Uveitis – Diagnosis and Treatment
Diagnosis
To figure out if someone has uveitis, an eye specialist starts by asking about the person’s symptoms and health history. Common symptoms of uveitis can include eye pain, redness, blurred vision, and sensitivity to light.
Eye exams play a very important role. The eye doctor, also called an ophthalmologist, asks the person to read an eye chart to check visual acuity. They also check how the pupils react to light.
These steps help the doctor understand how well the eyes are working and if there are any signs of inflammation.
The doctor often uses a tonometer test to measure the pressure inside the eye. High pressure can signal problems and needs monitoring. The specialist may use numbing eye drops for these tests.
A slit-lamp exam provides another key tool. Using a special microscope that shines a thin beam of light into the eye, the doctor can see any small, white blood cells in the front part of the eye, which indicates inflammation.
Sometimes, the doctor performs a dilated exam. They give eye drops to make the pupil larger, then use a bright light to check the back of the eye. This step helps spot swelling or damage caused by uveitis.
For a more complete diagnosis, the doctor may use tests beyond basic eye exams:
- Color photographs document changes in the retina.
- Optical Coherence Tomography (OCT) scans provide detailed images of the retina and choroid.
- Angiography tests (fluorescein or indocyanine green) use special dyes and photos to map blood flow and spot leaky or swollen blood vessels.
If the doctor suspects infection or another disease, they might:
- Take samples of the fluid inside the eye for analysis.
- Order blood tests to find signs of infection or autoimmune problems.
- Request imaging tests like CT scans or MRIs to look for other causes.
Summary Table: Common Tests for Uveitis
| Test Name | What It Shows |
|---|---|
| Visual Acuity Test | How well you see |
| Tonometry | Eye pressure |
| Slit-Lamp Exam | Inflammation in the front of the eye |
| Dilated Exam | Swelling or damage at the back |
| OCT | Swelling in retina/choroid |
| Angiography | Blood vessel problems |
| Blood/Fluid Analysis | Signs of infection or disease |
| Imaging (CT/MRI) | Other causes in or around the eye |
Often, doctors cannot determine the exact cause of uveitis. Early diagnosis and following up with the eye specialist help to manage symptoms and protect vision.
Treatment
Medicine-Based Approaches
Doctors often use medicine to help lower swelling and pain in the eye. A common first step includes eye drops with anti-inflammatory medicine, like corticosteroids. These drops help treat the front part of the eye.
For swelling that involves deeper areas, doctors may give corticosteroids as pills or as injections near or inside the eye.
Sometimes, doctors add drops that widen the pupil to stop spasms in eye muscles and reduce pain. If an infection causes uveitis, treatment may include antibiotics or antiviral medicines.
These medicines can be used alone or combined with corticosteroids to control infections.
When uveitis does not respond to steroids, or when both eyes are affected, doctors might prescribe immunosuppressive drugs. These medicines lower the body’s immune response, preventing further harm to the eyes.
Some well-known medicines in this group include immunosuppressants (antimetabolite) and biologic drugs.
Below is a simple table summarizing some medication options:
| Treatment | How It’s Used | Purpose |
|---|---|---|
| Steroid eye drops | Applied to surface of eye | Lower front-eye inflammation |
| Corticosteroid pills | Taken by mouth | Treat deeper or severe swelling |
| Steroid injections | Injected near or in the eye | For long-lasting or tough cases |
| Antibiotics & antivirals | Taken by mouth, drops, or shots | Fight infections |
| Immunosuppressants | Pills or injections | Suppress immune response |
| Biologics | Injections | For difficult cases |
Some medicines, especially steroids, can cause side effects. These may include high eye pressure (which can lead to glaucoma), cataracts, or side effects elsewhere in the body. Regular checkups and blood tests help monitor for these problems.
Operations and Advanced Treatments
If medicine does not work well, or if the case is complicated, other options are available. One option is a vitrectomy, where a doctor removes some of the gel-like substance inside the eye.
Doctors perform this surgery rarely, usually when other treatments have not helped.
Another choice is a slow-release implant placed in the eye. This small device slowly releases corticosteroid medicine over many months or even years. Doctors use it most often for people with hard-to-control swelling deep in the eye.
However, these implants can sometimes lead to other issues. Many patients need to be checked for higher eye pressure or glaucoma. If a person has not had cataract surgery before, the implant may make cataracts develop over time.
Here is a list of some procedures:
- Vitrectomy: Removal of vitreous gel, used rarely.
- Medication implant: Small device releases medicine slowly inside the eye.
Regular visits to an eye specialist are important to track how well these options are working and to adjust the plan as needed.
Getting Ready for Your Eye Specialist Visit
Steps You Can Take Beforehand
To make the most out of your appointment, organize your thoughts and gather information. This approach helps the doctor understand the full picture of your situation.
- Write down all symptoms. Make a detailed list of any problems you have noticed, such as eye pain, redness, sensitivity to light, floaters, blurred vision, or any loss or decrease of vision. Include symptoms that might not seem related.
- Note important personal events. Record details about recent illnesses, big life changes, or injuries that may affect your health.
- Prepare a medication list. Include all prescription drugs, over-the-counter medicines, vitamins, or supplements you are currently taking.
- Bring support. Ask someone you trust to come along. Having another person can help you remember information and, if your vision is affected by inflammation or pain, help you get to and from the appointment safely.
- Make a list of questions. Consider what you want to ask the doctor. Possible questions include:
| Suggested Questions for Your Doctor |
|---|
| What might be causing my eye issues? |
| Are there other possible reasons for my symptoms? |
| What tests do I need and how should I prepare? |
| Is this problem temporary or long-term? |
| Are there treatments to prevent vision loss? |
| What side effects should I know about? |
| How can I manage this along with my other health issues? |
Having clear questions written out makes it easier not to forget what’s important during the appointment.
What Your Eye Doctor Might Ask
During the visit, the specialist will ask for detailed information to better understand your situation. Be ready to answer questions that help identify the cause and severity of your eye problem.
- When did you first notice symptoms such as eye pain, redness, light sensitivity, or vision changes?
- Are your symptoms always present, or do they come and go?
- How intense are your symptoms? Have you noticed them getting worse or better?
- Do certain actions or situations ease your symptoms? Are there things that make them worse?
- Have you experienced similar issues before, like uveitis or other eye inflammation?
- Do you have any medical conditions such as arthritis or problems with your back?
- Have you had skin rashes, mouth sores, or genital ulcers recently?
- Did you have a recent cold or other respiratory issues?
