What is Intermediate Uveitis?

Intermediate Uveitis (sometimes called iridocyclitis, cyclitis, vitritis
or pars planitis) is inflammation inside the eye, affecting the vitreous
(see the diagram below).  Intermediate means it is located in the middle
part of the eye.  Uveitis is inflammation of the eye. 
 
Which part of the eye is affected?  Inflammation affects the middle
section of the eye, called the vitreous.  The vitreous is the clear,
jelly-like substance that fills the middle of the eye that fills the
space between the lens and the retina (see diagram).    It is also
called the vitreous humour (humour in medicine refers to fluid or semi
fluid substances). 

Who does it affect?
Intermediate uveitis typically affects teenagers but can occur in very
young children. The over 40’s are not often affected. This pattern
differs from most other forms of uveitis.

Symptoms of Intermediate Uveitis 

Intermediate uveitis can vary greatly in its severity. In a few people
it can be a mild, self limiting condition, needing only careful
monitoring, rather than active treatment.   Most people will experience
more severe inflammation or there may be complications which require
much more aggressive treatment.

* Both eyes are usually affected 
* One eye may be worse than the other
* The eyes may not be affected at the same time
* You usually do not experience pain
* You usually do not have red eyes
* You may have floaters - dots and wispy lines that move across the field of vision 
* You may have blurred vision due to cells from the blood vessels leaking into the gel of the eye.

The condition may be present for quite some time before it is diagnosed
because the patient may not be aware of any problem.   Often vision may
not be affected at all, but there are a number of ways that vision loss
can occur, or other complications may arise.

Complications

Vitreous opacification is caused by 'debris' resulting from the
inflammation getting into the vitreous gel or humour, the 'clear jelly'
which fills the eye. This produces the 'floaters' which can be merely
irritating and not affecting measured vision, or more severe, when the
vision may be obscured.  Macular oedema The macula is the tiny part of
the retina, which is responsible for our central or detailed vision.
Fluid can build up in the macula and cause very specific problems with
vision. If our central vision is affected in this way then reading and
recognising people’s faces, for example,  will be difficult.  If
there is a large build up of fluid, then straight lines such as white
lines along a road may appear distorted.

Anterior uveitis Some people with intermediate uveitis also get the
anterior type (also known as iritis).  An indication that anterior
uveitis is occurring can be pain and redness of the eye.  There are some
complications which can arise with any form of uveitis.  These include
cataracts, and raised eye pressure, leading to glaucoma. Additional
information on these complications is available from UIG.

Causes

In 69% of cases of intermediate uveitis the cause is unknown
(idiopathic), although it may be associated with an illness such as
multiple sclerosis (MS), sarcoidosis, inflammatory bowel disease or Lyme
Disease.  Because of this, there will always be a thorough general
investigation to rule out these causes.  

How long will the condition last?

This is difficult to answer, as the severity, the predictability and the
length of intermediate uveitis is variable.  There are different views
about whether it is self limiting (lasts only a certain amount of time)
or burns itself out.  Some people have intermediate uveitis for a period
of weeks or months, whilst others experience it for a number of years.
The main aim of the treatment is to minimise the inflammation to avoid
any damage to the eyes and eyesight, and to monitor the condition whilst
it is active.  

Treatment, if required

Because the severity varies, the treatment will be geared to the
individuals needs.  Most treatment is designed to minimize the
inflammation, but you may sometimes need treatment for any complications
caused by the intermediate uveitis.  

The main treatments are:
* Use of steroids as tablets to reduce inflammation.  Occasionally
* steroid injections are given around the eyes.  These may be carried
* out under local anaesthetic or general anaesthetic, particularly with
* children.  

* Immunosuppressant drugs such as cyclosporine.  These are used to try
* and stop the inflammation or to work alongside steroids to allow you
* to reduce your steroid intake.  

* More information about drugs used in uveitis and complications can be
* found in the other UIG “Factsheets” available from the UIG. 

Please contact us if you need any further information.

South House, Vidlin, 
Shetland, ZE2 9QE, UK. 
Tel: 0845 604 5660

email: info@uveitis.net
website:  www.uveitis.net

Revised by Uveitis Information Group (UIG) September 2009

Produced by Uveitis Information Group – a Scottish charity
(registration number SC028439)

		1