The word uvea originated from ‘uva’ the Latin word for grape. Uvea is the middle layer of the eye behind the external layer sclera (the white of the eye) and in front of retina, the transparent layer at the back of the eye.
The department of Uveitis and ocular immunology at Narayana Nethralaya, armed with highly qualified consultants, a well-equipped clinical laboratory and state of the art ophthalmic diagnostic equipment deals with the whole battery of ocular inflammations including autoimmune diseases and infections in both adults and children. We co-ordinate with the other subspecialities of ophthalmology and internal medicine efficiently to get the optimal treatment outcomes for patients with complex Uveitic disorders.
The Uveitis & Ocular Immunology Service provides a multidisciplinary approach to the treatment of ocular inflammatory disease and other infectious disorders. Experts here deal with diagnosis and management of complex infectious and autoimmune diseases of the eye as well as eye diseases associated with various other systemic medical disorders. The diagnostics are backed by a well-equipped laboratory, pathology and molecular diagnostic services, and the consultants are conversant with appropriate intervention techniques. In addition, we have the experience with the latest treatments including the use of immunosuppressive and immunomodulation for autoimmune eye diseases.
We were the first in the world to have reported “Ocular Manifestations associated with Chikungunya fever” especially Chikungunya Retinitis
Uvea consists of three parts:
- Iris is a coloured part of the visible portion of the eye that surrounds the pupil, an opening at the centre. It contains muscles that allow the pupil to become larger (after dilatation) and smaller (after constriction);
- Ciliary body, which also contains muscles, secretes a transparent liquid within the eye; and
- Choroid, which contains blood vessels and connective tissue, lies between the sclera and the retina.
Inflammation of any of these three parts is called uveitis.
Classification of Uveitis
According to standardisation of uveitis nomenclature (SUN), uveitis is classified into-
- anterior
- intermediate
- posterior
- panuveitis (Image)
In addition to uveitis, adjacent structures may also be affected; for example, retinitis may be caused when retina is affected; similarly, uveitis may also be associated with optic neuritis (optic nerve), keratitis (cornea) and scleritis (sclera).
Causes of Uveitis
Uveitis occurs due to certain infections in the body or due to disbalance of immune system caused by various not well understood external and internal factors. It is not always possible to pin point the cause of uveitis. Common causes of uveitis are listed below:
- Infections (Bacterias, Viruses Fungus and protozoal)
- Tuberculosis, Syphilis, Leprosy, Toxoplasmosis, Leptospirosis, Brucellosis, Typhoid and Rikettsial
- Herpes, Dengue, Chikungunya, cytomegalovirus (CMV), Mumps, HIV, H1N1, COVID
- Candida, Ring worm, Tinea, Aspergillus, Histoplasma
- Auto immune diseases
- Ankylosing spondylitis, Rheumatoid arthritis, Psoriasis, SLE, Behcet’s syndrome, Sarcoidosis,VKH disease etc.,
- Cancers can cause uveitis like conditions
- , Lymphomas, leukaemia, and secondries from other cancers in the body (like breast cancer, lung cancer or prostate cancer)
- Trauma can cause uveitis in the same eye or even other eye
- When the cause is unknown the uveitis is known as idiopathic
Investigations for Uveitis
It is important to know the cause of the uveitis. Once it is identified uveitis can be treated successfully. Since most of the uveitis are due to disbalance of body’s immune system or due to certain infections in the body, work up of uveitis includes many investigations, which various scans for eye as well as body, lab tests from eye fluid or from body fluid like blood, sputum, urine etc.
Common eye investigations which can be done at the eye hospitals are: OCT scan, FFA scan to study the retina and ICG scan to study the choroidal vessels, Ultrasound scan (B scan), etc.
Eye fluid test is a procedure where a small needle goes into eye and aspirates fluid for certain lab tests to find out the cause for uveitis.
Common blood tests for uveitis are: CBC, ESR, CRP, TPHA, RBS, HIV, Mantoux, Urine test
Certain uveitis may require specific investigations which are available in selected laboratories. Eg: HLA B 27, HLA B 5 1, ANA, ANCA
Mantoux test is a skin test. After the skin test patients should not touch the injection site till the reading is over. Usually reading is taken after 48 hours.
Test which cannot be done at eye hospital are: Chest X-ray, CT scan, MRI, PET scan
Treatment of Uveitis
Non-steroidal anti-inflammatory drugs (NSAIDs)
- Oral COX- 2 inhibitors
- Eye drops
Non-steroidal anti-inflammatory drugs (NSAIDs)
- Given when mild inflammation is present
- For pain relief
- As a long term alternative for steroids
- This should be avoided in severe renal diseases
Corticosteroids
- Eye drops/ointment
- Injections
- Outside the eye
- Inside the eye
- Oral
Corticosteroids
- Dose, strength and duration of the drops are determined by your doctor who decides the treatment in accordance to the amount of inflammation.
- Do not start them on your own
- Steroid eye drops can cause high eye pressure(glaucoma), Cataract and increase risk for infections
- Injectable steroids can cause
- Cataract
- High eye pressure
- Risk of infection
- Bleeding
- Retinal detachment (rare)
- Systemic corticosteroids can cause
- Acne
- Blurred vision
- Cataracts or glaucoma
- Easy bruising
- Increased appetite, weight gain
- Increased growth of body hair
- Disturbed sleep
- Lower resistance to infection
- Muscle weakness
- Nervousness, restlessness
- Osteoporosis
- Stomach irritation or bleeding
- Sudden mood swings
- Swollen, puffy face
- Water retention, swelling
- New onset or worsening of diabetes and blood pressure
Immunosuppression
- Oral
- Injections
Immunosuppression
- Are often used as steroid sparing agents for long term medication
- Usually administered in conjunction with a rheumatologist
- Oral
- Methotrexate
- Azathioprine
- Cyclosporine
- Tacrolimus
- Mycophenolate
- Injections
- Methotrexate
- When on these medications regular follow up with the ophthalmologist and the rheumatologist is mandatory.
- Repeat blood tests are necessary during this period.
These drugs can cause, hair loss, increased liver enzymes, secondary malignancies and predisposed development of superadded infections.
Biologics
- These medications are obtained biologically hence their name and they specifically target certain elements of the immune system and, in so doing, avoid some of the potential risks of the more conventional IMT medications.
- It is contraindicated in patients with tuberculosis (TB), chronic hepatitis B or C, or any active infection
- Avoid pregnancy till 5 months after stopping the last dose of biologics
- Patients are advised to see a doctor if the patient develops fever, sore throat, bleeding from anywhere in the body
- Infliximab
- Adalimumab
- Rituximab
- Tocilizumab
- Secukinumab
Uveitis Consultation – Patient Process Flow
If you have constant redness, pain, watering, inability to see bright light, floaters and/or decreased vision, you should schedule an appointment with an ophthalmologist to get your eyes checked immediately. Your initial consultation with the doctor will approximately take 2 hours if you do not require cross-consultation and up to 4 hours if you require cross-consultation. During your consultation, our doctors and counsellors will determine the best course of action for your visual needs, go over the risks and benefits of treatment, and help you choose the best procedure that is suitable for preserving/improving your vision. We suggest you bring a family member or friend with you to help you with your decision-making.
Uveitis Doctors NN1
Dr. Padmamalini Mahendradas
HOD
Uveitis Consultant
Dr. Ankush Kawali
Consultant
Dr. Sai Bhakti Mishra
Consultant
Uveitis Doctors NN2
Dr. Namita Dave
Consultant
Uveitis Doctors NN4
Dr. Namita Dave
Consultant
Uveitis
Case Study 1
VKH disease
A 26 year old female visited Narayana Nethralaya with the complaints of headache and sudden decrease in vision in both eyes. After detailed dilated fundus examination and relevant investigations, she was diagnosed to have Vogt- Koyanagi Harada ( VKH ) syndrome . Systemic steroids along with topical steroids were started, Subsequently she was started on systemic immunosuppressive therapy. Her vision improved to 6/6 in both eyes. After two months topical and systemic steroids were stopped. She was on systemic immunosuppressive therapy for two years. Now we have 7 years follow up and the patient is doing fine.
Book an appointment with our Uveitis Team
Uveitis
Case Study 2
Retinal vasculitis
A 17 year old boy visited Narayana Nethralaya with complaints of floaters in his left eye. He was found to have retinal vasculitis. On investigations he tested positive for tuberculosis. He was treated with anti-tubercular treatment (ATT) along with oral steroids. He also underwent laser treatment to prevent chances of bleeding inside the eye. His vasculitis completely resolved after completion of 9 months ATT course. During 5 years of follow up he remained asymptomatic and enjoyed floater free vision.
Book an appointment with our Uveitis Team
Uveitis Patient Reviews
At Narayana Nethralaya, we are committed to providing our uveitis patients with advanced quality eye care at affordable prices. These uveitis eye surgery experiences stand testimony to the excellence in eye care that we offer.
Patient Testimonials
At Narayana Nethralaya, we are committed to providing our uveitis patients with advanced quality eye care at affordable prices. These uveitis eye surgery experiences stand testimony to the excellence in eye care that we offer.
FAQ
Frequently Asked Questions
What is uveitis?
Uveitis is an inflammation of the pigmented layer of the eye known as uvea comprising of iris, choroid and ciliary body.
What are the causes of uveitis?
There are various causes of uveitis. They can be classified into infectious, autoimmune, due to injury or could be due drugs.
Infectious causes could be viral like herpes virus, varicella virus; bacterial like tuberculosis; parasitic like toxoplasmosis.
Post fever immune mediated reactions can cause uveitis for example Dengue, Chikungunya, Rickettsia and Typhoid.
What are treatment options in uveitis?
Treatment options could be eye drops, eye injections, oral medications or systemic medications.
Systemic medications may sometimes be administered in consultation with an pulmonologist or a rheumatologist.
What are the ocular tests for diagnosis of uveitis?
They can be invasive or non-invasive. Non- invasive tests include ultrasound Bscan, optical coherence tomography, fundus photo and fundus autofluoroscence.
Invasive tests can be fundus fluorescein angiography and Indocyanine angiography.
Sometimes eye fluid is tested for organisms in specific instances.
What are the systemic tests for diagnosis of uveitis?
Includes blood, urine analysis and x rays of the chest or hip bones.
What is duration of treatment in uveitis?
Depends on the severity of disease, sometimes it may go on for few months to years.
What are complications of uveitis?
The eye pressure can increase, you may develop cataract, swelling in the macula (sensitive layer of the eye). It is important to follow the instructions as advised by your consultant.
Do I need to visit any other specialists?
There may be a need to visit rheumatologist or a physician/ chest physician according to the diagnosis of your condition.
Can I get uveitis after fever?
Yes, many cases have been reported to involve the ocular structures after fever/infections.
How frequently I have to visit OPD after treatment?
Depends on the diagnosis but mostly each patient needs a customized follow up based on the advise of your consultant.
