Uveitis, what is it? Causes and treatment. Uveitis - what is it, how to treat acute eye disease, causes Eye disease uveitis

The main reason that causes the inflammatory process is most often infection. Choroiditis can be caused by tuberculosis, streptococcal, brucellosis and staphylococcal infections.

The peculiarity of the structure of the choroid causes a delay in bacteria and viruses that are carried by the blood or lymph flow. With reduced immunity and chronic diseases, when the body is weakened, rapid development of pathogenic microorganisms occurs.

If the disease is not diagnosed in time and treatment is not started, the inflammatory process spreads to the retina.

The choroid of the eyes can become infected as a result of injury or infection with dangerous infectious diseases. The classic example of the development of choroiditis in the photo should alert you, since inflammation of the choroid can be one of the first symptoms of serious diseases:

• the tuberculosis bacillus is transported through the blood and lymph into the blood vessels of the eye;
• the syphilis virus also causes inflammation of the eyeballs;
• streptococcal and staphylococcal infections;
• helminthiasis;
• toxoplasmosis.

Inflammatory processes can be caused by seasonal allergies or general hypothermia of the body. In order for the ophthalmologist to prescribe correct and effective treatment, it is important to correctly determine the cause that caused the inflammation.

Symptoms and diagnosis of chorioditis

The network of blood vessels in the eye is very vulnerable to viruses and infections. At the initial stage of infection, chorioditis is almost invisible. Slight redness of the eyeball and swelling of the eyelid are diagnosed. Visual disturbances at the initial stage of infection are periodic.

If treatment is started in a timely manner, then all symptoms disappear quickly and vision is completely restored.

Severe chronic course of chorioditis is characterized by a serious inflammatory process of the retina, partial disintegration of pigment epithelial cells is diagnosed. The normal blood supply to the eye is disrupted, as the blood vessels are damaged by the inflammatory process (compressed).

Acute and chronic choroiditis - symptoms:

• with minor initial inflammation, only an ophthalmologist can diagnose the infectious process; visual impairment is not observed at the initial stage of the disease;
• if treatment is not started on time, infection spreads to the entire surface of the choroid, as a result of which visual acuity decreases, distortion appears in the perception of surrounding objects (blurred contours, flickering), floating dots or flashes appear before the eyes;
• with the development of the disease, the process of appearance of scotomas - areas of decreased or absent vision - progresses;
• at dusk a person begins to see poorly (hemeralopia);
• even with chronic and acute choroiditis, the patient does not experience pain in the eyeballs, which is very dangerous, since a trip to the ophthalmologist is postponed;
• if the inflammatory process affects the central part of the fundus of the eye, then distortion of objects, a sharp decrease in visual acuity, flickering and spots before the eyes are observed;
• if the peripheral part of the eye is damaged, twilight vision, moving dots in front of the eyes are diagnosed, and affected areas of peripheral vision appear;
• When diagnosing the fundus, yellowish or gray foci with blurred contours are observed that protrude into the vitreous body of the eye. The retinal vessels are not damaged, but are located above such a lesion;
• local lesions (hemorrhages) in the vitreous body, retina and choroid are diagnosed. The chronic inflammatory process causes clouding of the retina at the site of infection.

It is very dangerous that this disease is not accompanied by pain and is rarely diagnosed at the initial stage, when treatment gives the most positive effect. Therefore, at the first signs of choroiditis - floating spots before the eyes, unclear outlines of objects, decreased vision in the dark, it is important to immediately consult an ophthalmologist.

This disease, if treatment is not started on time, is accompanied by serious complications. Regular examination by an ophthalmologist - once every six months - will help to diagnose and quickly treat infectious inflammation of the eyes.

Treatment and prevention of choroiditis

For treatment to be effective, it is important to find out the cause of the infection. In some cases, with eye injury, therapeutic treatment aimed at increasing general immunity is sufficient.

If the infectious or bacterial nature of the inflammation is identified, then a course of local or general antibiotics is prescribed. Choroiditis - treatment should be comprehensive:

• it is necessary to eliminate the source of infection;
• it is important to regulate and block local and systemic autoimmune reactions of the body;
• a set of measures is being taken to prevent the development of serious complications that arise as a result of infection;
• prescribing antihistamines if the cause is allergic reactions;
• the introduction of antigens of viral pathogens in small doses (hyposensitization) is aimed at preventing relapses of the disease;
• prescription of anti-inflammatory drugs (glucocorticoids) - maxides drops, dexamethasone ointment;
• in chronic and severe forms of the disease, it is recommended to administer Kenalog (a week’s course);
• antimicrobial therapy - okomistin drops, floskal, okoferon.

The above medications and course of treatment can only be prescribed by a doctor after an examination, since it is important to identify the causative agent of the infection in order to prescribe the necessary medications.

Eye choroiditis is a serious infectious disease that causes dangerous complications if treatment is not carried out on time. The infection affects the choroid of the eye and leads to complete tissue atrophy.

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Uveitis is an inflammatory disease of the choroid of the eye. The choroid is also called the uveal tract and consists of 3 parts: the ciliary body, the iris and the choroid. The uveal tract performs one of the most important functions - it provides blood supply to all the main structural elements of the eye. Uveitis of the eye is one of the most common causes of decreased visual acuity up to complete blindness.

Among all inflammatory diseases of the eye, uveitis accounts for almost half of the cases; in 30% of cases, inflammation leads to a sharp decrease in vision or its complete loss. This disease is recorded on average in 1 person per 2-3 thousand of the population, while in men it is 2 times more common than in women.

Classification

Depending on the location of the inflammatory process, uveitis can be anterior, posterior, peripheral and diffuse.

The most common is anterior uveitis, it comes in the following types:

• Iritis is inflammation of the iris.
• Cyclitis is inflammation of the ciliary body.
• Iridocyclitis is an inflammation of the ciliary body and iris.

Posterior uveitis (choroiditis) is inflammation of the posterior part of the choroid (choroid) with damage to the retina and optic nerve (chorioretinitis, neurouveitis).

Peripheral - inflammation of the ciliary body and choroid with damage to the retina and vitreous body.

Diffuse (panuveitis) - damage to both the anterior and posterior parts of the choroid.

Depending on the etiology, ocular uveitis can be exogenous (when the infection spreads from the cornea, sclera, orbit, etc.) and endogenous (the infection enters through the blood or autoimmune mechanisms).

Depending on the course of the disease - acute, subacute and chronic.

Depending on the nature of the inflammatory process - serous, fibrinous, purulent, hemorrhagic, mixed.

ICD-10 code

• H20. Iridocyclitis.
• H21. Other diseases of the iris and ciliary body.

Symptoms of uveitis of the eye

General symptoms:

• Pain in the eyeball. On palpation the pain intensifies.
• Redness of the eye.
• Decreased visual acuity.
• Increased sensitivity of the eye to light.
• The so-called “floaters” before the eyes.

In addition to the general signs of uveitis, there are other symptoms characteristic of a particular type of disease.

Symptoms of anterior uveitis:

• Tearing.
• Constriction of the pupil, irregular pupil shape.
• Photophobia.
• Increased intraocular pressure.

Symptoms of peripheral uveitis:

• Usually both eyes are affected.
• Decreased central vision.
• Blurred vision, outlines of objects blur.

Symptoms of posterior uveitis:

• Flashes before the eyes.
• Distortion of the shape of objects. Hemeralopia.
• Sometimes – scotoma, absence of pain.

Symptoms of panuveitis: since panuveitis is a lesion of both the anterior and posterior parts of the choroid, all of the above symptoms apply to it.

Causes

This disease can be caused by various reasons, the main ones are the following:

• Infections – uveitis of an infectious nature occurs in 45% of cases. The causative agents of the inflammatory process are most often streptococci, toxoplasma, mycobacterium tuberculosis, cytomegalovirus, treponema pallidum, and fungi. Infectious agents penetrate the vascular bed from any source of infection, usually with tuberculosis, sepsis, tonsillitis, syphilis, influenza and even dental caries.
• Allergic reaction - can cause inflammation of the choroid with the development of allergies to medications and food, hay fever, administration of potent serums and vaccines.
• Systemic diseases - rheumatism, spondyloarthritis, multiple sclerosis, psoriasis, Reiter's syndrome, sarcoidosis, glomerulonephritis, Vogt-Koyanagi-Harada syndrome, etc.
• Eye injuries - burns, punctures, eye cuts, foreign body getting into the eye.
• Hormonal disorders - diabetes, menopause, blood diseases, etc.
• Eye diseases - keratitis, blepharitis, conjunctivitis, retinal detachment, scleritis, etc.

Diagnostics

When the first symptoms of uveitis appear in the form of pain in the eyes, redness, and decreased visual acuity, you should consult an ophthalmologist. The doctor will first conduct an external examination of the eyes (pay attention to the condition of the skin of the eyelids, pupils, conjunctiva), visometry (determining visual acuity), perimetry (examination of visual fields). Intraocular pressure should also be measured.

Additionally, to diagnose uveitis, the following studies are performed: biomicroscopy, gonioscopy, ophthalmoscopy, ultrasound of the eye, angiography of retinal vessels. To clarify the diagnosis, rheoophthalmography, electroretinography, and optical coherence tomography are sometimes performed. To identify the underlying disease that caused uveitis, a consultation is held with an allergist, endocrinologist, and infectious disease specialist with all the necessary tests.

Differential diagnosis is carried out with the following diseases:

• Anterior uveitis - with keratitis, scleritis, conjunctivitis, episcleritis, acute attack of glaucoma.
• Posterior uveitis – with tumors of the choroid, the initial phase of retinal detachment.

Complications

Due to deposits of lens masses, visual acuity decreases up to complete blindness. The sooner treatment is started, the greater the chance of stopping the process of vision loss. As a result of posterior synechiae (adhesions) of the iris, intraocular pressure increases and angle-closure glaucoma develops. Other complications of inflammation of the choroid are cataracts, vasculitis, papilledema, and retinal detachment.

Treatment of uveitis

It is very important to differentiate uveitis from other diseases as early as possible, and also to establish the underlying disease that caused uveitis. After this, treatment of uveitis by an ophthalmologist is reduced to preventing complications and measures to preserve vision, and the main efforts are directed to treating the underlying disease, for example, infection or allergy.

Treatment of anterior and posterior uveitis is carried out using antibacterial and anti-inflammatory drugs: non-steroidal anti-inflammatory drugs (NSAIDs), cytostatics, antihistamines (for allergies), etc.

Mydriatics are also prescribed, which are designed to eliminate spasm of the ciliary muscle and prevent adhesions. Short-acting mydriatics:

• Tropicamide (0.5% and 1%), duration of action up to 6 hours.
• Cyclopentolate (0.5% and 1%), duration of action up to 24 hours.
• Phenylephrine (2.5% and 10%), duration of action up to 3 hours, but without cycloplegic effect.

Long-acting mydriatics: atropine 1% - has a strong cycloplegic effect; it is not recommended to use this drug for more than 2 weeks. When the inflammatory process weakens, atropine is replaced with tropicamide.

The use of steroids plays an important role in the treatment of uveitis. Prednisolone (2 drops of a 1% suspension in the eye every 4 hours, gradually reducing the dosage), dexamethasone (0.1% solution in eye drops), betamethasone in the form of drops, ointments, parabulbar injections are prescribed. Parabulbar injections allow therapy to be administered behind the lens, in addition, the drugs penetrate the cornea in this way, which provides a longer-lasting effect. When improvement occurs, electrophoresis or phonophoresis with enzymes is used.

If the opportunity to relieve the acute phase of the disease is missed or the treatment was chosen incorrectly, i.e. in case of complications, surgical intervention may be required: dissection of the anterior and posterior synechiae (adhesions) of the iris, surgical treatment of cataracts, glaucoma, retinal detachment, surgery to remove the vitreous, as well as evisceration of the eyeball (surgery to remove the internal contents of the eyeball).

The prognosis depends on the complexity and neglect of the underlying disease. Acute uveitis usually lasts 4-6 weeks, recurrent uveitis worsens in autumn and winter. Chorioretinitis leads to a significant decrease in visual acuity. Advances in the treatment of the underlying disease will certainly affect the treatment of uveitis.

Prevention of uveitis consists of timely treatment of eye diseases, infectious diseases, avoiding eye injuries, contact with allergens, as well as regular vision monitoring by an ophthalmologist.

Uveitis is a group of diseases that occur with inflammation of the vascular network of the eye in its different areas - in the iris, choroid, and ciliary body. Uveitis is accompanied by symptoms such as redness, pain and discomfort, increased photosensitivity, excessive lacrimation, the appearance of spots and floating circles in the field of vision.

Diagnosis of diseases includes perimetry, visometry, retinography, ophthalmoscopy, biomicroscopy, ultrasound, CT or MRI of the eye, electroretinography, etc.

Treatment is based on identifying and eliminating the cause of uveitis. The patient is prescribed local and general therapy; complications of the pathology often require surgical intervention.

What is uveitis?

Uveitis is an inflammation of the uveal tract. This pathology is quite common and is observed in approximately half of all cases of inflammatory eye diseases.

The choroid of the organs of vision consists of the ciliary (ciliary) body, the iris and the vascular network itself - the choroid, which lies directly under the retina.

Due to this anatomical structure, the main forms of uveitis are cyclitis, iritis, iridocyclitis, chorioretinitis, choroiditis and others.

Up to a third of cases of uveitis lead to complete or partial blindness.

The high incidence of pathologies is due to the fact that the vessels of the eye are branched and spread to many structures of the eye, while in the area of ​​the uveal tract the blood flow is very slow.

This specificity affects some stagnation of microbes in the choroid of the eye, which easily leads to the development of an inflammatory process. Another characteristic feature of the uveal tract is the separate blood supply to its anterior part (iris with ciliary body) and its posterior part - the choroid.

The anterior part of the uveal tract is supplied by the posterior long arteries and the anterior ciliary arteries. Blood enters the posterior part of the uveal tract from the posterior short ciliary arteries.

Due to this feature, the pathology of these two parts of the uveal tract, as a rule, is not related to one another, that is, the diseases often occur separately.

The supply of nerve roots to the choroid of the organs of vision is also not the same. The ciliary body and iris are innervated by ciliary fibers of one of the branches of the facial nerve, and the choroid is not penetrated by nerve fibers at all.

Types of uveitis

According to the location of the inflammatory phenomena, uveitis is:

1. Anterior (among them - iritis, anterior cyclitis, iridocyclitis).
2. Posterior (this group includes choroiditis, retinitis, neurouveitis, chorioretinitis).
3. Median (including pars planitis, posterior cyclitis, peripheral uveitis).
4. Generalized.

If a patient develops anterior uveitis, then the ciliary body and iris are involved in the pathological process. This type of disease is the most common.

Median uveitis leads to damage to the choroid and ciliary body, as well as the retina and vitreous body. If posterior uveitis is diagnosed, then in addition to the retina and choroid, the optic nerve is affected.

If inflammatory processes cover all parts of the uveal tract, then panuveitis, or generalized uveitis, develops.

According to the type of inflammation, uveitis can be purulent, serous, fibrinous, hemorrhagic, mixed. Due to its occurrence, the pathology can be primary (associated with systemic diseases), secondary (develops against the background of other eye diseases), as well as endogenous and exogenous.

According to the nature of the course, uveitis is differentiated into acute, chronic, and recurrent. Based on the type of changes in the choroid, diseases are classified into non-granulomatous, or toxic-allergic widespread, and granulomatous, or local metastatic.

Causes of uveitis

There are many etiological factors that can lead to the development of uveitis. Among them are infections, systemic diseases, allergies, toxic lesions, metabolic diseases, hormonal imbalances, and eye damage.

The most common are uveitis, which develops due to the penetration of infectious particles (more than 40% of cases). The causative agents of the disease are most often: staphylococci, streptococci, mycobacterium tuberculosis, herpes viral agents, pathogenic fungi.

This type of uveitis is caused by the penetration of infection from a chronic focus located in any part of the body through the hematogenous route. Often infection occurs against the background of tuberculosis and syphilis, caries, sinusitis, sepsis, etc.

Allergic uveitis occurs with high sensitivity to various irritants (external, internal) - when taking medications, food allergens. In some cases, uveitis can become a side effect of immunization or serum administration.

The appearance of uveitis is often associated with general pathologies and syndromes. These include rheumatoid arthritis, systemic lupus erythematosus, vasculitis, psoriasis, multiple sclerosis, Reiter's disease, uveomeningoencephalitis and others.

Uveitis often develops after injury to the eye - injury, burn, foreign body penetration, contusion. In addition, uveitis can be accompanied by metabolic disorders - gout, diabetes, blood diseases, hormonal disorders.

Secondary uveitis develops in parallel with other eye diseases - conjunctivitis, retinal detachment, keratitis, scleritis, ulcerative defects of the cornea, etc.

Clinical picture of uveitis

Symptoms of uveitis vary depending on the location of the inflammation, the type of infection that has entered the eye, and the state of the body's immune system.

Acute anterior uveitis is expressed by the following symptoms: pain, irritation and redness of the eye, increased photosensitivity, lacrimation, decreased visual acuity, constriction of the pupil. The pressure inside the eye often increases.

If anterior uveitis becomes chronic, then often there are no subjective signs at all, or they are weakly manifested in the form of slight redness of the eyes, the rare appearance of floating “flies” in the field of vision.

With frequent exacerbations of anterior uveitis, precipitates form on the endothelium of the cornea. In addition, the activity of the pathological process is indicated by the presence of microorganisms in the fluid secreted from the anterior chamber of the eye (this is revealed as a result of performing a bacterial analysis).

Often, anterior uveitis is complicated by the formation of synechiae - adhesions between the iris and the lens. The disease can also lead to the development of cataracts, glaucoma, swelling of the central part of the retina, and inflammation of the eye membrane.

Uveitis, involving the peripheral parts of the choroid, affects two eyes simultaneously. The patient notes a decrease in the sharpness and brightness of central vision, the appearance of floating circles and “floaters”.

Posterior type uveitis is subjectively expressed by decreased clarity of vision, distorted images, and decreased visual acuity.

Posterior uveitis is characterized by the appearance of macular edema, its ischemia, blockage of retinal vessels, and the development of optic neuropathy.

The most complex form of uveitis is generalized iridocyclochoroiditis. Typically, this type of disease is characterized by damage to the entire body, which, for example, happens with sepsis. The disease often accompanies panophthalmitis.

If uveitis occurs against the background of Vogt-Koyanagi-Harada syndrome, then the patient has severe headaches, hearing loss, hair loss, psychosis, and the appearance of vitiligo. Uveitis accompanying sarcoidosis has the following clinical picture: ocular manifestations, cough and shortness of breath, inflammation of the lymph nodes, lacrimal glands, salivary glands.

Diagnosis of uveitis

Diagnosis of the disease by an ophthalmologist necessarily includes the following procedures: visual examination, including assessment of the condition of the eyelids, mucous membrane of the eye, checking the reaction of the pupils, perimetry, visometry. The doctor measures intraocular pressure because many types of uveitis cause it to increase or decrease.

During biomicroscopy, zones of band-like degeneration, posterior adhesions, cellular reaction, precipitates, and sometimes cataracts are determined. Gonioscopy helps to identify the presence of pathological exudate, the presence of anterior adhesions, the formation of new vessels in the iris and anterior chamber of the eye.

Ophthalmoscopy is required to determine focal changes in the fundus of the eye, as well as swelling of the retina and optic nerve head. If such an examination is not possible, which often happens when the vitreous body, lens and cornea lose transparency, then an ultrasound of the eye is prescribed.

To differentiate uveitis by type and to accurately diagnose neovascularization of ocular structures, vascular angiography, optical tomography, and laser scanning tomography are recommended.

In addition, rheoophthalmography and electroretinography can effectively reflect ongoing processes.

According to indications, chorioretinal biopsy and paracentesis of the anterior chamber of the eye may be prescribed. Some patients (depending on the cause of uveitis) may need consultation with a phthisiatrician or venereologist, as well as lung X-rays, tuberculin tests, consultations with a neurologist, rheumatologist, allergist, immunologist and a number of relevant studies.

In addition to instrumental examinations, laboratory methods for diagnosing uveitis are required - tests and analyzes to identify causative agents of the disease (herpes virus, chlamydia, cytomegalovirus, etc.), as well as determination of indicators of rheumatoid factor, C-reactive protein, allergy tests and other studies.

Treatment of uveitis

Therapy is prescribed by an ophthalmologist together with other specialists. If the diagnosis of the disease was early and correct, and the treatment was timely and aimed at eliminating the etiological factor, then a complete recovery is possible. Also, uveitis therapy should include measures to prevent complications that can cause a decrease in visual acuity.

The main therapeutic course consists of drugs to dilate the pupil (mydriatics), glucocorticosteroids to eliminate inflammation, and immunosuppressants.

If the cause of uveitis is infection with pathogenic bacteria, then antiviral drugs and antibiotics are prescribed.

For other conditions of uveitis, antihistamines, cytostatics, non-steroidal anti-inflammatory drugs, etc. will be needed.

Mydriatics - atropine, cyclopentol - are instilled locally. This treatment eliminates spasm of the ciliary muscle, and is also a prevention of the formation of posterior adhesions and a measure of therapy for existing adhesions.

Local remedies with glucocorticosteroids are of great importance in the treatment of uveitis - putting ointments, instillation into the conjunctival sac, etc. Some patients require systemic administration of glucocorticosteroids - dexamethasone, prednisolone, hydrocortisone.

If there is no positive dynamics, immunosuppressants are introduced into the course of therapy - cytostatics, etc. If the patient has increased intraocular pressure, special medications in the form of drops and hirudotherapy are recommended.

When the acute phase of uveitis subsides, physiotherapeutic methods and phonophoresis with enzymes are included in the treatment.

If therapy is ineffective or was started untimely, complications of uveitis may develop. Their treatment is often surgical - dissection of adhesions of the iris, surgery on the vitreous body, surgery for glaucoma and cataracts, and detached retina.

The generalized form of the disease may require removal of the vitreous body, and sometimes evisceration of the eye.

Forecast

Adequate and timely treatment usually leads to complete recovery in 3-6 weeks. When uveitis becomes chronic, it often worsens, which often occurs against the background of another relapse of the underlying disease.

If complications of the pathology develop, posterior adhesions, glaucoma, cataracts, retinal edema and detachment, and retinal infarction may form. Central chorioretinitis can cause a decrease in visual acuity.

Prevention of uveitis

Prevention of the disease comes down to the treatment of all ophthalmological pathologies, correction of systemic diseases, prevention of eye injuries, and prevention of contact with allergens.

The anterior and posterior parts of the choroid are supplied with blood from different sources, so isolated lesions of their structures most often occur. The innervation is also different (the iris and ciliary body are by the trigeminal nerve, and the choroid has no sensitive innervation at all), which causes a significant difference in symptoms.

The disease can affect patients regardless of gender and age and is one of the leading causes of blindness (about 10% of all cases) in the world. According to various sources, the incidence is 17-52 cases per 100 thousand people per year, and the prevalence is 115-204 per 100 thousand. The average age of patients is 40 years.

What it is?

Uveitis is a general term for an inflammatory disease of the choroid of the eyeball. Translated from Greek “uvea” means “grape”, since in appearance the choroid of the eye resembles a bunch of grapes.

Causes

In most cases, uveitis is provoked by such a cause - an infection that enters the eye through the bloodstream, transferred from another infected organ, or through eye injuries from the environment. There can be a variety of bacteria and viruses here. Basically, bacteria penetrate from the outside, and viruses and other microorganisms are carried through the bloodstream.

But let’s not rule out other causes of uveitis:

1. Hypothermia.
2. Low immunity.
3. Blood diseases.
4. Reiter's syndrome.
5. Allergic reaction to food or medicine.
6. Metabolic disorders or hormonal imbalances: diabetes, menopause.
7. Injuries to the eye when a foreign body, piercing objects or burns enter it.
8. Infectious or chronic diseases: psoriasis, rheumatism, etc.
9. Other eye diseases: scleritis, retinal detachment, etc.

Classification

In medicine, there is a certain classification of the disease. It all depends on its location:

1. Peripheral. With this disease, inflammation affects the ciliary body, choroid, vitreous body, and also the retina.
2. Front. A type of disease that is much more common than others. Accompanied by damage to the iris and ciliary body.
3. Rear. The optic nerve, choroid, and retina become inflamed.
4. When there is inflammation throughout the entire choroid of the eyeball, this type of disease is called “panuveitis.”

As for the duration of the process, an acute type of the disease is distinguished, when the symptoms intensify. Chronic uveitis is diagnosed if the pathology worries the patient for more than 6 weeks.

Symptoms of uevit

Depending on where the inflammatory process develops, the symptoms of uveitis are determined (see photo). In addition, it matters how much the human body can resist the pathogens of the disease and at what stage of development it is. Depending on these factors, the signs of the disease may worsen and have a certain sequence.

Peripheral uveitis occurs with the following symptoms:

• often both eyes are affected symmetrically,
• floaters before eyes,
• deterioration of visual acuity.

Posterior uveitis is characterized by late onset of symptoms. They are characterized by:

• blurred vision,
• distortion of objects,
• floating spots before the eyes,
• decreased visual acuity.

Anterior uveitis is characterized by the following symptoms:

• chronic lacrimation,
• constriction of the pupil,
• soreness,
• redness of the eyes,
• photophobia,
• decreased visual acuity,
• increased intraocular pressure.

In the chronic course of anterior uveitis, symptoms occur rarely or are mild: only slight redness and floating spots before the eyes.

Diagnostics

The patient’s medical history and information about his immunological status play an important role in diagnosis. With the help of an ophthalmological examination, the localization of inflammation in the choroid of the eye is clarified.

The etiology of ocular uveitis is clarified by skin testing for bacterial allergens (streptococcus, staphylococcus or toxoplasmin). In the diagnosis of a disease of tuberculous etiology, the decisive symptom of uveitis is the combined damage to the conjunctiva of the eyes and the appearance of specific pimples on the patient’s skin - phlyctenas.

Systemic inflammatory processes in the body, as well as the presence of infections when diagnosing ocular uveitis, are confirmed by analyzing the patient’s blood serum.

What uveitis looks like: photo

The photo below shows how the disease manifests itself in adults.

Complications

Serious complications of uveitis include profound and irreversible loss of vision, especially if the uveitis was unrecognized or the wrong therapy was prescribed.

Also among the most common complications are retinal, optic disc or iris detachment and cystoid macular edema (the most common cause of vision impairment in patients).

Treatment of ocular uveitis

Treatment of uveitis is complex, consisting of the use of systemic and local antimicrobial, vasodilating, immunostimulating, desensitizing drugs, enzymes, physiotherapeutic methods, hirudotherapy, and traditional medicine. Patients are usually prescribed drugs in the following dosage forms: eye drops, ointments, injections.

For drug treatment of anterior and posterior uveitis, the following is used:

1. Vitamin therapy.
2. Antihistamines - “Clemastin”, “Claritin”, “Suprastin”.
3. Viral uveitis is treated with antiviral drugs - Acyclovir, Zovirax in combination with Cycloferon, Viferon. They are prescribed for local use in the form of intravitreal injections, as well as for oral administration.
4. Broad-spectrum antibacterial agents from the group of macrolides, cephalosporins, fluoroquinolones. The drugs are administered subconjunctivally, intravenously, intramuscularly, intravitreally. The choice of drug depends on the type of pathogen. To do this, a microbiological examination of eye discharge is carried out for microflora and the sensitivity of the isolated microbe to antibiotics is determined.
5. Immunosuppressants are prescribed when anti-inflammatory therapy is ineffective. Drugs in this group inhibit immune reactions - Cyclosporine, Methotrexate.
6. Anti-inflammatory drugs from the group of NSAIDs, glucocorticoids, cytostatics. Patients are prescribed eye drops with prednisolone or dexamethasone, 2 drops into the affected eye every 4 hours - “Prenacid”, “Dexoftan”, “Dexapos”. Indomethacin, Ibuprofen, Movalis, Butadione are taken internally.
7. Fibrinolytic drugs have a resolving effect - “Lidaza”, “Gemaza”, “Wobenzym”.
8. To prevent the formation of adhesions, eye drops “Tropicamide”, “Cyclopentolate”, “Irifrin”, “Atropine” are used. Mydriatics relieve spasm of the ciliary muscle.

Treatment of uveitis is aimed at the rapid resorption of inflammatory infiltrates, especially in cases of indolent processes. If you miss the first symptoms of the disease, not only the color of the iris will change, its degeneration will develop, and everything will end in disintegration.

Folk remedies

When treating uveitis, you can use some traditional medicine methods, after discussing the possibility of such treatment with your doctor:

1. You can use crushed marshmallow root. To do this, you need to pour 3-4 tablespoons of marshmallow root into a glass of water at room temperature. You need to infuse it for 8 hours and then use it for lotions.
2. A decoction of chamomile, rose hips, calendula or sage helps with uveitis. To prepare it, you need 3 tablespoons of herbs and a glass of boiling water. The mixture should infuse for about an hour. Then you should strain it and rinse your eyes with this decoction.
3. Aloe can also help. You can use aloe juice for eye drops, diluting it in cold boiling water in a ratio of 1 to 10. You can make an infusion from dry aloe leaves.

As a rule, folk remedies are additional treatment options that are used comprehensively. Only timely adequate therapy for an acute inflammatory process in the eyeball gives a good prognosis, that is, it guarantees that the patient will recover. This will take a maximum of 6 weeks. But if this is a chronic form, then there is a risk of relapse, as well as exacerbation of uveitis as the underlying disease. Treatment in this case will be more difficult, and the prognosis will be worse.

Surgery

Surgery is required if the disease occurs with serious complications. As a rule, the operation involves certain stages:

• the surgeon cuts the adhesions that connect the membrane and the lens;
• removes vitreous humor, glaucoma or cataracts;
• removes the eyeball;
• using laser equipment, attaches the retina.

Every patient should know that surgery does not always result in a positive result. The specialist warns him about this. After surgery, there is a risk of exacerbation of the inflammatory process. Therefore, it is important to promptly identify the disease, diagnose it, and prescribe effective therapy.

The group of diseases of the organ of vision includes uveitis of the eye. With this pathology, the iris, ciliary body and choroid are affected. The human eye has a very complex structure. The apple is formed by 3 membranes: fibrous, choroid and retina. With uveitis, the vascular layer, which is rich in capillaries, becomes inflamed.

Uveitis is a collective term that refers to inflammation of the iris, ciliary body and choroid. This disease is very common among people under 40 years of age. Uveitis is often diagnosed in children and adolescents. A type of this disease is iridocyclitis. The following forms of uveitis are known:

• front;
• median;
• rear;
• generalized.

Iritis is an inflammation of the iris, and cyclitis is a lesion of the ciliary body. In the middle form of uveitis, the ciliary body, the choroid itself, the retina and the vitreous body are involved in the process. A feature of the posterior form of the disease is damage to the optic nerve. The greatest danger is panuveitis.

With it, all the membranes of the eye become inflamed. Depending on the nature of the exudate, serous, purulent, mixed and fibrinous-lamellar uveitis are distinguished. This pathology can be primary or secondary.

According to the nature of the course, uveitis is divided into acute, chronic and recurrent. There are also allergic, infectious, mixed, traumatic and systemic forms of the disease. Sometimes the cause of inflammation cannot be identified.

Etiological factors

With uveitis, the causes can be very different. The following etiological factors are of greatest importance:

Very often, uveitis develops against the background of influenza and ARVI. Possible causes include streptococcal diseases, gonorrhea, tuberculosis, malaria and chlamydia. Infectious anterior uveitis most often develops. Inflammation is caused by bacteria and viruses. Fungi are detected less frequently. Pathogens can enter the eye through the blood from chronic foci of infection.

Peripheral uveitis may be a manifestation of an allergic reaction. This is possible in response to the administration of immunological drugs (serums), consumption of certain foods and medications. Sluggish uveitis occurs with systemic diseases. The traumatic form most often develops from burns and penetration of foreign bodies.

Predisposing factors are the following:

• endocrine disorders;
• decreased immunity;
• hypothermia;
• keratitis;
• blood diseases;
• menopause

The risk of developing this pathology increases with stress, intense physical work and an improperly organized daily routine.

General clinical manifestations

With uveitis, the symptoms are numerous. The clinical picture is determined by the underlying cause and location of the lesion. The most commonly observed manifestations are:

• pain in the eyes on one or both sides;
• lacrimation;
• redness;
• fear of bright light;
• presence of floating spots before the eyes.

Acute purulent uveitis is the most severe. It causes severe pain. Maybe . Often these people have increased intraocular pressure. Glaucoma may develop. Chronic uveitis occurs with scant symptoms. The peripheral form of the disease is characterized by damage to both eyes.

The following symptoms are possible:

• blurred vision;
• decreased central vision;
• hyperemia.

With posterior uveitis, visible objects are often distorted. The clinical picture largely depends on the underlying disease. In Vogt-Koyanagi-Harada syndrome, in addition to visual disturbances, hair loss, hearing loss, headache and psychosis are observed.

If the cause of uveitis is sarcoidosis, then the lymph nodes become enlarged and shortness of breath with cough appears.

Development of iridocyclitis in humans

The most commonly diagnosed pathology is iridocyclitis. This is anterior uveitis. Initially, only the iris or ciliary body becomes inflamed. Then the pathological process spreads to neighboring structures. The development of this pathology is based on the following disorders:

• immune cytolysis;
• production of inflammatory mediators;
• vascular damage;
• microcirculation disturbance.

The following symptoms are observed with iridocyclitis:

• change in iris color to green or rusty red;
• pain;
• redness;
• pain on palpation;
• moderate vision impairment;
• Availability .

A mild corneal syndrome is determined. It includes lacrimation, photophobia and blepharospasm. There may be accumulation of pus at the bottom of the anterior chamber. This condition is called hypopyon. A yellow-green stripe is visually identified. In severe cases, pupil deformation develops. It may narrow.

If uveitis is not treated, blindness is possible. The reason is pupil overgrowth. Intraocular pressure is increased or decreased. If the cause is tuberculosis, then yellowish tubercles are detected in the area of ​​the iris. Posterior synechiae (fusions) are formed. Autoimmune uveitis is distinguished by the fact that it often recurs and is severe.

If the cause is injury, then after one eye the second is affected. This state is called. If iridocyclitis is caused by Reiter's syndrome due to chlamydia, then there are signs of damage to the conjunctiva, joints and urethra.

How does chorioretinitis occur?

Posterior uveitis can occur as chorioretinitis. With it, the choroid becomes inflamed along with the retina. The following forms of this disease are known:

• peripapillary;
• central;
• equatorial;
• peripheral.

If symptoms persist for less than 3 months, we are talking about. The peripheral form of the disease often occurs hidden. If an exacerbation occurs, the following symptoms are possible:

• blurred vision;
• dark spots;
• distortion of objects;
• violation .

Chorioretinitis develops against the background of infection, radiation, allergic reactions and autoimmune disorders. The risk group includes people with immunodeficiency.

How dangerous is uveitis for humans?

With peripheral and central uveitis, dangerous complications can develop. The following consequences of this disease are possible:

• macular edema;
• blindness;
• significant visual impairment;
• acute occlusion of retinal vessels;
• optical neuropathy;
• glaucoma;
• cataract;
• synechia;
• corneal damage;
• pupil overgrowth;
• optic nerve atrophy;
• retinal detachment.

The autoimmune form of anterior uveitis causes cataracts, scleritis, etc. Glaucoma is a common complication. It is manifested by pain in the area of ​​the superciliary arches, decreased visual acuity of objects, blurred vision, the appearance of rainbow circles before the eyes and loss of visual fields.

Recurrent uveitis of infectious etiology can cause the spread of microbes. This leads to endophthalmitis and.

Patient examination plan

With iridocyclochoroiditis, the symptoms are similar to other eye diseases. If uveitis is suspected, the following studies are performed:

• external inspection;
• assessment of visual acuity using special tables;
• perimetry;
• biomicroscopy;
• gonioscopy;
• ophthalmoscopy;
• tonometry;
• angiography;
• coherence optical tomography;
• rheoophthalmography;
• electroretinography.

Gonioscopy is very informative. During it, the anterior chamber of the eye is examined. The condition of the iris root, ciliary body, Schwalbe ring, Schlemm's canal and trabecula is assessed. Using gonioscopy, you can identify the presence of synechiae and exudate, as well as determine the condition of the blood vessels. Biomicroscopy is required.

A slit lamp will be needed. It allows you to examine all the structures of the eye at high magnification. The fundus, retina, and optic nerve can be visualized during ophthalmoscopy. In the infectious form of the disease, it is necessary to identify the pathogen. A bacteriological or virological study is carried out.

If necessary, consultation with a phthisiatrician, rheumatologist, infectious disease specialist and other specialists is required. A blood test is performed for sugar and rheumatoid factor. Specific antibodies are detected. Differential diagnosis is carried out with primary glaucoma, keratitis and acute conjunctivitis.

Treatment methods for uveitis

The symptoms and treatment of this pathology are not known to everyone. For this pathology, drug therapy is carried out. The following groups of drugs can be prescribed:

• antiviral drugs;
• NSAIDs;
• mydriatics;
• systemic corticosteroids;
• antihistamines;
• cytostatics.

To eliminate spasm of the ciliary muscle, drops are prescribed that dilate the pupil. These include Atropine. The basis of therapy for patients with uveitis is the use of corticosteroids. They are prescribed in the form of tablets, drops and ointments for the eyes.

Instillations are most often performed. Prednisolone Nycomed is used. If glaucoma develops, medications are used that reduce the accumulation of fluid in the eye. These can be adrenergic blockers and sympathomimetics.

In severe cases of infectious uveitis of the eye, treatment requires detoxification therapy. Enzymes are often prescribed to resolve exudate. After eliminating the pain syndrome, physical therapy (magnetic therapy, electrophoresis, laser correction) is carried out in the remission phase. If complications develop, surgical intervention is required. The resulting synechiae are dissected.

Radical treatment is also required in case of lens clouding, glaucoma and retinal detachment. Sometimes it is necessary to remove the vitreous. The indication is iridocyclochoroiditis. In more severe cases, evisceration is organized. It removes the internal structures of the apple.

The prognosis for uncomplicated uveitis is favorable. The duration of the disease is 3-6 weeks. Relapses are possible. When the retina is involved in the process, vision often decreases.

Prevention measures

This disease can be prevented. To do this, you must follow the following recommendations:

• promptly treat infectious diseases;
• Wear safety glasses when performing work that is hazardous to the eyes;
• exclude injuries;
• prevent eye burns;
• visit an ophthalmologist periodically;
• monitor hormonal levels;
• do not contact with allergens;
• lead a healthy lifestyle.

The most common causes of uveitis are infection, trauma, and systemic disease. They need to be prevented or treated in the early stages. Most often, uveitis is a complication of another pathology. Prevention should be carried out from a young age. To protect children from this pathology, it is necessary to prevent bacterial and viral infections.

If uveitis does develop, the goal is to prevent complications. To do this, you need to visit your doctor in a timely manner and follow all his prescriptions. Self-medication can lead to dangerous complications, including loss of an eye. Thus, uveitis is a very common ophthalmological pathology.

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