infected cat feces) and dogs (toxocariasis). You can also get this condition from eating undercooked pork (cysticercosis or toxoplasmosis).

2. Causes that affect the entire body (Systemic causes)

Sometimes uveitis is not caused by something that affects just the eyes. It can be a side effect of medication or a symptom of a medical condition that affects the whole body. In this case , both eyes are often affected. Here are some autoimmune and inflammatory conditions that are associated with uveitis:

• `Inflammatory Bowel Disease ( IBD )`
• `Sarcoidosis`
• ` Behçet's disease `
• `Lupus (Systemic Lupus Erythematosus - SLE)`
• Tubulo-interstitial nephritis (TINU)

People with a specific DNA mutation called `HLA-B27` can also develop inflammatory joint diseases that increase the risk of developing uveitis. Examples include:

• `Juvenile Idiopathic Arthritis`
• Ankylosing Spondylitis
• `Psoriatic Arthritis`
• `Axial Spondyloarthritis`
• `Enteropathic Arthritis`
• `Reactive Arthritis`

3. Injuries

An eye injury can damage the muscles and/or blood vessels in the uvea. When an injury occurs, our immune system uses a process called inflammation to heal it. For this reason , uveitis can also occur after eye surgery. Even small changes in the structure inside the eye, such as changes caused by inflammation, can cause the symptoms of uveitis. The severity of the symptoms depends on factors such as the location and severity of the injury.

4. Medications

The risk of developing uveitis may increase when using certain medications. Some examples include:

• `Cidofovir`
• `Rifabutin`
• `Bisphosphonates`
• `Brimonidine eye drops`
• `Tyrosine Kinase Inhibitors`

Is this a contagious disease?

Uveitis is not contagious from person to person. However, some infections (e.g. viruses, bacteria) that cause it can be contagious. Also, it can be caused by diseases that can be transmitted from animals to humans (e.g. toxoplasmosis), so you should be aware of that as well.

What are the possible complications of Uveitis?

The main and most dangerous complication of uveitis is vision loss and blindness. This condition causes changes inside the eye, and those changes are what cause the complications. Some of these changes are:

• Cataracts
• Cystoid Macular Edema
• Detached retina or damage to the retina
• Glaucoma (damage to the optic nerve due to increased eye pressure)
• High intraocular pressure
• Macular pucker - epiretinal membrane
• Optic nerve swelling and damage
• Synechiae (this occurs when the iris of the eye sticks to either the lens or the cornea)

How is Uveitis diagnosed?

An ophthalmologist can diagnose uveitis. He or she will ask you about your symptoms, including your medical history and any recent infections or injuries. In addition, he or she may examine your eyes and perform special tests to look for signs of uveitis. The tests for uveitis usually start with an eye exam. These include a visual acuity test and a slit lamp exam . Your doctor may also order a tonometry test to measure eye pressure and an optical coherence tomography (OCT) scan to look for changes in the back of your eye. Other tests may also be ordered, depending on your symptoms and suspected causes. For example:

• Blood tests: These can detect changes in the blood that indicate infection, signs of the immune system, or other medical conditions.
• Imaging scans: Things like a chest X-ray or an MRI (Magnetic Resonance Imaging) scan of the brain can help to look for problems elsewhere. Some imaging scans use a special dye, such as fluorescein, to show the blood vessels inside the eye. Changes in the dye pattern can give doctors important clues about the cause of uveitis.

Because tests may vary depending on your symptoms and condition, your eye specialist is the best person to explain them to you. He or she can tell you more about these tests and why they are recommended.

How is Uveitis treated?

Because there are many causes of uveitis, treatments can vary widely. There is no specific cure for uveitis. However, some of the conditions that cause it can be treated. If so, treating the cause may help to clear up the uveitis. If no cause can be found, your eye doctor may use standard treatments. Treatments may include medications, surgery, and other methods to help reduce your symptoms and prevent future problems. Treatments based on symptoms usually focus on:

• Pain control: Because uveitis can be painful, treatments to reduce pain are common. This may include medications (cycloplegics) that temporarily paralyze the muscles of the iris (especially the pupil).
• Inflammation reduction: Medications such as steroids and nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce the pain and inflammation caused by uveitis.
• Condition-specific treatments: For example, antiviral medications that treat viruses do not help with bacterial, fungal, or parasitic infections.

Because there are many treatment options, your ophthalmologist is the best person to talk to about your options.

Can uveitis be prevented?

Unfortunately, uveitis cannot be completely prevented. Many of the things that cause it are either unexpected or work in ways that experts still don't fully understand. However, there are a few things you can do to reduce your risk of developing conditions or events that can lead to uveitis. The main things you can do are:

• Get regular eye exams to detect eye problems early (that means at least twice a year, or more often if you have a condition that requires more frequent exams).
• Wear eye protection to prevent or reduce the severity of eye injuries.
• If you have infections (if possible), get them treated before they get worse or spread.

What should I expect if I have Uveitis?

If you have uveitis, your experience will depend on several factors. Some of the most important are:

• How long it takes to get a diagnosis and treatment.
• The specific part of the eye that is affected.
• The underlying cause (if your doctor can find it).
• Your overall health and any other illnesses you may have.

Because these factors can have a big impact, your eye specialist can best tell you what to expect. He or she can tailor the information to your specific situation and the details of the case. He or she can also advise you on things you can do to help yourself.

What is the outlook for uveitis?

Uveitis is a common cause of vision loss and legal blindness. In the United States, up to 10% of people who become legally blind are due to or are related to uveitis. Delays in diagnosis and treatment can lead to poor outcomes. That's why it's important to not ignore the symptoms of uveitis or "just be patient." If you're diagnosed and treated early, you're less likely to have long-term vision problems. If you do, you're more likely to make a full recovery and avoid permanent vision problems.

How do I take care of myself?

If you have uveitis, your eye specialist will guide you through treatment and tell you what you need to do as part of your treatment. It is very important to follow your eye specialist's instructions, as this can reduce the risk of permanent vision loss.

When should I see my doctor?

Your eye doctor will schedule follow-up visits for you, and it is important to keep them. These appointments allow your doctor to monitor your symptoms and the success of your treatment. Your doctor will also tell you what signs or symptoms you should see a doctor for or seek emergency medical attention if you develop any. Here are some warning signs that you should see a doctor or seek emergency medical attention:

• If the pain increases.
• If your vision worsens or you suddenly lose your vision (completely or partially).
• If you see flashes of light before your eyes.
• If you suddenly start seeing floaters, or if existing floaters get worse or become more prominent.
• If you experience photophobia, which means your eyes hurt or feel uncomfortable in bright light.

What questions should I ask my doctor?

You can ask your doctor questions like these:

• "What type of uveitis do I have?"
• "Do you know the reason for this? So what is it?"
• "What treatment options do I have? What do you recommend?"
• "Are there any risks or side effects of the treatment?"
• "Can this come back after treatment?"
• "What can I do to protect my vision, prevent vision loss, or prevent this from happening again?"
• "Should I be aware of signs of complications? If so, what are those signs?"

It's normal to feel scared when you hear about a condition like uveitis, and to hear that you may lose your vision. But there are many things you can do to improve your condition. Early detection and treatment can prevent serious problems like permanent vision loss. So, if you have symptoms of uveitis, don't ignore them. After a diagnosis, following your eye doctor's instructions is the best way to get the best results. If there's anything you don't understand, ask your doctor. Working together is the best way to help you and prevent future problems.

What are the most important things we should remember from this story?

Okay, so let's summarize some of the things we've talked about that you need to keep in mind:

• Uveitis is an inflammation of the middle layer of the eye (the uvea). It can seriously affect your vision.
• If you have symptoms like red eyes, eye pain, blurred vision, sensitivity to light, or seeing things floating in front of your eyes , never ignore them. See an ophthalmologist as soon as possible.
• There can be many reasons for this; infections, other diseases in the body, injuries, certain medications, etc. Sometimes, no cause can be found.
• The most important thing is to recognize the disease early and start the right treatment. This can go a long way in preventing dangerous complications such as permanent vision loss.
• Follow your eye doctor's instructions and treatment exactly. Use your medication correctly, and don't skip your doctor's appointments.
• Although it cannot be completely prevented, getting regular eye exams, wearing eye protection (especially in hazardous work), and treating infections in the body promptly can help reduce the risk of this condition to some extent.

Remember, your eyes are very precious, so it is your responsibility to take care of them.