Ep. 026: Causes and Treatments of Ocular Inflammation with Lou Chorich, MD

Healthy Eyes 101

Jun 20 2021 • 35 mins


Inflammation can occur in any part of the body and the eye is no exception. In this episode, we discuss uveitis and scleritis, two specific inflammatory conditions of the eye.

Uveitis, one of the major causes of vision loss, is an intraocular inflammatory condition that can be broken up into three categories: infectious, non-infectious, and traumatic. It can further be classified by where the inflammation occurs in the eye: anterior (front part - iris), intermediate (middle part – ciliary body), posterior (back part – choroid), and panuveitis (entire eye).

Infectious uveitis can be caused by bacteria, viruses, fungi, and parasites in the eye or by a systemic infection like herpes, tuberculosis, syphilis, toxoplasmosis, or Lyme disease. Noninfectious uveitis, the most common type, can be caused by autoimmune conditions like rheumatoid arthritis, lupus, sarcoidosis, Reiter syndrome, ankylosing spondylitis, Behcet’s disease, psoriatic arthritis, and inflammatory bowel disease. The most common reason for uveitis is called idiopathic – no reason can be found.

Symptoms of uveitis will vary according to its location in the eye. Anterior uveitis, also called iritis, can cause ocular pain, photophobia (light sensitivity), red eye, and decreased vision. Uveitis in the back of the eye mainly causes vision loss but usually does not cause pain.

After a thorough eye examination, a lab work-up should be performed especially after the second recurrent episode or if the first episode affects both eyes. Ruling out an infectious cause can be done in the office. Bloodwork to rule out some of the autoimmune diseases is the next step. Sometimes a chest x-ray may be necessary to help rule out TB or sarcoidosis.

Treatment of infectious uveitis is directed at the pathogen causing the infection. This may involve a combination of topical antibiotics or anti-virals and systemic medications. Steroids are the mainstay of treatment of non-infectious uveitis. Most anterior uveitis is treatable with topical steroid eye drops. Intermediate and posterior uveitis is mainly treated with oral steroids and steroid injections around or in the eye. For patients with chronic or recurrent uveitis, immunomodulatory therapies may be necessary. Some of these medications may include methotrexate, Cellsept, Humira, and Remicade.

Scleritis is an inflammatory condition of the outer coating of the eye (sclera). Symptoms include severe eye pain, red eye, and sometimes a decrease in vision. If the back part of the eyewall is inflamed, the eye may not appear red. An ultrasound of the eye may be necessary to properly diagnose this condition. Some of the causes of scleritis include rheumatoid arthritis, HLA-B27-related diseases, and gout. Oral and injectable steroids are the primary treatments for this condition. Sometimes immunomodulatory therapies are also needed to control the inflammation.

Here are some more links to learn more about inflammation in the eye.

Uveitis.org

Preventblindness.org/uveitis/

Scleritis


To find out more about Dr. Lou Chorich and his practice, go to Midwest Retina’s website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.