There are several causes of blindness, and uveitis is potentially serious eye condition that can cause severe vision loss.
Uveitis produces inflammation that can destroy important eye tissues. It is extremely rare, but it is a leading cause of legal blindness in the United States.
Uveitis primarily strikes the uvea, where the pigmented parts of the eye (including the iris, ciliary body and choroid) are located, but it also can affect the lens, retina, optic nerve and vitreous (the gel-like substance that fills the middle of the eye).
At Yale Medicine, our doctors have access to a fully-equipped uveitis service, where physicians use the latest techniques designed to reverse the condition and preserve patients' eyesight.
What are the symptoms of uveitis?
“Symptoms vary from mild to severe,” says Ninani Kombo, MD, a Yale Medicine ophthalmologist. Dr. Kombo notes that uveitis can strike anyone, including children, but mostly affects people from age 20 to 60.
These are the main symptoms to watch for:
- Sharp pain
- Sensation of pressure on the eyeball
- Light sensitivity
- Flashes or strobes of light
- Difficulty with night vision
Are there different kinds of uveitis?
There are several types of uveitis. According to Dr. Kombo, the primary location of the inflammation determines the type of the uveitis:
Anterior uveitis occurs in the front of the eye. Other names used to describe this are iritis and iridocyclitis.
Intermediate uveitis occurs in the vitreous, the jelly in the eye.
Posterior uveitis is inflammation that occurs in the retina and the choroid (the layer between the retina and the sclera). It can also be referred to as chorioretinitis or choroiditis.
Panuveitis uveitis is uveitis that affects all three parts of the eye: anterior, vitreous and retina and choroid.
How is uveitis diagnosed?
“A thorough personal family history is obtained that guides diagnostic investigations, and the patient is sent for blood work,” says Dr. Kombo.
Photography is also used for diagnosis. “If the patient has inflammation of the retina, optic nerve or blood vessels,” Dr. Kombo says, “photography performed in the office can capture pictures of the front and/or back of the eye.”
Another test used to diagnose uveitis is a fluorescein angiogram. The exam, in which a fluorescent dye is injected into the bloodstream, highlights the blood vessels in the back of the eye so they can be photographed.
How is uveitis treated?
”Patients usually stay on self-administered steroid drops for four to six weeks after a uveitis flare," says Dr. Kombo.
If the uveitis is concentrated in the back of the eye, the steroid prednisone might be given, either in pills or intravenously.
A second step, if needed, could be use of methotrexate, or of medications called biologics.
If the condition still persists, Yale Medicine specialists frequently perform a procedure where an implant called Retisert is placed in the eye and then slowly and gently releases a medication that relieves the uveitis in the vast majority of cases.
What is Retisert?
Retisert is a very small FDA-approved device, about the size of a grain of rice, containing the corticosteroid fluocinolone acetonide. Retisert is surgically implanted in the eye through a small incision and releases precise amounts of the medication each day for about 30 months.
“The Retisert implant surgery is a same-day outpatient procedure,” says Dr. Kombo. "The surgery is approximately 45 minutes to 60 minutes long.” The patient then goes home and applies antibiotic drops for about a week.
Once the device is implanted, it never needs to come out. However, the patient does need to return to the doctor for checkups, because either cataracts (clouding of the lens of the eye) or glaucoma (excess pressure within the eye) might develop after the implant is in place.
Dr. Kombo says that is a tradeoff most patients are willing to make, because controlling the uveitis is so important and Retisert does that well in the vast majority of cases.
As she explains to her patients when they visit her at Yale Medicine, cataracts and glaucoma are both highly treatable—in fact far easier to manage than the uveitis.
"Because cataract surgery is so safe and so widely performed," Dr. Kombo says, it's actually easier to fix than the uveitis that we're often trying to treat." Similarly, if glaucoma develops, "we know how to lower pressure pretty effectively."
Why go to Yale Medicine for treatment of uveitis?
Yale Medicine has physicians who specialize in uveitis and have years of experience treating patients with the condition, including Retisert implantation.
We also have physicians from other specialties who collaborate with our ophthalmologists to trace the source of inflammation that affects the eye.
Yale Medicine's ophthalmologists have a wide range of expertise, and have advanced training to care for every aspect of your vision health.