Red eyes, blurry vision, light sensitivity, floaters and eye pain are common, and minor, vision problems. However, sometimes they can be symptoms of uveitis, serious inflammation of the interior of the eye. The underlying cause of uveitis can be a general infection or a systemic inflammatory disease. The appropriate treatment is very different for these two possibilities.
Complications of uveitis include cataracts, glaucoma, cystoid macular edema, retinal detachment, band keratopathy and neovascularization of the retina and optic nerve. The Cleveland Clinic Journal of Medicine recommends aggressive reduction of inflammation to prevent these sight-threatening results. First, it's important to find out where the inflammation originates.
In some cases, eye inflammation is the first sign of a systemic inflammatory condition. There are many possibilities. Reactive arthritis, psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease are called HLA-B27 associated diseases, and all have a high incidence of uveitis. Other associated conditions are sarcoidosis, Behcet disease, juvenile idiopathic arthritis, Vogt-Koyanagi-Harada syndrome, tubulointerstitial nephritis, Kawasaki disease, multiple sclerosis, relapsing polychondritis, Sjogren syndrome, Wegener granulomatosis, Lyme disease and allergic reactions to drugs or other chemicals. In these cases, the treatment options include immune modulating drugs such as steroids and TNF blockers.
If the cause is an infection, immunosuppressive drugs can be disastrous, according to The Cleveland Clinic Journal of Medicine. This is not the usual case, but patients with compromised immune systems because of organ transplants, HIV, or other illness are at significant risk. Possibilities include toxoplasmosis, cytomegalovirus, tuberculosis, syphilis, leprosy, leptospirosis, cat scratch disease, and whipple disease. If the underlying cause of uveitis is an infectious disease, then the infection should be treated first.
Corticosteroid therapy is the main treatment for eye inflammation when there is no infectious cause. Treatment includes eye drops, injections near the eye, or as oral drugs. An unfortunate side effect of steroid treatment is cataracts which can be caused either by the uveitis or by the treatment. Thus, if the inflammation does not respond readily to steroid therapy, other immunosuppressive medications may be used.
References:
Rula AH et al, “Uveitis in the internist's office: Are a patient's eye symptoms serious?”, Cleveland Clinic Journal of Medicine 2005 April; 72(4): 329-339.
Behcet's disease:
https://www.empowher.com/news/herarticle/2009/12/15/what-would-you-risk-save-your-eyesight
Reactive arthritis:
https://www.empowher.com/news/herarticle/2009/12/01/reactive-arthritis-and-reiters-syndrome
Sarcoidosis:
https://www.empowher.com/news/herarticle/2009/10/29/sarcoidosis-current-research
Inflammatory bowel disease:
https://www.empowher.com/news/herarticle/2009/10/27/inflammatory-bowel-diseases-update
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.