OCULAR IMMUNOLOGY

OCULAR IMMUNOLOGY

INFLAMMATORY EYE DISEASES

Ocular immunology is a highly specialized branch of medicine devoted to diagnosing and treating patients with inflammatory eye diseases. These diseases can slightly reduce vision or lead to severe vision loss. 

Ophthalmologists use the general term, uveitis, when referring to the range of inflammatory diseases that affect the uvea. In addition, uveitis is used to describe any inflammatory disease that produces swelling and destroys eye tissues, including within the retina. It’s commonly associated with systemic diseases, such as rheumatoid arthritis. Anatomically, uveitis is classified into anterior, intermediate, posterior, and panuveitic forms, depending on which part of the eye is affected. No matter the classification, Sabates Eye Centers can handle it all. 

Causes of Uveitis

Many different things can cause uveitis. In some cases the cause is unknown, or in doctor language, ‘idiopathic.’ The body's immune system may be a cause.  Bruising, infections, tumors and toxins can cause eye pain, sensitivity to light, poor vision, and increased floaters.

Patients with the following diseases carry a higher risk of developing uveitis:

  • AIDS
  • CMV retinitis
  • Herpes zoster infection
  • Histoplasmosis
  • Kawasaki disease
  • Multiple sclerosis
  • Psoriasis
  • Reactive arthritis
  • Rheumatoid arthritis
  • Toxoplasmosis
  • Tuberculosis
  • Ulcerative colitis

Treating Uveitis

Since uveitis is typically caused by any number of underlying diseases or disorders, treating the inflammation depends on the treatment of the disease. Typically, a steroid (pill or drops) will be prescribed to prevent further inflammation or decrease swelling. Your ophthalmologist will work closely with your medical team if a stronger immunosuppressive medication is needed. 

The two most common uveitis diseases that we treat at Sabates Eye Centers are toxoplasmosis and birdshot retinochoroidopathy. 

Toxoplasmosis

Toxoplasmosis (a form of posterior uveitis) affects the retina, the light-sensitive cells lining the back of the eye. Both eyes are usually involved. If the infection settles in the macula, the area of the retina responsible for central vision, good vision is lost forever.

When toxoplasmosis heals, it leaves a scar. The infection may recur years later, sometimes near the previously infected area. Swelling that fights the infection may cause floating spots in one’s vision; red, painful eyes; and poor vision.

Treating toxoplasmosis with oral medications can be very effective. Pyrimethamine and sulfa drugs are the classic antibiotics although some doctors add or substitute clindamycin. Occasionally steroids, laser, or freezing (cryotherapy) treatments are prescribed. Screening tests can identify women of childbearing age who are at risk of passing the infection to an unborn child.

When contracted by a pregnant woman, toxoplasmosis can pose serious risks to the unborn baby. Pregnant women should avoid handling litter boxes and eating raw meat because the parasite may originate in cat feces or undercooked meat. If acquired during the first trimester of pregnancy, the infection can be devastating to an infant.

Birdshot Retinochoroidopathy (BR)

Birdshot retinochoroidopathy is a rare form of bilateral posterior uveitis of the retina and choroid, the layer of blood vessels under the retina. BR usually occurs in Caucasian women over the age of 40. The cause of BR is unknown. It usually affects both eyes. Symptoms are poor vision, night blindness, and disturbance of color vision. Pain is rare.

Fluorescein angiography, a test for evaluating the retina and choroid, detects BR’s characteristic cream-colored spots, similar in appearance to the splattered pattern of birdshot from a shotgun.

Birdshot retinochoroidopathy is a chronic disease that flares up and then goes into remission. Although some people eventually lose vision, others maintain or recover good vision.