Uveitis or autoimmune eye disease
What is uveitis?
The immune system protects us from disease and is amazingly complex. Like other complex systems in our body, the immune system can malfunction. When the immune system malfunctions and acts on our own body’s tissues, that is autoimmune disease (“auto-” for “self”).
Uveitis can reduce vision in may ways. Going from “front to back,” the cornea, the very front window into the eye, may develop calcium deposits that block vision. The lens of the eye may develop clouding, known as cataract. The front colored portion of the eye, the iris, may develop adhesions. The vitreous gel of the eye may develop cloudiness (“haze”) and floaters. The center of the retina, the macula, may develop swelling (macular edema). If the RPE-choroid underneath the retina thins or atrophies with chronic inflammation the retina itself will lose visual function. The cells in the retina can degenerate with chronic inflammation.
How is uveitis treated?
In some patients, uveitis treated in this fashion will “stay quiet” for months to years after the steroids are stopped. In other patients with more severe disease, the inflammation will return quickly. In these patients, therapy may be needed for months to years. In this case, we recommend alternative non-steroid medications that can be taken for longer time periods without the side effects of steroids. These medications are borrowed from the field of organ transplantation and include methotrexate, azathioprine (Imuran), mycophenolate (Cellcept), cyclosporine, infliximab (Remicade), daclizumab (Zenapax), and others. These medicines do have their own possible side effects and a patient on these medications needs to be monitored in conjunction with an internal medicine doctor while on the medications. In general, however, when we recommend these medications, we believe the potential benefit of the medicines in preserving vision justifies the risk of side effects of the medicines.
Disease-specific information, in alphabetical order:
Macular edema from uveitis, booklet from the European uveitis patient group (caution: this file is large and may take time to download).
Steroids and their use in uveitis, from the European uveitis patient group (caution: this file is large and may take time to download).