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Wednesday, September 08, 2010
 
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Posterior Uveitis
PU, retinitis, Choroidoretinitis, or Choroiditis
Inflammation (irritation, swelling, damage) of the uvea, the part of the eyeball that contains the retina (i.e., screen upon which images are project), ciliary body (muscles that control the lens), and the choroid (a rich layer of blood vessels covering the retina).  PU refers to the inflammation of the choroids and the retinal layer leading to vision problems.
  • Sudden occurrence is rare.
  • Decreased vision -- Blurred Vision
  • Distortion of size and shapes of the objects seen
  • Often affects both eyes
  • Pain and redness is rarely seen unless the iris is involved as well.
  • There may be signs of related disorders (i.e., infection, etc.).
  • Floaters or floating black spots may be seen in the field of vision.
  • Sensitivity to light
  •  
    • 25% of cases are without a cause (idiopathic).
    • Infections:
      1. Bacteria, parasites, viruses, and fungi
      2. Tuberculosis
      3. Toxoplasmosis (commonly affects newborns)
      4. Leprosy
      5. Histoplasmosis
      6. Toxocariasis
      7. Candidiasis
      8. HIV
      9. Herpes virus
      10. Syphilis
      11. Measles
      12. And many others
    • Autoimmune disorders -- the body's natural defenses attack the uvea for reasons unknown at this time.
    • Some malignancies (cancers) may be mistaken for eye inflammation, such as:
      1. Leukemia
      2. Retinitis pigmentosa
      3. Retinoblastoma
    • Other conditions of the eye:
      1. Acute retinal necrosis
      2. Pars plantis
      3. Others
  • Infections
  • Autoimmune disorders
  • Rheumatoid Arthritis
  • Sarcoidosis
  • Ankylosing Spondylitis
  • Behcet's Syndrome
  • Psoriatic arthritis
  • Multiple Sclerosis
  • Allergic reaction to drugs, etc.
  •  
    • The doctor may consult with an ophthalmologist (eye doctor).
    • History:
      1. Symptoms
      2. Injury
      3. Illnesses
      4. Surgeries
      5. Occupation
      6. Habits
      7. Medications
      8. Allergies
    • Medical exam:
      1. General exam must be done.
      2. Vision exam -- using an eye chart, there may be spotty vision loss corresponding to areas where the retina or choroid layer is damaged.
      3. The eye is examined with an Ophthalmoscope (device which allows the doctor to see inside the eyes) or a slit lamp -- a special microscope used to see the back of the eye.  Slit lamp exam is done after staining the eye with an orange fluorescein dye, and applying eye drops to enlarge the pupils (enhances viewing back of eyes).
      4. Floaters (debris from damaged retina) and scars (damaged areas) may be seen.
    • Blood tests, X-Rays, and other tests may be done to identify the cause.
  • Treat underlying cause
  • Warm compresses with a warm (not hot) towel help relieve discomfort.  Repeat as needed.
  • Painkillers -- over-the-counter (e.g., Tylenol) or if pain is severe, Codeine (prescribed).
  • Infections must be treated first.
  • Eye is protected with dark sunglasses with UV protection
  • Eye drops such as Isopto ophthalmic solution are often given, along with steroid eye drops (Prednisolone acetate) until symptoms resolve.
  • Steroids are not to be given if infection is not treated.
  • Check to make sure patient is not on any medications that could cause uveitis.
  • Contact your doctor immediately, and get routine eye exams (at least once a year) if you have an autoimmune disorder or are on medications that may cause eye problems.
  • Conjunctivitis
  • Keratitis
  • Glaucoma
  • Scleritis

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