Uveitis
consists of a group of diseases characterized by
significant sight threatening intraocular
inflammation primarily involving the uveal tract
(iris, ciliary body, and choroid), although
inflammation of adjacent tissues, such as
retina, optic nerve, and vitreous humor also
occurs.
Little is known about the pathogenesis of uveitis,
but in cases of endogenous uveitis in which no link
with an infectious agent can be identified,
autoimmunity has been invoked as the cause. Many
cases are often labelled as idiopathic, but in some
it may be part of systemic disease process, such as
sarcoidosis, multiple sclerosis, and Behçet’s
disease, or associated with the HLA-B27 positive
group of diseases. Infectious agents, such as the
herpes group of viruses, toxoplasma gondii,
mycobacterium tuberculosis, and treponema pallidum
are also well-recognized causes.
Uveitis mainly occurs in the 20-50 year age group,
and can affect one or both eyes. The incidence of
uveitis varies from 14 to 52.4/100,000 with the
overall prevalence around the world is up to 0.73%.
A recent study found that the extrapolated 10-year
incidence of uveitis was almost three times higher
than that reported almost 40 years
previously.
Most uveitis patients present at an age where they
are in the most active period of their working
life. In about half the patients the age of onset
is in the third or fourth decade of life. This age
distribution makes uveitis a group of ocular
diseases with an important socioeconomic impact.
Many cases will resolve rapidly, but a significant
number of patients develop persistent disease with
inflammatory damage to ocular structures resulting
in severe visual impairment. The main causes of
sight loss are cystoid macular edema, cataract, and
glaucoma.
Approximately 5-20% of legal blindness in developed
countries is due to uveitis, and it has been
estimated that uveitis accounts for 10-15% of all
cases of total blindness in the USA. Acute anterior
uveitis is the commonest subtype and carries the
best visual outcome, with a worse visual prognosis
seen in patients with posterior uveitis and
panuveitis.
In non-infectious causes, therapy is usually aimed
at dampening down the immune response with
corticosteroids being the first line treatment. In
sight threatening disease immunosuppressive agents
may need to be added to improve or preserve
sight.