Uveitis

Disease Description (Causes and Symptoms)

Uveitis refers to inflammation that occurs in the uvea, which includes the iris, ciliary body, and choroid. Causes are broadly divided into noninfectious causes (autoimmune or idiopathic) and infectious causes (such as tuberculosis, syphilis, and herpesviruses). Pathophysiologically, inflammation of the uvea causes damage to the blood–aqueous barrier, cellular infiltration, and protein leakage, resulting in cells and flare in the anterior segment and vitreous opacities and damage to the retina and retinal blood vessels in the posterior segment.

Main symptoms:

• Eye pain, photosensitivity (sensitivity to light), and photophobia
• Blurred vision or decreased visual acuity
• Eye redness (especially anterior chamber redness) and floaters (floating spots)
• Rapid vision loss if symptoms are severe

Treatment Methods

Treatment varies depending on the cause (infectious vs. noninfectious), the location of the inflammation (anterior, posterior, or panuveitis), and its severity.

Medication Treatment

• Topical treatment: Along with potent anti-inflammatory drugs (mainly topical corticosteroid eye drops, such as prednisolone acetate), mydriatics/cycloplegics (such as atropine and cyclopentolate) are used to relieve pain and prevent posterior synechiae (iris synechiae).
• Local injections: For severe localized inflammation, subconjunctival, sub-Tenon’s, or intravitreal steroid injections may be considered.
• Systemic treatment: For extensive/posterior uveitis or severe bilateral inflammation, oral steroids (generally starting with prednisone at approximately 0.5–1 mg/kg/day; individualization is necessary) or high-dose steroids may be used.
• Immunosuppressants: Methotrexate, azathioprine, mycophenolate, cyclosporine, and others may be used for steroid-dependent or chronic noninfectious uveitis.
• Biologics: For refractory or recurrent cases, anti-TNF agents (such as adalimumab and infliximab) may be considered.

Treatment of Infectious Causes

• Tuberculous uveitis: Combination antituberculous therapy (as directed by a physician or specialist)
• Syphilis: Penicillin antibiotics
• Herpesviruses: Antiviral drugs (such as acyclovir)
• If an infection is suspected, immunosuppressive treatment may be contraindicated or dangerous, so the source of infection must first be identified.

Procedures/Surgery

• Laser or surgical treatment for complications (such as cataracts, glaucoma, or retinal complications), including cataract surgery, glaucoma surgery, or vitrectomy, may be necessary.

Lifestyle Management and Precautions

• When taking steroids, systemic side effects such as weight gain, edema, increased blood pressure or blood glucose, and insomnia must be monitored.
• Do not suddenly stop topical or systemic steroids without a doctor’s instructions.
• Do not use immunosuppressants on your own while infectious causes have not been ruled out.
• Excessive fatigue, colds, and excessive alcohol consumption or smoking may trigger recurrence, so caution is needed.

Outpatient Visit Checklist (Including Example Questions)

What to Prepare (What to Bring)

• A list of currently used medications (including eye drops), with doses and administration times
• Previous ophthalmic examination results (visual acuity chart, intraocular pressure, OCT, fluorescein angiography, etc.) and examination dates
• A written record of when recent symptoms began and how they have changed (visual acuity, pain, floaters, photosensitivity, etc.)
• A history of systemic diseases (rheumatoid arthritis, tuberculosis, syphilis, recent infections, etc.) and results of recent tests (blood tests and imaging)
• A history of allergies and previous use of steroids or immunosuppressants

Examples of Questions Doctors Frequently Ask (For Patient Preparation)

• When did the symptoms begin? Have they gradually worsened?
• Is it in one eye or both eyes?
• Have you recently had systemic symptoms such as fever, weight loss, skin lesions, oral ulcers, or joint pain?
• Have you been exposed to tuberculosis, had a previous diagnosis of tuberculosis, or undergone testing for syphilis or sexually transmitted diseases?
• What medications are you currently taking, and have you recently had any injections or surgery?

Examples of Tests a Doctor May Perform During an Outpatient Visit

• Visual acuity testing, intraocular pressure measurement, slit-lamp microscopy (anterior segment), and dilated retinal examination of the posterior segment
• OCT, fluorescein angiography (if necessary), and B-scan ultrasonography (when there is media opacity)
• Blood tests: CBC, ESR/CRP, HLA-B27, syphilis tests (FTA-ABS, VDRL), tuberculosis tests (QuantiFERON/PPD), and autoimmune-related tests if necessary
• Systemic examinations such as chest X-ray (if tuberculosis is suspected)

Examples of General Questions to Ask the Doctor

• Is the cause of this uveitis infectious or noninfectious (autoimmune)?
• What is the recommended treatment duration, and what side effects can be expected?
• What should I be careful about when stopping or changing the medication?
• How likely is recurrence, and what should I do to reduce the risk of recurrence?
• What is the likely long-term outlook for my vision?

Examples of Disease-Specific Questions

• In my case, are additional systemic tests (such as tuberculosis, syphilis, or rheumatologic tests) necessary? Which tests should be performed first?
• If the current inflammation is in the posterior segment (the retina or the back of the uvea), is systemic treatment (steroids or immunosuppressants) necessary, or is local treatment sufficient?

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