Uveitis Information Group (Scotland)

The Treatment of Uveitis

This article aims to discuss the treatment of Uveitis. The reasoning behind treatment will be concentrated upon instead of trying to cover a long list, and detailed descriptions of, different treatments.

Two of the most important things to remember about Uveitis are that:

1. There are many quite different causes.
2. There are different types of Uveitis normally depending on which part of the eye is affected. e.g. anterior or posterior (or front or back).

Although this means that the types of treatment will vary considerably, there are also certain treatments that will be common to various types of Uveitis.

If you are interested in finding out more about your condition and its treatment then it is very important to get the most accurate description of your uveitis from your doctors. This will help you to pick out the information that is most relevant to you. Some of the terms you may hear, such as glaucoma, may refer to a complication of Uveitis, but is all part of the whole picture.

As you can see, so far, it can all get terribly confusing, but as long as you remember that the term uveitis is used to describe a variety of conditions, then you should always be able to select the relevant bits of information which you need for your particular case.

What Should Treatment Achieve?

• Relieve pain and discomfort
• Prevent sight loss due to the disease or its complications
• Treat the cause of the disease where possible

All drugs and other treatments used in uveitis are powerful in their action and may have significant side effects. The dilemma for the doctors, then, is to balance the benefits of the treatments against the possible harmful effects.

To get this balance right the doctors must know a lot about our condition and be able to assess, as much as possible, things like:

• What are the risks to our eyesight?
• What problems are we having with our medication?
• What is our eyesight actually like?

The more we know about our condition, the better we will be able to help our doctors decide what is the most appropriate treatment for us and how to get the balance of benefits against possible side effects just right.

To illustrate this we could look at the potential problem of long term steroid use. Steroids may be a vital way of controlling uveitis and preventing vision loss, but we know that side effects of steroids can include causing cataracts and raised eye pressure. Following a close assessment of a case, the doctors may feel that there is a high risk of visual loss in the future. And if both eyes are involved, then they may feel more confident about treating a cataract or raised eye pressure than letting the uveitis go under treated by avoiding the more vigorous use of steroids or other drugs.

This, hopefully demonstrates the idea of this balance to be struck and if we, as patients, armed with a bit of good information about our condition can describe our condition, our visual problems and any problems with our general health, then we will have the best chance of allowing the doctors to choose the most appropriate approach to our treatment.

The aims of treatment have been mentioned and the fact that deciding between "too much or too little treatment" can be difficult. Before continuing, it is probably worth stressing that the treatment we receive may be dealing with:

• the actual process of uveitis
• complications arising from the uveitis eg raised eye pressure
• underlying medical conditions such as toxoplasmosis or ankylosing spondylitis, (not to mention dozens of others)

It is quite important to be aware of this because this is where a lot of confusion arises. However one type of treatment or drug may be used to treat one or more of the above points.

It might now be worth thinking about what uveitis is, exactly, and what it means to treat the "actual process of uveitis?"

The main disease process going on in uveitis is called inflammation. The "itis" bit in uveitis means that it is an inflammatory type of disease. (arthritis - inflammation affecting the joints is one of many other examples). I think it is worth a bit of a struggle to try to understand what inflammation is, because it should help you to understand how different treatments work, especially steroid treatment.

So what is inflammation?

It is a very familiar sounding word, conjuring up visions of a sore, red, throbbing thumb following a nasty encounter with a hammer. Although this scenario describes nicely some features of inflammation, it is a quite specific and very important process in the body. Also many people associate inflammation with infection and/or pain but this is misleading because inflammation has different causes, as we will see, and it may be completely painless, and be present with or without the presence of infection. A reasonable definition of inflammation is:

"The reaction of living tissues, especially the small blood vessels and the blood cells within them, to injury."

The "injury" can take different forms:

• Trauma back to our hammer again and also burns and frostbite.
• Infection from bacteria, viruses or fungi. These are recognised as foreign bodies and we react against them
• Allergies foreign bodies such as pollen grains cause the inflammation here.
• Our own immune system This is a complicated area but essentially our immune system (the body's defence system), unfortunately recognises a bit of our own body as "foreign". This bit may be very small, like a protein molecule, but we react against it and cause inflammation.

To get back to the plot, these different causes of inflammation match nicely the many different causes of uveitis. This wide variety of causes is something that is always worth remembering about in uveitis, (inflammation is the common factor with them all).

Unknown Cause

At this point, it may be worth considering the many people with uveitis who are told that the cause of their problem is unknown. I think some people may worry that the cause just hasn't been found in their case, but it is more likely to mean that their condition falls into the "immune system" group. This is something that could be asked of the doctors treating you if it is a concern.

Types of Treatment

As mentioned at the start, it is not intended to cover all the details of the various drugs and treatments here. This will hopefully be well covered in future newsletters and in the range of leaflets available.

I hope this article will help you to understand the reasoning behind the different types of treatment that we may receive.