Inflammation of the eye is uveitis. Uveitis is an inflammation of the iris or choroid of the ciliary body of the eye.

Uveitis(wrong uevitis) - inflammatory pathology of various parts of the uveal tract ( choroid eyes), manifested by pain in the eyes, hypersensitivity to light, blurred vision, chronic lacrimation. The term "uvea" translated from ancient Greek means "grape". The choroid has a complex structure and is located between the sclera and the retina, resembling appearance bunch of grapes.

The structure of the uveal membrane has three sections: the iris, the ciliary body and the choroid, located under the retina and lining it outside.

The choroid performs a number of important functions in the human body:

The most basic and vital function of the uveal membrane for the body is to supply the eyes with blood. The anterior and posterior short and long ciliary arteries provide blood flow to various structures of the visual analyzer. All three parts of the eye are supplied with blood from different sources and are affected separately.

The parts of the choroid are also innervated differently. The branching of the vascular network of the eye and slow blood flow are factors that contribute to the retention of microbes and the development of pathology. These anatomical and physiological features influence the occurrence of uveitis and ensure their high prevalence.

With dysfunction of the choroid, the functioning of the visual analyzer is disrupted. Inflammatory diseases of the uveal tract account for about 50% of all eye pathologies. Approximately 30% of uveitis lead to a sharp drop in visual acuity or its complete loss. Men suffer from uveitis more often than women.

variety of forms and manifestations of eye lesions

Main morphological forms of pathology:

1. Anterior uveitis is more common than others. They are represented by the following nosologies - iritis, cyclitis,.
2. Posterior uveitis – choroiditis.
3. Median uveitis.
4. Peripheral uveitis.
5. Diffuse uveitis - damage to all parts of the uveal tract. The generalized form of the pathology is called iridocyclochoroiditis or panuveitis.

Treatment of uveitis is etiological, consisting of the use of local dosage forms in the form of eye ointments, drops, injections and systemic drug therapy. If patients with uveitis do not promptly consult an ophthalmologist and do not undergo adequate therapy, they develop severe complications: cataract, secondary glaucoma, swelling and detachment of the retina, accretion of the lens to the pupil.

Uveitis is a disease, the outcome of which directly depends on the time of detection and consultation with a doctor. In order not to lead the pathology to loss of vision, treatment should be started as early as possible. If the redness of the eye does not go away for several days in a row, you should visit an ophthalmologist.

Etiology

The causes of uveitis are very diverse. Taking into account etiological factors, the following types of disease are distinguished:

In children and the elderly, ocular uveitis is usually infectious in nature. In this case, the provoking factors are often allergies and psychological stress.

Foci of inflammation in the uveal membrane are cotton wool-like infiltrates with fuzzy contours of yellow, gray or red color. After treatment and the disappearance of signs of inflammation, the lesions disappear without a trace or a scar is formed, visible through the sclera and looking like a white area with clear contours and vessels along the periphery.

Symptoms

Expression and variety clinical symptoms in uveitis, it is determined by the localization of the pathological focus, the general resistance of the body and the virulence of the microbe.

Anterior uveitis

anterior uveitis has the most noticeable manifestations

Anterior uveitis is a unilateral disease that begins acutely and is accompanied by a change in the color of the iris. The main symptoms of the disease are: eye pain, photophobia, blurred vision, “fog” or “veil” before the eyes, hyperemia, excessive lacrimation, heaviness, pain and discomfort in the eyes, decreased sensitivity of the cornea. The pupil in this form of pathology is narrow, practically unresponsive to light and has an irregular shape. Precipitates are formed on the cornea, which are an accumulation of lymphocytes, plasma cells, and pigments floating in the chamber moisture. The acute process lasts on average 1.5-2 months. In autumn and winter the disease often recurs.

Anterior rheumatoid serous uveitis has chronic course and erased clinical picture. The disease is rare and is manifested by the formation of corneal precipitates, posterior adhesions of the iris, destruction of the ciliary body, and clouding of the lens. Rheumatoid uveitis has a long course, is difficult to treat and is often complicated by the development of secondary ocular pathology.

Peripheral uveitis

With peripheral uveitis, both eyes are often affected symmetrically, and “floaters” before the eyes, visual acuity deteriorates. This is the most diagnostically difficult form of pathology, since the focus of inflammation is located in an area that is difficult to study with standard ophthalmological methods. In children and individuals young peripheral uveitis is especially severe.

Posterior uveitis

Posterior uveitis has mild symptoms that appear late and do not worsen the general condition of patients. In this case, there is no pain and hyperemia, vision decreases gradually, flickering dots appear before the eyes. The disease begins unnoticed: patients experience flashes and flickering before their eyes, the shape of objects is distorted, and vision becomes blurred. They have difficulty reading, it gets worse twilight vision, color perception is impaired. Cells are found in the vitreous humor, and white and yellow deposits are found on the retina. Posterior uveitis is complicated by macular ischemia, macular edema, retinal detachment, and retinal vasculitis.

The chronic course of any form of uveitis is characterized by the rare occurrence of mild symptoms. The patient's eyes become slightly red and floating spots appear before the eyes. In severe cases, complete blindness, glaucoma, cataracts, and inflammation of the eyeball membrane develop.

Iridocyclochoroiditis

Iridocyclochoroiditis is the most severe form of pathology, caused by inflammation of the entire vascular tract of the eye. The disease manifests itself with any combination of the symptoms described above. This is a rare and serious disease resulting from hematogenous infection of the uveal tract, toxic damage or severe allergization of the body.

Diagnostics

Ophthalmologists diagnose and treat uveitis. They examine the eyes, check visual acuity, determine visual fields, and perform tonometry.

The main diagnostic methods to detect uveitis in patients:

1. Biomicroscopy,
2. Gonioscopy,
3. Ophthalmoscopy,
4. Ultrasound of the eye,
5. Fluorescein angiography of the retina,
6. Ultrasonography,
7. Rheoophthalmography,
8. Electroretinography,
9. Anterior chamber paracentesis,
10. Vitreal and chorioretinal biopsy.

Treatment

Treatment of uveitis is complex, consisting of the use of systemic and local antimicrobial, vasodilating, immunostimulating, desensitizing drugs, enzymes, physiotherapeutic methods, hirudotherapy, drugs traditional medicine. Patients are usually prescribed drugs in the following dosage forms: eye drops, ointments, injections.

Traditional treatment

Treatment of uveitis is aimed at the rapid resorption of inflammatory infiltrates, especially in cases of indolent processes. If you miss the first symptoms of the disease, not only the color of the iris will change, its degeneration will develop, and everything will end in disintegration.

For drug treatment of anterior and posterior uveitis, the following is used:

• Antibacterial agents wide range actions from the group of macrolides, cephalosporins, fluoroquinolones. The drugs are administered subconjunctivally, intravenously, intramuscularly, intravitreally. The choice of drug depends on the type of pathogen. For this purpose they carry out microbiological examination eye discharge for microflora and determination of the sensitivity of the isolated microbe to antibiotics.
• Viral uveitis is treated antiviral drugs – “Acyclovir”, “Zovirax” in combination with “Cycloferon”, “Viferon”. They are prescribed for local application in the form of intravitreal injections, as well as for oral administration.
• Anti-inflammatory drugs from the group of NSAIDs, glucocorticoids, cytostatics. Patients are prescribed eye drops with prednisolone or dexamethasone, 2 drops into the affected eye every 4 hours - “Prenacid”, “Dexoftan”, “Dexapos”. Indomethacin, Ibuprofen, Movalis, Butadione are taken internally.
• Immunosuppressants prescribed when anti-inflammatory therapy is ineffective. Drugs in this group inhibit immune reactions - Cyclosporine, Methotrexate.
• To prevent the formation of adhesions, eye drops “Tropicamide”, “Cyclopentolate”, “Irifrin”, “Atropine” are used. Mydriatics relieve spasm of the ciliary muscle.
• Fibrinolytic drugs have a resolving effect - “Lidaza”, “Gemaza”, “Wobenzym”.
• Antihistamines means “Clemastin”, “Claritin”, “Suprastin”.
• Vitamin therapy.

Surgical treatment of uveitis is indicated in severe cases or in the presence of complications. The adhesions between the iris and the lens are surgically cut, the vitreous body, glaucoma, cataracts, and eyeball are removed, and the retina is soldered with a laser. The outcomes of such operations are not always favorable. An exacerbation of the inflammatory process is possible.

Physiotherapy is carried out after acute symptoms have subsided. inflammatory phenomena. The most effective physiotherapeutic methods: electrophoresis, phonophoresis, vacuum pulsed eye massage, infitatherapy, ultraviolet irradiation or laser irradiation blood, laser coagulation, phototherapy, cryotherapy.

ethnoscience

The most effective and popular methods of traditional medicine that can complement the main treatment (in consultation with the doctor!):

Prevention of uveitis consists of maintaining eye hygiene, preventing general hypothermia, injuries, overwork, treating allergies and various pathologies of the body. Any eye disease should begin to be treated as early as possible so as not to provoke the development of more serious processes.

Video: mini-lecture on uveitis

2965 09/18/2019 5 min.

Eyes are an important component of the entire body. Sometimes, during diagnosis, the source of the problem is discovered in a completely different place than where it was previously looked for. The treatment of any health problem must be approached comprehensively. This is especially true for an eye disease such as uveitis. It is important to treat not only the symptoms, but to identify the cause of the disease.

What is uveitis?

Uveitis – general concept, which means inflammation of various parts of the choroid (iris, ciliary body, choroid). This disease is quite common and dangerous. Often (in 25% of cases) uveitis leads to and even blindness.

The appearance of this disease is facilitated by the high prevalence of the vascular network of the eye. In this case, blood flow in the uveal tract is slowed down, which can lead to retention of microorganisms in the choroid. Under certain conditions, these microorganisms are activated and lead to inflammation.

Watery eyes as one of the signs of uveitis

The development of inflammation is also influenced by other features of the choroid, including different blood supply and innervation of its different structures:

• anterior section (iris and ciliary body) is supplied with blood by the anterior ciliary and posterior long arteries, and is innervated by the ciliary fibers of the first branch of the trigeminal nerve;
• the posterior section (choroid) is supplied with blood via the posterior short ciliary arteries and is characterized by the absence of sensory innervation.

These features determine the location of the lesion in the uveal tract. The anterior or posterior region may be affected.

Classification

The anatomy of the eye predisposes the disease to be localized in different locations of the uveal tract. Depending on this factor, there are:

• Anterior uveitis: iritis, anterior cyclitis. Inflammation develops in the iris and. This variety is the most common.
• Median (intermediate) uveitis: posterior cyclitis, pars planitis. The ciliary or vitreous body, retina, and choroid are affected.
• Posterior uveitis: choroiditis, retinitis, neurouveitis. The choroid, retina, etc. are affected.
• Generalized uveitis – panuveitis. This type the disease develops if all parts of the choroid are affected.

Forms

The nature of inflammation in uveitis can be different, and therefore the following forms of the disease are distinguished:

• serous;
• hemorrhagic;
• fibrinous-plastic;
• mixed.

Depending on the duration of inflammation, acute and chronic (more than 6 weeks) forms of uveitis are distinguished.

Causes of inflammation

Uveitis can develop due to a wide variety of reasons, the main ones being:

• infections;
• injuries;
• systemic and syndromic diseases;
• metabolic and hormonal regulation disorders.

Infectious uveitis is the most common: they occur in 43.5% of cases. Infectious agents in this case are mycobacterium tuberculosis, streptococci, toxoplasma, treponema pallidum, cytomegalovirus, herpesvirus, and fungi. As a rule, such uveitis is associated with infection entering the vascular bed from any source of infection and develops with sinusitis, tuberculosis, syphilis, viral diseases, tonsillitis, sepsis, dental caries, etc.

In the development of allergic uveitis, increased specific sensitivity to environmental factors plays a role - drug and food allergy, hay fever, etc. Often, with the introduction of various serums and vaccines, serum uveitis develops.

Uveitis can occur against the background of systemic and syndromic diseases, such as:

• rheumatism;
• rheumatoid arthritis;
• psoriasis;
• spondyloarthritis;
• sarcoidosis;
• glomerulonephritis;
• autoimmune thyroiditis;
• multiple sclerosis;
• ulcerative colitis;
• Reiter's, Vogt-Koyanagi-Harada syndromes, etc.

Post-traumatic uveitis occurs due to penetrating or contusive injuries to the eyeball, or foreign bodies entering the eyes.

The following diseases also contribute to the development of uveitis:

• metabolic disorders and hormonal dysfunction (diabetes mellitus, menopause, etc.);
• diseases of the circulatory system;
• diseases of the visual organs (conjunctivitis, keratitis, blepharitis, scleritis, perforation of corneal ulcers).

And this is not the entire list of diseases as a result of which uveitis can arise and develop.

Symptoms and diagnosis

On initial stage disease, the color of the iris changes and adhesions appear. The lens of the eye becomes cloudy. Further, uveitis can manifest itself in different ways, depending on the type and form of inflammation. General symptoms are:

• photophobia;
• chronic lacrimation;
• aching or sharp pain;
• pain and discomfort;
• deformation, ;
• the appearance of a slight “fog” before the eyes;
• deterioration of visual acuity, up to blindness;
• unclear perception;
• promotion intraocular pressure(at the same time there is a feeling of heaviness in the eye);
• transition of inflammation to the second eye.

The main reason that causes the inflammatory process is most often infection. Choroiditis can be caused by tuberculosis, streptococcal, brucellosis and staphylococcal infections.

The peculiarity of the structure of the choroid causes a delay in bacteria and viruses that are carried by the blood or lymph flow. With reduced immunity and chronic diseases, when the body is weakened, rapid development of pathogenic microorganisms occurs.

If the disease is not diagnosed in time and treatment is not started, the inflammatory process spreads to the retina.

The choroid of the eyes can become infected as a result of injury or infection with dangerous infectious diseases. The classic example of the development of choroiditis in the photo should alert you, since inflammation of the choroid can be one of the first symptoms of serious diseases:

• the tuberculosis bacillus is transported through the blood and lymph into blood vessels eyes;
• the syphilis virus also causes inflammation of the eyeballs;
• streptococcal and staphylococcal infections;
• helminthiasis;
• toxoplasmosis.

Inflammatory processes can be caused seasonal allergies or general hypothermia of the body. In order for the ophthalmologist to prescribe the correct and effective treatment, it is important to correctly determine the cause that caused the inflammation.

Symptoms and diagnosis of chorioditis

The network of blood vessels in the eye is very vulnerable to viruses and infections. At the initial stage of infection, chorioditis is almost invisible. Slight redness of the eyeball and swelling of the eyelid are diagnosed. Visual disturbances at the initial stage of infection are periodic.

If treatment is started in a timely manner, then all symptoms disappear quickly and vision is completely restored.

Severe chronic course of chorioditis is characterized by a serious inflammatory process of the retina, partial disintegration of the pigment cells is diagnosed epithelial cells. The normal blood supply to the eye is disrupted, as the blood vessels are damaged by the inflammatory process (compressed).

Acute and chronic choroiditis - symptoms:

• diagnose with minor initial inflammation infectious process can only be done by an ophthalmologist; visual impairment is not observed at the initial stage of the disease;
• if treatment is not started on time, infection spreads to the entire surface of the choroid, as a result of which visual acuity decreases, distortion appears in the perception of surrounding objects (blurred contours, flickering), floating dots or flashes appear before the eyes;
• with the development of the disease, the process of appearance of scotomas - areas of decreased or absent vision - progresses;
• at dusk a person begins to see poorly (hemeralopia);
• even with chronic and acute choroiditis, the patient does not experience pain in the eyeballs, which is very dangerous, since a trip to the ophthalmologist is postponed;
• if the inflammatory process affects the central part of the fundus, then distortion of objects is observed, a sharp decline visual acuity, flickering and spots before the eyes;
• in case of defeat peripheral part eyes are diagnosed with twilight vision, moving dots in front of the eyes, affected areas of peripheral vision appear;
• When diagnosing the fundus, yellowish or gray foci with blurred contours are observed that protrude into the vitreous body of the eye. The retinal vessels are not damaged, but are located above such a lesion;
• local lesions (hemorrhages) in the vitreous body, retina and choroid are diagnosed. The chronic inflammatory process causes clouding of the retina at the site of infection.

It is very dangerous that this disease is not accompanied by pain and is rarely diagnosed at the initial stage, when treatment gives the most positive effect. Therefore, at the first signs of choroiditis - floating spots before the eyes, unclear outlines of objects, decreased vision in the dark, it is important to immediately consult an ophthalmologist.

This disease, if treatment is not started on time, is accompanied by serious complications. Regular examination by an ophthalmologist - once every six months - will help to diagnose in time and quickly treat infectious inflammation eye.

Treatment and prevention of choroiditis

For treatment to be effective, it is important to find out the cause of the infection. In some cases, with eye injury, therapeutic treatment aimed at increasing general immunity is sufficient.

If an infectious or bacterial nature inflammation, then a course of local or general action. Choroiditis - treatment should be comprehensive:

• it is necessary to eliminate the source of infection;
• it is important to regulate and block local and systemic autoimmune reactions of the body;
• a set of measures is being taken to prevent the development of serious complications that arise as a result of infection;
• appointment antihistamines if the cause is allergic reactions;
• the introduction of antigens of viral pathogens in small doses (hyposensitization) is aimed at preventing relapses of the disease;
• prescription of anti-inflammatory drugs (glucocorticoids) - maxides drops, dexamethasone ointment;
• in chronic and severe forms of the disease, it is recommended to administer Kenalog (a week’s course);
• antimicrobial therapy - okomistin drops, floskal, okoferon.

The above medications and course of treatment can only be prescribed by a doctor after an examination, since it is important to identify the causative agent of the infection in order to prescribe the necessary medications.

Eye choroiditis is a serious infectious disease that causes dangerous complications if treatment is not carried out on time. The infection affects the choroid of the eye and leads to complete tissue atrophy.

In contact with

Uveitis is an inflammation of the choroid of the eye, which manifests itself as pain, increased sensitivity to light, lacrimation, and blurred vision.

The uveal tract has a complex structure, located between the sclera and the retina, and looks like a bunch of grapes. It consists of vessels that supply the eyes with nutrients. The uveal tract is formed by the iris, vitreous and ciliary bodies, and the choroid itself.

Classification of the disease

According to anatomical structure The following types of uveitis are distinguished from the uveal tract:

• Front. The development of inflammation in the iris and vitreous body is characteristic. This is the most common type of disease, which can occur in the form of iritis, anterior cyclitis,;
• Intermediate. Inflammation affects the ciliary body, retina, vitreous body, and choroid. The pathology occurs in the form of posterior cyclitis, pars planitis;
• Rear. Characteristic damage to the choroid, retina, optic nerve. Depending on the location of the pathological process, chorioretinitis, retinitis, choroiditis, neurouveitis may occur;
• Generalized. The inflammatory process affects all parts of the uveal tract. In such cases, they talk about the development of panuveitis.

Depending on the nature of inflammation, 4 forms of pathology are distinguished:

1. Serous;
2. Purulent;
3. Fibrinous-plastic;
4. Mixed.

By etiological factors Uveitis is usually divided into:

• Endogenous. Infectious agents enter the eye through the bloodstream;
• Exogenous. Infection occurs as a result of injury to the choroid of the eye.

Uveitis can develop as primary disease when it is not preceded by pathological processes. Secondary uveitis is distinguished when the pathology occurs against the background of other eye diseases.

According to the nature of the flow, they are distinguished:

• acute process, the duration of which does not exceed 3 months;
• chronic pathology that lasts more than 3-4 months;
• recurrent uveitis, when after full recovery inflammation of the uveal tract develops again.

Etiological factors

Highlight following reasons development of uveitis:

• bacterial infection caused by streptococci, staphylococci, chlamydia, toxoplasma, tubercle bacilli, Brucella, treponema pallidum, leptospira;
• viral infection: herpes virus (including the pathogen chickenpox), cytomegalovirus, adenovirus, HIV;
• fungal infection;
• presence of lesions chronic infection– tonsillitis, caries, sinusitis;
• development of sepsis;
• autoimmune diseases (rheumatism, systemic lupus erythematosus, spondyloarthritis, ulcerative colitis, Crohn's disease, polychondritis, interstitial nephritis, glomerulonephritis);
• eye injuries, burns, foreign bodies;
• hormonal imbalances;
• eye damage from chemical reagents;
• genetic predisposition;
• development of hay fever, food allergies;
• metabolic disorders.

The disease often develops in patients who have a history of other eye pathologies. In childhood and old age, infectious uveitis is mainly diagnosed, which occurs against the background of allergies or stressful situations.

Symptoms of the disease

The clinical picture depends on the localization of the inflammatory process, the state of the immune system, and the nature of the disease. In acute anterior uveitis, patients report the following symptoms:

• soreness and redness of the affected eye;
• constriction of the pupil;
• increased lacrimation;
• photophobia;
• decreased visual acuity and clarity;
• increased

For chronic inflammation The anterior part of the uveal tract is characterized by an asymptomatic course. Only in some cases do patients notice slight redness of the eyeballs and the appearance of dots in front of the eyes.

A characteristic sign of peripheral uveitis is damage to both eyes. Patients complain of decreased central vision and the appearance of “floaters” before the eyes.

The following symptoms are typical for posterior uveitis:

• feeling of blurred vision;
• objects become distorted;
• the appearance of floating spots before the eyes;
• decreased visual acuity.

It is also possible to develop macular edema, optic neuropathy, macular ischemia, and retinal detachment.

Diagnostic measures

Diagnosis of uveitis is carried out by an ophthalmologist. Within initial appointment a specialist must examine the eyes, check visual acuity, visual fields, and conduct tonometry to determine the value of intraocular pressure.

Additionally, the following studies are carried out:

• Ultrasound of the eye;
• study of pupillary reaction;
• biomicroscopy, which involves examining the eye using a slit lamp;
• gonioscopy, which allows you to determine the angle of the anterior chamber;
• . The study is carried out to study the fundus of the eye;
• fluorescein angiography of the retina;
• tomography of various eye structures if necessary;
• electroretinography;
• rheoophthalmography, which allows you to measure the speed of blood flow in the vessels of the eyes.

Features of treatment

Drug therapy for anterior and posterior uveitis involves the use of the following groups of drugs:

1. Broad-spectrum antibiotics (fluoroquinolones, macrolides, cephalosporins). Drugs can be administered subconjunctivally, intravitreally, or parenterally. The choice of a suitable antibiotic depends on the type of pathogen, its sensitivity to drugs;
2. Antiviral drugs are prescribed for the treatment of uveitis of viral origin. Widely used: while taking Viferon or Cycloferon. Medicines are prescribed in the form of intravitreal injections or taken orally;
3. Non-steroidal anti-inflammatory drugs, glucocorticosteroids allow short time stop inflammation. Dexamethasone or prednisolone drops are prescribed subconjunctivally, Ibuprofen, Movalis or Butadione are taken orally;
4. Immunosuppressants are used when anti-inflammatory treatment is ineffective. Cyclosporine and Methotrexate are indicated, which can suppress immune reactions;
   To prevent the occurrence of adhesions, drops of Cyclopentolate, Tropicamide, Atropine are recommended;
5. Fibrinolytics have a resolving effect. Widely used: Gemaza, Lidazu, Wobenzym;
6. Complex multivitamins;
7. Antihistamines: Claritin, Lorano, Cetrin, Clemastin, Suprastin.

If drug therapy helps eliminate acute inflammation, then physiotherapeutic treatment is indicated. Electrophoresis, infitatherapy, laser blood irradiation, vacuum pulse massage, phototherapy, phonophoresis, laser coagulation, cryotherapy are highly effective.

Surgical intervention

The development of complications or severe course of uveitis requires surgical treatment. The operation may include the following steps:

• dissection of the commissure between the iris and the lens;
• deletion vitreous, glaucoma or;
• soldering of the retina using a laser;
• removal of the eyeball.

Surgery does not always have favorable outcome. In some cases, surgery causes an exacerbation of the inflammatory process.

Traditional medicine methods

During the treatment of uveitis, you can use some folk recipes. However, before any manipulation you need to consult your doctor.

The following recipes will help effectively eliminate inflammation:

• washing the eyes with a medicinal decoction. It is necessary to take equal quantities of chamomile, calendula, and sage flowers. Grind the raw materials. Take 3 tablespoons of the mixture and pour a glass of boiling water. The composition is infused for 1 hour. Strain the resulting product and rinse the eyes with the decoction;
• aloe juice is diluted cold boiled water in a ratio of 1:10. The resulting solution is dripped 1 drop no more than 3 times a day into the affected eye;
• marshmallow root lotions. The raw materials should be crushed, pour 3-4 tablespoons of 200 ml of cold water. The product is infused for 8 hours, then used for lotions.

Complications and prognosis

With absence effective treatment uveitis can lead to the development serious illnesses eyes:

• cataracts, in which the lens becomes cloudy;
• damage to the retina up to its;
• , developing due to impaired outflow of fluid inside the eye;
• persistent vitreous opacification;
• damage to the optic nerve;
• pupillary fusion, in which the pupil stops responding to light due to adherence to the lens.

With timely and complex therapy Acute inflammation of the eye can be completely cured in 3-6 weeks. However, chronic uveitis is prone to relapses when the underlying pathology worsens, which significantly complicates therapy and worsens the prognosis.

Uveitis is an inflammatory pathology of the choroid of the eye that can lead to complete loss of vision. Therefore, it is so important to diagnose and begin treatment of the disease in time. Great value has disease prevention, which involves timely therapy pathological processes in the body, eliminating household eye injuries, allergization of the body.

In the eye, between the sclera and the retina, there is the most important structure - choroid, or, as it is also called, . It is distinguished front(iris and ciliary body) and back(choroid, from the Latin Chorioidea - the choroid itself). The main function of the iris is to regulate the amount of light entering the retina. The ciliary body is responsible for the production of intraocular fluid, fixation of the lens, and also provides an accommodation mechanism. The choroid performs the most important function for the delivery of oxygen and nutrients to the retina.

Uveitis This is an inflammatory disease of the choroid of the eye. Its causes and manifestations are so diverse that even a hundred pages may not be enough to describe them; there are even ophthalmologists who specialize only in the diagnosis and treatment of this pathology.

The anterior and posterior parts of the choroid are supplied with blood from different sources, so isolated lesions of their structures most often occur. The innervation is also different (iris and ciliary body - trigeminal nerve, and the choroid does not have sensitive innervation at all), which causes a significant difference in symptoms.

The disease may affects patients regardless of gender and age and is one of the leading causes of blindness(about 10% of all cases) in the world. According to various sources, the incidence is 17-52 cases per 100 thousand people per year, and the prevalence is 115-204 per 100 thousand. Average age patients - 40 years old.

Interestingly, Finland has the highest incidence of uveitis, possibly due to the high incidence of HLA-B27 spondyloarthropathy (one of its causes) in the population.

Causes of uveitis

Often It is not possible to determine the cause of uveitis(idiopathic uveitis). Provoking factors can be genetic, immune or infectious diseases, injuries.

It is believed that the cause of uveitis after injury is the development immune reaction, damaging the cells of the uveal tract, in response to microbial contamination and accumulation of decay products of damaged tissues. If the disease is infectious the immune system begins to destroy not only foreign molecules and antigens, but also its own cells. In cases where uveitis occurs against the background of an autoimmune disease, the cause may be damage to the choroid's own cells by immune complexes, as a result of a hypersensitivity reaction.

The diseases that most often contribute to the occurrence of uveitis include: seronegative arthropathy (ankylosing spondylitis, Reiter's syndrome, psoriatic arthropathy, inflammatory diseases intestines (Crohn's disease, ulcerative colitis)), rheumatoid arthritis, systemic lupus erythematosus, Behçet's disease, sarcoidosis, tuberculosis, syphilis, herpes virus, toxoplasmosis, cytomegalovirus, AIDS.

According to Rodrigues A. et al. (1994), idiopathic uveitis predominates among other forms and accounts for about 34%. Seronegative spondyloarthropathy causes the disease in 10.4% of cases, sarcoidosis - in 9.6%, juvenile rheumatoid arthritis - in 5.6%, systemic lupus erythematosus - in 4.8%, Behçet's disease - in 2.5%, AIDS - at 2.4%. According to the same author, anterior uveitis is the most common (51.6%), posterior - in 19.4% of cases.

When identifying symptoms of uveitis in a patient, it is necessary to remember about the “masquerade” syndrome, which imitates the disease. It can be of either a non-tumor nature (with intraocular foreign bodies, retinal detachments, myopic dystrophies, pigment dispersion syndrome, retinal dystrophies, circulatory disorders in the eye, reactions to the administration of medications), or tumor (with such oncological diseases, such as intraocular lymphomas, leukemia, uveal melanoma, metastases of tumors of other localizations, paraneoplastic syndrome, cancer-associated retinopathy, retinoblastoma).

Classification

International working group To standardize the nomenclature of uveitis, recommendations for the classification of this disease were developed.

Thus, according to localization it is customary to distinguish

As we see, inflammation can involve both structures belonging to various parts of the choroid and surrounding tissues (sclera, retina, optic nerve).

By the morphological picture is distinguished focal (granulomatous) and diffuse (non-granulomatous) uveitis.

The onset of the disease can be either sudden or hidden, practically asymptomatic. Based on duration, uveitis is divided into limited (up to 3 months) and persistent. According to their course, they can be: acute (sudden onset and limited duration), recurrent (periods of exacerbation alternated with periods of remission without treatment for more than 3 months) and chronic (persistent uveitis with relapses less than 3 months after cessation of treatment).

To determine the degree of activity of the inflammatory process, cellular opalescence and the presence of cellular elements in the anterior chamber of the eye are assessed.

Uveitis is also differentiated according to many other parameters: morphological, according to the age of the patients, immune status and etc.

Symptoms

The symptoms of uveitis depend on many factors, the main ones being the localization of the inflammatory process (anterior, middle, posterior) and its duration (acute or chronic). Depending on the cause, specific manifestations characteristic of this form of the disease may be identified.

Anterior uveitis

The most common form - acute anterior uveitis - is usually accompanied by a sudden onset, severe pain on the affected side (typically increased pain at night, with changes in lighting, pressing on the eyeball in the limbus), photophobia, blurred or decreased vision, lacrimation, characteristic redness of the eye (ciliary or mixed injection of the eyeball), narrowing of the pupil and weakening of its reaction to light due to sphincter spasm. The symptoms of chronic anterior uveitis are similar, but are usually less severe, and some are even absent.

Upon examination, the ophthalmologist can detect the presence of cellular elements, purulent and fibrinous exudate (hypopyon) in the aqueous humor of the anterior chamber, its opalescence (Tyndall phenomenon); deposits (precipitates) on the posterior surface of the cornea; characteristic deposits on the pupillary edge of the iris (Keppe's nodes) or in its middle zone on the anterior surface (Boussac's nodes); posterior or anterior fusion of the iris with surrounding structures (synechia), its atrophic changes; difference in color between the right and left eyes (heterochromia); the appearance of pathological vessels in the iris (rubeosis). IOP levels can vary from low to high.

Average uveitis

Inflammation of the choroid in this localization is accompanied by floating opacities in the field of vision, deterioration of vision in the absence of pain (the clinical picture is similar to posterior uveitis), and mild photophobia.

Posterior uveitis

With such uveitis, patients note blurring, decreased visual acuity, the appearance of floating opacities, image distortion, photopsia in the absence of pain, redness and photophobia. The appearance of pain with uveitis of posterior localization may indicate involvement in the inflammatory process of the anterior chamber of the eye, bacterial endophthalmitis, or posterior scleritis.

An ophthalmological examination can reveal the presence of cellular exudate in the vitreous body, exudative and hemorrhagic preretinal and intraretinal lesions of various shapes and types, which in the inactive stage can turn into atrophic areas with scarring, affecting surrounding tissues.

Patients with panuveitis may experience all of the above symptoms.

Diagnosis of uveitis

The most important thing in diagnosing uveitis is a correct and complete history taking. This saves the patient from undergoing unnecessary types of examination. Many experts have even proposed various questionnaires containing key questions for implementation. They help to standardize the survey and avoid incomplete clarification of the medical history.

There are no mandatory specific ophthalmological methods for diagnosing uveitis. A general complete examination will reveal certain characteristic features diseases. It is important to pay attention to the level of intraocular pressure, which, according to Herbert, tends to increase in approximately 42% of patients. Inspection of the anterior segment is indispensable, which will help identify precipitates on the posterior surface of the cornea, hypopyon or pseudohypopyon, changes in the iris and other characteristic changes. To differentiate changes in the posterior segment of the eye, in addition to the standard examination of the fundus, FA and OCT can be used.

Laboratory diagnostics (PCR, HLA typing and others), X-ray, MRI and cytological methods of examination are carried out according to indications depending on the suspected cause of uveitis.

In 2005, a working group to standardize the nomenclature of uveitis developed recommendations on the volume diagnostic measures at various forms uveitis (see appendix). They contain a list of the basic necessities in each specific clinical case examinations and help avoid prescribing unfounded ones.

A special place is occupied by the diagnosis of “masquerade” syndrome, which imitates the symptoms of uveitis. It is necessary to suspect it in cases of minimal response to the ongoing aggressive drug therapy. The scope of diagnostic procedures depends on the suspected cause.

It is important to understand that the purpose of examination for uveitis it can be not only the establishment of the cause of the disease, but also the exclusion of pathology, the treatment of which is excluded by certain drugs (for example, infectious, in particular those that cannot be identified by specific tests, “masquerade” syndrome); systemic diseases, which can worsen the patient’s general condition, the prognosis of recovery, and require correction of the treatment regimen.

Treatment of uveitis

Drug treatment. Treatment of uveitis directly depends on the reason which caused the disease. Due to the fact that it is often not possible to establish it, regimens contain drugs that are symptomatic or prescribed empirically until the etiology of inflammation is established. Specific treatment should be applied after identifying the cause of the disease.

The gold standard for the treatment of uveitis is corticosteroids.. The main purposes of the prescription are: reduction of exudation, stabilization cell membranes, inhibition of the production of inflammatory hormones and lymphocytic reaction. The choice of a specific drug of this group, as well as the method of administration, is carried out taking into account the activity of the inflammatory process, the tendency to increase IOP, etc. Currently, local and systemic use is possible, as well as installation of an implant into the cavity of the eyeball or under the membranes of the eye that secretes medicinal substance in small doses over a long period of time.

The next most often prescribed for uveitis are drugs with cycloplegic and mydriatic action. Their use is due to the prevention of the formation of synechiae (fusions) of the iris with surrounding structures, reducing pain by reducing spasm of the pupillary and ciliary muscles, stabilizing the blood-ophthalmic barrier and preventing further leakage of protein into the aqueous humor.

Second-line drugs for the treatment of uveitis are NSAIDs. They have less anti-inflammatory activity compared to steroids, but may be useful for relief pain syndrome, inflammation reactions, prevention and treatment of relapses of the disease, as well as macular edema accompanying it in some cases. When prescribed together with corticosteroids, NSAIDs help reduce the dose of the former required to relieve inflammation in long-term treatment some forms of chronic uveitis. The drug can be prescribed either as eye drops, and in tablet form.

Special attention should be paid relatively new group drugs - immunomodulators, which are now successfully used in some forms of uveitis (for example, caused by Behçet's disease, involving the posterior segment of the eye; Wegener's granulomatosis; necrotizing scleritis). This group includes antimetabolites (methotrexate, azathioprine, mycophenolate mofetil), T-lymphocyte inhibitors (cyclosporine and tacrolimus), alkylating agents (cyclophosphamide, chlorambucil). The goal of this therapy is targeted inhibition of certain mechanisms of the immune inflammatory response that led to damage to the organ of vision (immunosuppression). The drugs can be used both with and without corticosteroids, allowing to reduce Negative influence the latter on the body.

Recently it has also become possible to use special forms uveitis (serpinginous choroiditis, shotgun chorioretinitis, sympathetic ophthalmia; caused by Behçet, Vogt-Koyanagi-Harada diseases, juvenile idiopathic arthritis, seronegative spondyloarthropathy) drugs-inhibitors of tumor growth factor-α, or the so-called biological therapy. The most commonly used are adalimumab and infliximab. All biological agents are “second-line” drugs in the treatment of these diseases and are used in cases where previous therapy was unsuccessful.

Surgery

The goals of this type of treatment are visual rehabilitation, diagnostic biopsy to clarify the diagnosis, removal of clouded or altered structures that complicate examination of the posterior segment of the eye or contribute to the development of complications (cataracts, vitreous destruction, secondary glaucoma, retinal detachment, epiretinal membrane), administration of drugs directly to the site of inflammation. Also, removal of the affected eye structures can help relieve the inflammatory process. The most frequently used surgical methods include vitrectomy, phacoemulsification, glaucoma filtering surgery, intravitreal injections.

Success of these interventions directly depends on the timeliness of their implementation, the stage of the disease, and the prevalence of irreversible changes in the eyeball.

Prognosis for the treatment of uveitis

Patients suffering from uveitis should be informed of the importance of following the prescribed treatment and examination regimen. This is exactly what it is the most important factor, causing a favorable prognosis for the outcome of the disease. However, some forms of uveitis are capable of recurrence, even despite adequate treatment.

Of course, uveitis by itself does not lead to fatalities, however, if not adequately treated, they can cause blindness.

Application

Bibliography

1) Saadia Zohra Farooqui, MBBS Senior Resident, Singapore National Eye Centre, Singapore General Hospital, Singapore, Uveitis Classification, 2016. [Medscape]
2) Monalisa N Muchatuta, MD, Iritis and Uveitis Clinical Presentation, 2016. [Medscape]
3) Herbert HM, Viswanathan A, Jackson H, Lightman SL. Risk factors for elevated intraocular pressure in uveitis. J Glaucoma. 2004;13(2):96–9
4) C. Stephen Foster, Albert T. Vitale. Diagnosis and treatment of uveitis. Jaypee-Highlights, 2013.
5) Niaz Islam, Carlos Pavesio, Uveitis (acute anterior), 2009. [ Academia ]
6) Robert H Janigian, Jr, MD, Uveitis Evaluation and Treatment, 2016. [ Medscape ]
7) Monalisa N Muchatuta, MD, Iritis and Uveitis Follow-up, 2016. [ Medscape ]
8) George N. Papaliodis. Uveitis. A practical Guide to the Diagnosis and Treatment of Intraocular Inflammation. Springer, 2017
9) Kanski's Cinical Ophthalmology. A systematic approach. 8th edition. Eisevier, 2016
10) E.A. Egorov. Emergency ophthalmology: Textbook. Pos. M.: GEOTAR-Media, 2005