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Uveitis and Other Inflammatory Diseases

red-eye

A red eye can be a diagnostic dilemma for a primary care physician or an optometrist. The diagnosis could include one of the following conditions (or something different). You should see an ophthalmologist for further management.

Anterior Uveitis and Iritis
What is it Anterior Uveitis and Iritis?

Anterior uveitis, also referred to as iritis or iridocyclitis, is an inflammation of the iris and ciliary body. It is an autoimmune reaction that may be either isolated or part of a systemic condition such as psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, juvenile rheumatoid arthritis, Reiter’s syndrome, sarcoidosis, tuberculosis, brucellosis, herpes simplex, herpes zoster, or Behçet’s disease.

How does it present?

Symptoms of uveitis and iritis are most frequently redness, pain and light sensitivity. Vision is often normal or slightly blurred. The redness may be more prominent on the white part of the eye adjacent to the cornea. The pupil may be irregular in shape because a portion has become scarred the anterior surface of the lens or the posterior surface of the cornea. The eye pressure is low to normal in most cases, however it can be high in some forms of uveitis.

 What to do?

You should see an ophthalmologist immediately. Treatment includes topical dilating drops and anti-inflammatory steroid drops. You may need a drop to reduce your intraocular pressure.

Most cases are unassociated with systemic disease and resolve within weeks of treatment. An evaluation for a systemic autoimmune, infectious, or genetic disorder should take place if the patient has repeated attacks of uveitis or uveitis in both eyes.

 

Episcleritis

What is Episcleritis?

Episcleritis is an inflammation of the white part of the eye. It affects the episclera, but not the sclera. Usually an isolated condition, it may be seen as part of dry eye syndrome, a viral infection, or for unknown reasons

 What are the symptoms?

Most patients have mild ocular pain and redness. 

 What should you do?

You should see an ophthalmologist urgently, because the diagnosis of episcleritis is difficult. Episcleritis often responds to lubricating drops or mild steroid drops. Underlying conditions like dry eye may require further evaluation and treatment.

 

Scleritis

What is scleritis?

Scleritis is a focal or diffuse inflammation of the sclera, the white part of the eye. It is often associated with a systemic immune or infectious condition. The most common associated disease is rheumatoid arthritis.

 What are the symptoms?

Severe ocular pain and a red eye is most common. The blood vessels on the white of the eye are often dilated at a spot remote from the cornea. The underlying sclera may begin to thin and show the dark, underlying uveal tissue. Untreated, this condition could cause severe melting of the cornea or sclera, perforation of the eye, loss of vision or the eye.

 What to should you do?

It is critical that you see an ophthalmologist immediately. The diagnosis is difficult and treatment may present problems. Scleritis requires systemic anti-inflammatory steroids or other immune-modulating agents. Severe thinning and ocular perforation may require surgical patch grafts. An evaluation for a systemic autoimmune disease is appropriate if no such diagnosis already exists. This will often involve a visit to a rheumatologist.

Immunogenic Conjunctivitis

What is Immunogenic Conjunctivitis?

Immunogenic conjunctivitis is a noninfectious inflammation of the white part of the eye associated with systemic disorders of the immune system, such as Graves’ disease (thyroid eye disease), rheumatoid arthritis, Sjögren’s syndrome, lupus erythematosus, Wegener’s granulomatosis, relapsing polychondritis, and polyarteritis nodosa.

 How does it present?

The symptoms are usually minimal, but the patient complains of a chronic red eye. The conjunctiva is diffusely red without discharge. Inflammation of the orbital soft tissues, cornea, and sclera may coexist. One or both eyes may be involved.

A systemic autoimmune disease may already be known, but sometimes the red eye is the first or most obvious sign. It will usually be mistaken for an infectious condition and treated without effect.

 What should you do?

If you have chronically red eyes—this is likely not caused by an infection. Optometrist sometimes attempt to treat these patients with antibiotics, steroids and allergy drops with no improvement. You will need to see an ophthalmologist immediately for a more thorough diagnostic evaluation.