Uveitis: diagnosis, therapy and prognosis

Uveitis and eye damage

It defines itself uveitis a generic inflammation of the uveal tract, the thin vascular membrane composed of three ocular sheets (choroid, ciliary body and crystalline) that separate the cornea and sclera from the retina.
Uveitis constitutes an ophthalmological urgency in all respects: when not treated properly, the disease can spread to other neighboring ocular structures - such as cornea, iris and retina - causing exaggerated and sometimes irreversible damage, first of all the compromise of the vision and blindness.
Mild and apparently insignificant symptoms such as intolerance to light, profuse lacrimation and ocular redness require a diagnostic assessment precisely because they could represent a clear sign of uveitis.

Diagnosis

The approach to the patient suffering from uveitis requires a meticulous and precise diagnostic examination, as well as a correct interpretation of the causes and the recognition of specific symptoms.

Only after the anamnestic excursus and the clinical evaluation of the patient can the doctor formulate a diagnostic hypothesis because only then will he have all the necessary information.

The diagnosis therefore begins with the patient's medical history: here, the doctor analyzes the symptoms exhibited by the patient and evaluates his clinical history.
We proceed with the objective analysis of the eye for the evaluation of the state of health of the different internal ocular structures. Often the onset symptoms of uveitis are almost superimposable to those of conjunctivitis: for this reason, the two conditions are often confused. The differential diagnosis is therefore essential to evaluate the appropriate therapy.
If the doctor deems it appropriate, in support of the physical examination - performed with ophthalmological instruments such as slit lamp, ophthalmoscope and tonometer for ocular pressure - the patient can be subjected to more precise diagnostic tests, such as in particular blood tests, skin and radiographs.
In case of suspected infectious uveitis, the doctor performs an eye biopsy, in which a tissue sample is taken from the patient's eye for a subsequent cytological (cellular) laboratory investigation.

Therapy

For further information: Medicines for the treatment of Uveitis

Goals of Uveitis Treatment

Although there are more than one variants of uveitis, therapy is always done for at least three common reasons:

Relieve the painful and annoying symptoms accused by the patient
Remove the cause (when possible)
Prevent complications that could compromise vision, especially glaucoma, cataracts, retinal detachment and blindness

The most suitable drugs for the symptomatic treatment (only of the symptoms) of uveitis are mydriatics and corticosteroids, capable of exerting a powerful anti-inflammatory action. By dilating the pupil, mydriatics (such as "Atropine, Cyclopentolateo and" Omatropine) are indicated both to treat ocular inflammations in general (including uveitis), and to prevent the formation of posterior synechiae. Corticosteroid drugs are indicated to reduce ocular inflammation, especially when associated with a "uveitis of uncertain etiology".
If the infectious origin of uveitis is ascertained, specific treatment is carried out against the pathogen:

Antibiotics (eg Sulfasalazine) are the first line drugs for the treatment of bacterial uveitis. To accelerate healing, acting on both the cause and the symptom, many eye drops for the treatment of uveitis are prepared with a mixture of antibiotics and cortisone: for example, the medicinal specialty Mixotone is an eye drop consisting of hydrocortisone (corticosteroid drug) and two antibiotics (neomycin and polymyxin B). Pre-G is a combined ophthalmic ointment, specifically indicated for the treatment of bacterial uveitis (and conjunctivitis): this drug consists of gentamicin (antibiotic) and prednisolone (corticosteroid drug).
Antimalarials (eg. Pyrimethamine) are useful for the treatment of protozoal uveitis, sustained for example by Toxoplasma gondii.
Antivirals can be prescribed in the presence of an "established viral uveitis. It is recommended not to use simultaneously corticosteroid drugs (eye drops / ophthalmic ointments) to avoid damaging the internal ocular structures.
Antifungals are drugs indicated for the treatment of uveitis caused by fungi such as Fusarium and Candida.

When uveitis is caused by an autoimmune disease, the most suitable drugs are immune system suppressants such as: methotrexate, adalimumab and infliximab.

Prognosis

Generally, in the face of immediate treatment for anterior uveitis, the prognosis is excellent: the symptoms subside in a few days and the eye regains full health.
Bacterial uveitis is probably the simplest variant to treat: in these cases, however, the promptness of intervention with antibiotic drugs is decisive for the prognosis. If the infection is treated appropriately, the risk of recurrence is minimal.
The above is independent of the simultaneous presence of uveitis and autoimmune diseases: this category of patients, in fact, is extremely at risk of relapse, even if the previous uveitis has been treated with the right drugs.
At other times, unfortunately, anterior uveitis can take on a chronic course even when treated early.
Intermediate and posterior uveitis, on the other hand, are more difficult to eradicate: in such circumstances, the treatment must be continued for longer periods or, when necessary, for a lifetime.
Patients with chronic uveitis must undergo regular routine check-ups by the ophthalmologist to make sure that the disease remains limited to a certain location, without involving other ocular structures.