The uvea or vascular tunic is the layer of the eye located beneath the sclera and above the retina, including the iris, ciliary body, and choroid in its structure. It is responsible for supplying the majority of blood flow to the retina, and its inflammation is known as uveitis. The origin of uveitis is typically due to infectious diseases (tuberculosis, toxoplasmosis, syphilis, herpes, etc.) or autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, Crohn’s disease, multiple sclerosis, etc.), as well as other conditions such as trauma or uveitis associated with certain medications or cancer.
The most common symptoms of uveitis are eye pain, blurred vision, perception of floaters, eye redness, and light sensitivity or photophobia.
However, these symptoms can vary depending on the area of the uvea affected, which defines the different types of the disease.
Anterior: This is the most common type and affects only the iris (iritis) or the iris and the ciliary body (iridocyclitis), and sometimes also the cornea. The symptoms include eye redness, conjunctival irritation, pain, and vision loss.
Intermediate or Pars Planitis: In this case, inflammation occurs in a zone located between the iris and the choroid known as the pars plana. It usually affects young people and can be complicated by macular inflammation, glaucoma, ocular hemorrhages, or deposits of material in the vitreous.
Posterior or Choroiditis: Inflammation is confined to the choroid, although it can sometimes also affect the retina (chorioretinitis). In this case, vision loss varies depending on the extent of the inflamed tissue and the location of the scar tissue that forms. If it affects the macula, it also results in deterioration of central vision.
Additionally, the retina (retinitis) or the blood vessels in the back of the eye (vasculitis) may be affected, often leading to vision loss.
Uveitis must be treated as soon as possible, as otherwise serious complications can occur: cataracts, glaucoma, cystoid macular edema, retinal detachment, or intraocular hemorrhages, with the consequent loss of vision.
However, it is always important to consider its possible association with other systemic or ocular pathologies, as these must be appropriately treated. Once the cause is treated, ocular treatment for anterior uveitis may be limited to the use of anti-inflammatory and pupil-dilating eye drops, in addition to wearing sunglasses to avoid light sensitivity reactions. In intermediate and posterior uveitis, injections around the eye (sub-Tenon or intravitreal injections) may be necessary. When there are more than three flare-ups per year, systemic treatments via oral or parenteral routes (intramuscular, subcutaneous, or intravenous infusions) are usually required.
Surgery is sometimes necessary either as a diagnostic test to take intraocular samples or for the treatment of ocular complications that can severely affect vision, such as cataracts, glaucoma, retinal detachment, macular edema, or intraocular hemorrhages.
The surgical technique will be specific to each of these pathologies and is performed by the vitreoretinal unit.
When the cause is known and the inflammation is treated, the prognosis is good, but the patient needs to be periodically evaluated to detect and treat inflammation, even if it is minimal.
As these are chronic diseases, patients must be followed long-term and special attention should be given to treating complications such as cataracts, macular edema, or glaucoma, which these patients develop more frequently. Additionally, systemic disease treatment must be administered.
