| | | | Other Names | | | Anterior Uveitis, Iritis, Eye Inflammation, Inflamed Eye, Inflamed Eyes, Pink-Eye, Pink Eye, Pinkeye, Conjunctivitis, Eye irritations, Eye Inflammation.
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| | | SIGNS AND SYMPTOMS
The typical presentation of anterior uveitis
involves pain, photophobia and excessive tearing. Patients report a deep,
dull aching of the involved eye and surrounding orbit. Associated
sensitivity to lights may be severe; often, these patients will present
wearing dark sunglasses. The excessive tearing occurs secondary to
increased neural stimulation of the lacrimal gland, and is not associated
with a foreign body sensation.
Visual acuity is not usually
impaired to any great extent (20/40 or better is common), although
patients may report some haziness. Accommodative tasks, however, may prove
more difficult and uncomfortable. Inspection may reveal mild to moderate
congestion of the lids, resulting in pseudoptosis. You'll typically see a
deep perilimbal injection of the conjunctiva and episclera, although the
palpebral conjunctiva is characteristically normal. The cornea may display
mild edema upon biomicroscopy. In more severe reactions, you may observe
grayish brown endothelial deposits, known as keratic
precipitates.
The hallmark signs of anterior uveitis are
"cells and flare." Cells are leukocytes (white blood cells)
floating in the convection currents of the aqueous; flare refers to
liberated protein from the inflamed iris or ciliary body which gives the
aqueous a particulate, or smoky, appearance. The iris may adhere to the
lens capsule (posterior synechia) or, less commonly, to the peripheral
cornea (anterior synechia). Additionally, you may see granulomatous
nodules within the iris stroma.
Intraocular pressure in the
affected eye is initially reduced due to secretory hypotony of the ciliary
body. However, as the reaction persists, inflammatory by-products may
accumulate in the trabeculum. If this debris builds significantly, and if
the ciliary body resumes its normal secretory output, the pressure may
rise sharply, resulting in a secondary uveitic
glaucoma.
PATHOPHYSIOLOGY
Uveitis, as the name implies,
represents an inflammation of the uveal tissues, chiefly the iris and
ciliary body. Inflammation may be associated with underlying systemic
disease, or it may occur as a direct result of ocular trauma.
Occasionally, inflammatory reactions in adjacent tissues (e.g.,
keratitis), can induce a secondary uveitis.
Uveitis can be either
acute or chronic. The chronic form is more often associated with systemic
disorders including, but not limited to, ankylosing spondylitis, Beh‡et's
syndrome, inflammatory bowel disease, juvenile rheumatoid arthritis,
Reiter's syndrome, sarcoidosis, syphilis, tuberculosis, and Lyme disease.
Chronic uveitis most likely occurs due to an immunopathological mechanism
which is not fully understood.
MANAGEMENT
There are two
primary goals when managing anterior uveitis. First, immobilize the iris
and ciliary body to decrease pain and prevent exacerbation of the
condition. Second, quell the inflammatory response. Begin by cyclopleging
the patient with homatropine 5% TID/QID, scopolamine 0.25% BID/QID or
atropine 1% BID, depending upon the severity of the reaction. Next,
prescribe a topical steroid Q2-3H, or more often if the reaction is
severe. If there's a posterior synechia present, attempt to break the
adhesion in the office using atropine 1% and phenylephrine 10%. Treat
secondary elevations in IOP using standard anti-glaucoma agents, such as
timolol 0.5% BID or dorzolamide 2% TID.
Avoid pilocarpine in
uveitic glaucoma, as it will only serve to worsen the inflammatory
response by mobilizing the uveal tissues. After beginning treatment,
re-evaluate the patient every one to seven days depending on the severity
of the reaction. As the uveitis resolves, discontinue the cycloplegics and
taper the steroids to QID or TID. Generally, it is better to taper slowly
rather than abruptly, and patients may need to remain on steroid drops
daily or every other day for several weeks. In recalcitrant uveitis which
is unresponsive to conventional therapy, consider injectible steroids such
as methylprednisolone 60mg or even oral steroids such as prednisone 60 to
80mg.
CLINICAL PEARLSAcute anterior uveitis results most
commonly as a result of blunt ocular trauma. In most instances, these
cases resolve without incident and do not recur when properly
managed.Consider any cases of recurrent uveitis, defined as three
or more unexplained incidents, to be representative of underlying systemic
inflammatory disease until proven otherwise. Hematologic testing is
indicated for any recurrent, chronic or bilateral presentation. A standard
battery of laboratory tests should include: complete blood count (CBC)
with differential, antinuclear antibody (ANA), HLA-B27, rheumatoid factor
(RF), angiotensin-converting enzyme (ACE), purified protein derivative
(PPD), fluorescent treponemal antibody absorption (FTA-ABS) and rapid
plasma reagin (RPR). A chest X-ray is also important in identifying both
sarcoidosis and tuberculosis. A Lyme titer is also recommended if you
suspect that the patient may have been bitten by a deer
tick.Always perform a comprehensive, dilated fundus evaluation in
these cases. Anterior uveitis may actually constitute a
"spillover" of posterior ocular inflammation.
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Please Note: This Traditional Use information is provided as a courtesy only. The products indicated above may be listed in error. This information is based on Traditional and Folklore Medicine which uses natural materials to support health. This information has not been evaluated or approved by the FDA and is not based on scientific evidence from any source. These statements have not been evaluated by the Food and Drug Administration (FDA). These products are intended to support general well being and are not intended to treat, diagnose, mitigate, prevent, or cure any condition or disease. If conditions persist, please seek advice from your medical doctor.
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Uveitis (Eye Inflammation) - Health - Oculoheel Eyedrops (15 Sterile Vials / 0.45 mL Each)
6.75 mL
16.13 US
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Uveitis (Eye Inflammation) - Health - Oculoheel
50 tablets
15.97 US
In Stock - Ships Today!
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