Patients often present with signs of a red eye thinking they have a “pink eye” or some type of conjunctivitis. Following a detailed examination by the doctor, the patient may be informed that the pink eye they thought they had has been diagnosed as an iritis or uveitis. So, what is an iritis or uveitis?
The uvea consists of three internal ocular structures: iris, ciliary body and the choroid. The iris is the colored segment which includes the circular opening in the center known as the pupil. The pupil’s size is contingent upon the amount of available light and changes its size accordingly as the light intensity changes. Thus, a smaller pupil is present when the light is very bright and subsequently enlarges as the amount of light diminishes. The ciliary body produces aqueous humor which provides nutrition to various internal structures as well as contributing to the eye’s intraocular pressure while the choroid is the vascular layer of the eye sandwiched between the sclera (the white outer coat) and the retina (photoreceptive layer) which permits the eyeball to visualize an object. It too, provides nutrition to important structures of the eye. So, an inflammation to one or all of the components of the uvea constitiutes a uveitis. The term “iritis” is technically a misnomer although it is frequently used and accepted in most medical establishments.
Uveitis can be unilateral or bilateral in presentation and usually patients present with similar symptoms. They are the following: photophobia or light sensitivity, possible blurred vision depending upon the severity of the inflammation, pain in and around the eye, smaller pupil in the involved eye in unilateral cases, irregularly-shaped pupils and a circular pattern of injection (redness) around the iris structure. Clinically, the diagnosis is made when the doctor evaluates the region of the eye directly behind the cornea (outer clear covering of the eye) and just in front of the iris known as the anterior chamber. The presence of white blood cells referred to as “cells” and protein leakage from the blood vessels known as “flare” into the anterior chamber confirms the diagnosis of uveitis.
Uveitis has a multitude of causes, the most common of which is trauma. However, uveitis can be an initial or an accompanying sign of systemic diseases such as ankylosing spondylitis, arthritis, tuberculosis, sarcoidosis, syphilis, inflammatory bowel disease (Crohn’s or ulcerative colitis), herpes or cancer to name just a few. The ocular treatment for uveitis is usually topical steroid drops and dilating drops, similar to those used to examine the internal contents of the eye during routine eye examinations. Steroids essentially calm the inflammatory process while the dilating drops assist in decreasing pain and spasming of the eye. Oral steroids may be necessary for severe ocular cases that do not resolve with only topically applied medications or if a systemic cause is uncovered during laboratory testing for recurrent uveitis.
Dr. Leonard Thurschwell practices at our East Cobb, Powder Springs, and Main office.
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