Harvard Medical School Adviser by the Faculty of Harvard Medical School

Q:

I'm 64 and have been diagnosed with anterior uveitis in my right eye. What causes this condition? What's the best treatment for it?

A.

The uvea is a complex structure that makes up the middle layer of the tissues that surround the fluid-filled interior of the eyeball. These three layers -- the retina (the inner layer that contains nerve cells responsible for vision), the uvea, and the sclera (the protective outer "white" of the eye) -- surround the cavity of the eyeball, which contains the gel-like vitreous humor. Uveitis is inflammation of one or more of the parts of the uvea.

The uvea has three parts: the iris, the colored part of the eye around the pupil; the ciliary body, the structure near the iris that produces the fluid inside the eye; and the choroid, which contains blood vessels that nourish important parts of the eye, including the retina.

Uveitis can develop suddenly and can affect one or both eyes. It can cause painful reddening of the eyeball, blurred vision, light sensitivity, and floaters or other debris in your field of vision.

Depending upon the part of your uvea that's affected, you may have all of these symptoms or none at all. In any case, it's a serious condition that can result in scarring and even blindness if left untreated.

Uveitis can be caused by infections, autoimmune conditions or trauma to the eye, which can include complications of eye surgery. Some of the autoimmune disorders linked to uveitis are ankylosing spondylitis, lupus, juvenile rheumatoid arthritis and multiple sclerosis. Infections that can trigger uveitis include tuberculosis, toxoplasmosis, herpes, syphilis or cytomegalovirus (especially in patients with AIDS).

Rarely, medications can cause uveitis. Possible culprits include bisphosphonates (especially when given intravenously), the antibiotics rifabutin (Mycobutin) and moxifloxacin (Avelox), and the antiviral drug cidofovir (Vistide).

In about 30 percent of cases, the cause of uveitis is unknown. Some patients develop "masquerade syndromes" that resemble uveitis but have other causes, such as a tear in the retina or a type of lymphoma.

The most common form of uveitis -- and the one you have -- is anterior uveitis. This form affects the front part of the eye, which is made up of the iris and ciliary body. But there are two other kinds. In intermediate uveitis, the inflammation affects mostly the vitreous humor. And in posterior uveitis, the least common form, the retina or choroid at the back of the eye is affected. Sometimes the whole eye is affected.

To diagnose uveitis, an ophthalmologist examines the eye with a slit lamp. This is a magnifying instrument that gives the doctor a detailed view of the eye structures.

Choosing the right treatment for uveitis depends on diagnosing the cause. Infectious uveitis is treated with an antibiotic, antifungal, antiviral or other medication. Noninfectious uveitis is usually treated with steroids applied topically in the form of eyedrops. Steroids can also be injected into the eye or taken by mouth. Lastly, there is an FDA-approved surgical implant that slowly releases steroids within the eye for severe uveitis.

All forms of steroid therapy can cause glaucoma or cataracts. Unfortunately, uveitis can also cause cataracts and glaucoma. But it must be treated to preserve your vision. If cataracts or glaucoma develop during your treatment, your ophthalmologist will recommend appropriate additional therapy.

Treating uveitis may require both an ophthalmologist and an internist. Once your ophthalmologist has confirmed the diagnosis, you should inform your internist or primary care provider. She or he may want to take a detailed history, perform a physical exam and order laboratory tests to determine whether your uveitis is related to a treatable underlying condition. It's also important to follow up with your ophthalmologist to make sure the treatment is working and to check for complications.

With treatment, most cases of anterior uveitis improve within a few days to a few weeks. But relapses are quite common. Your best bet for preventing permanent eye damage or complications is to begin treatment early and follow your doctor's orders to a T.

(Submit questions to harvard_adviser@hms.harvard.edu.)

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