Uveitis

Uveitis is a term which refers to inflammation involving the iris, ciliary body or choroid. Acute anterior uveitis (also referred to as iritis) is one of the commoner reasons for attendance in an eye casualty service. Very often it will respond quickly to treatment with steroid and mydriatic eye drops with no lasting adverse effect on vision and often no cause for it will be identifiable.

However, some varieties of uveitis can be severe, sight-threatening and difficult to treat. Uveitis can be a manifestation of a variety of systemic diseases, some of which may require investigation and treatment in their own right. It is sometimes necessary to use systemic steroids or other drugs to suppress over-activity of the body’s immune system to control uveitis and prevent loss of vision.

Severe intraocular infection (infective endophthalmitis) is an emergency and all ophthalmologists should be familiar with its first-line management – particularly where it occurs following surgery. The ophthalmologist with an interest in uveitis may acquire responsibility for the ongoing management of patients with infective endophthalmitis, particularly in cases where it is due to an unusual organism or where it has occurred secondary to a blood-borne infection.

The role of the ophthalmologist with an interest in uveitis is particularly important in the management of the minority of patients who have more complex or sight-threatening varieties of uveitis. Opththalmologists with an interest in uveitis often combine this with responsibility for other sub-specialties such as cornea and external eye disease or medical retina. They may play a leading role in the management of other inflammatory or autoimmune conditions such as scleritis and thyroid eye disease.

Uveitis specialists depending on case load, may also organise joint clinics on a regular basis with Rheumatologists / Paediatricans for paediatric uveitis cases eg Juvenile idiopathic arthritis etc.

The management of uveitis is largely non-surgical,though techniques of aqueous and vitreous biopsy and delivery of treatment by intravitreal injection are commonly employed.  Patients with uveitis have an increased risk of developing cataract and glaucoma, both of which can be challenging to manage, particularly in the presence of active uveitis. Vitrectomy may be required in the management of infective endophthalmitis and in some forms of non-infective posterior uveitis. Whether the ophthalmologist with an interest in uveitis undertakes these procedures or refers them to other colleagues depends on their training and experience.

Ophthalmologists with an interest in uveitis maintain close working links with other uveitis services as second opinions are sometimes required in difficult or complex clinical situations.There is also close collaboration with other specialties such as rheumatology, dermatology, microbiology and immunology. They may be part of a multidisciplinary team for the management of specific conditions for instance Bechet’s disease).