Uveitis: symptoms, healing time, is it serious?

A uveitis correspond to inflammation of the uvea in the eye. In the vast majority of cases, it is “previous” : the eye is red, painful, light sensitive and there is a loss of vision. She heals with anti-inflammatory drops prescribed by a physician (no self-medication !). What causes uveitis? Is that bad ? How the cure ? Answers.

What is the definition of uveitis?

“Uveitis is a very generic term which corresponds to an inflammation of the uvea. The uvea refers to all the vascular structures inside the eye. which are : iris, ciliary body and choroid“, explains Dr. Ludovic N’Kosi, Ophthalmologist Surgeon, co-founder of the Ophthalmological Center Paris 17 – SOS Eye. For the record, the uvea has a purple color that resembles the color of grapes (in Latin, “grape” is called “uva”).

What is anterior uveitis?

To schematize, there is three parts in the eye : a “front” part, an intermediate part and a “rear” part. The “front” or “anterior” part of the uvea is all that is in front of the iris (the part that gives the eye color). Thus, when the inflammation affects the anterior part of the iris: we speak of anterior uveitis. It is the most frequent uveitis (it represents almost 80% of uveitis). Anterior uveitis always heals if treatment is started early and diligent, but it is associated with a risk of recurrence.

What is posterior uveitis?

Posterior uveitis is inflammation of the choroid and/or retina. She is a lot very rare than anterior uveitis. “It is the most severe uveitis because it is associated with a risk increased loss of permanent visual acuity, even blindness“, warns Dr. N’Kosi. The symptoms are rapidly evolving and there is a risk of irreversible sequelae.

What are the symptoms of uveitis?

► Signs of anterior uveitis (the most common uveitis):

• A red eye
• A sore eye
• A decrease in vision
• Sensitivity to light (photophobia): it is generally the first warning symptom for recurrent uveitis.

► Signs of posterior uveitis:

• Sudden or rapidly progressive loss of vision (a few days)
• The perception of flying flies (called “myodesopsia”), like small black dots that constantly pass in the field of vision
• The eye is neither red nor painful

► There is also theintermediate uveitis which even rarer. Its main sign: the perception of flying flies.

►Finally, theuveitis can be total (this is called panuveitis), touching sectors of the eye at once.

Does uveitis affect one eye or both eyes?

“Anterior uveitis most commonly affects one eye at a time and when it recurs, can affect the same eye or the other (and vice versa). Simultaneous involvement of both eyes is possible, but rarer“, he explains.

What causes uveitis?

“There are nearlya hundred reasons known uveitis“, emphasizes our interlocutor. Uveitis is mainly caused by:

► Either by infections. The most frequent are:

• herpes virus
• Herpes zoster virus
• Tuberculosis
• Toxoplasmosis
• Syphilis

► Either by autoimmune diseases (To fight an infection, the body develops antibodies. Sometimes antibodies attack the structures of the eye). For example, we can cite:

• Sarcoidosis
• Ankylosing spondylitis
• rheumatoid arthritis

► It sometimes happens that the causes are unknown (we speak of idiopathic uveitis), either because the uveitis is linked to a disease that has not yet manifested itself in the patient, or because the uveitis is linked to a cause that is not yet known .

Is uveitis hereditary?

“No, uveitis is not hereditary. But it exists genetic predispositionsin other words, genetic grounds that promote autoimmune diseases that cause uveitis“, restores Dr. N’Kosi.

In the case of anterior uveitis: while the red eye and the pain can be bearable for some patients, photophobia generally causes an emergency consultation. The diagnosis of uveitis is made by theophthalmologist who will measure the patient’s visual acuity and do an eye examination (with a slit lamp for the anterior part and using a fundus for the posterior part. “Posterior and intermediate uveitis can be a little more treacherous and insidious because patients may not realize it (uveitis is usually unilateral and affects only one of the two eyes). There may therefore be delayed diagnosis”adds our interlocutor.

What treatment to treat uveitis?

Management depends on the type of uveitis, anterior uveitis being, remember, much more common than posterior or intermediate uveitis. “The support ofanterior uveitis East on an outpatient basis (without hospitalization) and consists of the administration of anti-inflammatory eye drops several times a day (in general, once per hour for the first 48 hours and then gradually reduced according to the patient’s recovery). The treatment lasts at the very least one month (in practice, it lasts rather 1 month and a half-2 months for avoid an “inflammatory rebound”). It is necessary to continue the treatment until the end even if it is better. posterior uveitiswhich is more serious, often requires hospitalization to be able to administer the drugs through the veins (and reach the back of the eye, where there is inflammation, editor’s note). Hospitalization also allows increased and close monitoring in case of loss of vision or if you realize that the treatment is not working properly“, explains the ophthalmologist surgeon. If the uveitis is of infectious cause, it is of course advisable to treat the infection in question.

Symptoms subside after a week with treatment.

► Caution: in the majority of cases, uveitis recurs. However, one should not self-medicate (a patient can have a fund of treatment that remains at home for example). “This is very bad because the treatment needs to be taken according to a set protocol. Taken alone, without consulting an ophthalmologist, there is a risk of side effects related to the treatment which can be serious (in the long term, complications can be glaucoma and cataracts)“, insists our interlocutor.

What is the healing time for uveitis?

“In general, about one week after the establishment of the treatment, the symptoms fade and the patient is much better. However, if he stops the treatment abruptly, he starts over and the uveitis will not be cured. It is therefore necessary to gradually decrease the treatment until the end so that the inflammation does not return.“, insists the expert.

Is that bad ? What complications?

Generally, anterior uveitis always heals when treatment is taken on time and diligently. However, the symptoms of uveitis do not go away on their own. “Without treatment, they can get worse and lead to complications : ocular hypertension, retinal detachment and loss of permanent visual acuity or blindness. There are also the complications related to the treatment of uveitis which are cataracts and glaucoma“, says Dr. N’Kosi.

“There is no preventive action to avoid having uveitis“, answers the ophthalmologist surgeon. People who have never had uveitis may delay consulting because they do not always know how to recognize uveitis. On the other hand, for people who have a history of uveitisthey must consult quickly as soon as they feel the first symptoms (in general, the first symptom is sensitivity to light) in order to start early treatment. The earlier the treatment is started, the shorter it will take. The total duration of treatment depends on the level of inflammation which itself depends on when the diagnosis was made.

Thanks to Dr. Ludovic N’Kosi, Ophthalmologist Surgeon, Cataract, eyelids and refractive, Center ophthalmologique Paris 17 – SOS Œil​​​​​​​