Irisitis uveitis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Arthritis can affect the eye in a number of ways. One way is by causing uveitis. Uveitis means "inflammation of the uvea", or the middle layer of the eye.

The uvea consists of three "pieces": the iris, the ciliary body, and the choroid. The iris is the colored area surrounding the pupil. The ciliary body is a structure containing muscle located behind the iris. It focuses the lens. The choroid is a layer containing blood vessels that line the back of the eye and is located between the retina, and the outer white eye wall, the sclera. Inflammation occurring in any of these three structures is termed "uveitis".

Inflammation in uveitis may involve any of these three structures. Depending upon which structures are inflamed, uveitis may be further subcategorized into one of three main diagnoses, these include:

-iritis or anterior uveitis,
-iridocyclitis or intermediate uveitis, and
-choroiditis or posterior uveitis.

While there is no specific cause in many cases, often iritis is a sign of autoimmune conditions such as : rheumatoid arthritis, sarcoid , lupus , scleroderma , Behcet's disease , anklylosing spondylitis, Reiter's disease, Crohn's disease, ulcerative colitis, and B-27 disease. A medical workup can be initiated and may include a detailed medical history, blood tests, a chest x-ray, x-rays of the lower back, and a skin test for tuberculosis.

Permanent visual loss can result from uveitis. In addition, uveitis can lead to other ocular complications, which may produce vision loss, including glaucoma, cataracts, or retinal damage. Early detection and treatment is mandatory to avoid the risk of permanent vision loss.

The symptoms of iritis usually appear suddenly and develop rapidly over a few hours or days.The symptoms of iritis include light sensitivity, red eye, blurred vision, tearing, pain, and sometimes floaters. The pupil may appear small in the affected eye when compared to the normal pupil. Frequently iritis is a recurrent problem.

Treatment may include steroid eyedrops, injections, or pills, as well as eyedrops to dilate the pupil and reduce pain.

In serious cases, complications may arise. Cataracts, glaucoma, and corneal changes are possible consequences of both the disease and the medicines used to treat it. If the medicines are withdrawn too rapidly, a recurrence is very possible. More severe cases of uveitis may even require treatment with chemotherapeutic agents to suppress the immune system. This is particularly true with severe types of arthritis conditions.

Drugs that have been used have been corticosteroids, methotrexate, sulfasalazine, azathioprine, and biologic agents such as etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade), certolizumab (Cimzia), and golimumab (Simponi).

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