Anterior Uveitis

Anterior Uveitis

Also referred to as: Iritis

(bold items are things I'm emphasizing, italics are for where I'm translating in the middle of a long quote)

Intro: http://www.myvision2020.com/h_uveitis.htm

Cause The eye is shaped like a hollow ball with three different tissue layers surrounding a central cavity. The middle layer is the uvea. The uvea is a vascular area which nourishes the eye. The choroid, ciliary body, and iris, as a whole, is referred to as the uvea and when inflammation in this section of the eye occurs, it is known as uveitis.

Uveitis is often associated with systemic disease, which means the entire body and the diseases which affect it, must be taken into consideration before making a proper diagnosis.

Treatment Uveitis is often treated with eyedrops. A cyclopleging (scopolamine: muscle relaxant) agent will relax the ciliary muscle and decrease pain. Steroid eyedrops (prednisolone) are used to reduce the inflammation of the uvea. Since many eye conditions may present with similar symptoms, appropriate treatment hinges upon prompt evaluation.

List of some of the body-wide diseases than can be the root cause ("etiology") of it: http://www.eyemdlink.com/Condition.asp?ConditionID=68 : Reiter's syndrome, Ankylosing spondylitis, Ulcerative colitis (Crohn's disease), Psoriatic arthritis, Aortitis, Juvenile rheumatoid arthritis.

There are different ways of classifying types of AU, see first section of http://www.nova.edu/~kimreed/uveitis.html (is hers "granulomatous" or not?)

• this document also lists a number of tests ("work up") that can be given to identify the root cause

• it also lists some "optional" treatments that can be used in addition to the 2 sets of eyedrops

The "Clinical Pearls" section of http://www.revoptom.com/handbook/sect4e.htm says

• Acute (1-time) anterior uveitis results most commonly as a result of blunt ocular trauma (a poke in the eye). 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... (see link for list)

• Always perform a comprehensive, dilated fundus evaluation in these cases. Anterior uveitis may actually constitute a "spillover" of posterior ocular inflammation.

"Management of AU" (http://www.vetsoftware.com/acvc2002-glaze1.htm) says:

• A thorough physical examination should be performed on all patients in which uveitis is diagnosed, especially if the uveitis is bilateral (both eyes)

• In order to successfully manage anterior uveitis, every effort must be made to determine the underlying cause of the inflammatory disease.

• Primary ocular disorders causing uveitis include trauma, infection, neoplasia, or the autoimmune phenomenon triggered by leakage of lens protein into the anterior chamber. Idiopathic disease (e.g. "we can't figure out the cause") may ultimately be diagnosed if an etiology cannot be documented.

  • "secondary" disorders are more likely when the symptoms are bilateral (in both eyes)

  • Infectious diseases are abundant and include viral (ICH, FIP, herpesvirus!), bacterial (brucellosis), fungal (blastomycosis, etc), parasitic (dirofilariasis), protozoal (toxoplasmosis) and rickettsial diseases (ehrlichiosis, RMSF), to name a few. Immune mediated disorders include rheumatoid arthritis, SLE and Vogt-Koyanagi-Harada-like syndrome.

• As a general rule, therapy should be initially aggressive, tapering frequency of administration as clinical signs subside. Anti-inflammatory therapy should be continued for at least 2 weeks beyond resolution of clinical signs (2 weeks after the symptoms have gone away). Recurrences of inflammation following cessation of treatment suggest the need for prolonged if not indefinite maintenance therapy.

Bill's summary/recommendations:

• print out this summary, and any linked pages that seem important, to take along

• take the drops as often as they say; make sure you go back in for review when they say to: ask whether it's clearing up as quickly as it should.

• how specifically have they identified the root cause? Or do they think that's not an issue when it's a first-time problem, and in just one eye?