Eye disease uveitis. Uveitis of the eye - what is this disease, photo, causes, symptoms and treatment

Any violation of the normal operation of the membranes of the eye will lead to serious changes for the entire organ of vision. That is why uveitis, like any other ophthalmic pathology, must be treated quickly. About what types of this disease are, what caused its development and how it should be treated, will be described in detail in this article.
Uveitis is the medical term for an inflammatory process that can occur in different parts of the choroid. This is a fairly rare disease and in 25% of cases it leads to visual impairment, and sometimes even blindness.
In men, the pathology develops somewhat more often. This can be explained from an anatomical point of view. Uveal (vascular) pathways look like a branched vascular network with slow blood flow. This becomes the main reason that infectious agents linger here. With normal immunity, they do not affect human health in any way, but as a result of exposure to negative factors, they begin to activate and cause an inflammatory process.

Important: you need to contact an ophthalmologist when the very first signs of eye pathology appear. This will allow time to stop the development of the disease and cure it.

The uveal membrane has a rather complex structure. It occupies the space between the retina and sclera, looks like grapes. From here comes its name - "uvea", which in Russian means "grape".
It has 3 main sections:

• iris;
• ciliary body;
• choroid - the choroid itself (located directly under the retina, lines it from the outside).

Among the important functions that are assigned to the choroid are:

1. Regulation of the flow of sunlight. This protects the eyeball from excess light.
2. Transport of nutrients throughout the retina.
3. Removal of decay products from the eye.
4. Participation in the adaptation of the eyeball, i.e. changing the refractive power of the optical system of the eye for a clearer and clearer perception of different objects that are at different distances from it.
5. Production of intraocular fluid.
6. Normalization of pressure inside the eye.
7. Thermoregulation.

The main function of this shell is to supply the organs of vision with blood. Thanks to the anterior, posterior short, as well as long ciliary arteries, blood is transported to all areas of the eye. However, due to the fact that each part of the eyeball is supplied with blood from its own source, the infection also occurs separately.

Etiology

Uveitis of the eye can occur due to infection, the onset of allergies, due to poor metabolism, injury, severe hypothermia, or against the background of any general illness.
The most common is considered to be infectious uveitis, leading to the development of inflammation. The infection is caused by fungi, streptococci, mycobacterium tuberculosis, treponema, toxoplasma, herpes virus, etc.
Acute allergic uveitis can start as a result of eating any food or medication. Background diseases are rheumatism, rheumatoid arthritis, glomerulonephritis, ulcerative colitis, psoriasis or multiple sclerosis.
Injuries include eye burns of varying severity, foreign bodies and other penetrating injuries of the eyeball.
Hormonal dysfunction can also cause uveitis, the causes of which are: menopause, menstrual irregularities, etc.

Classification of the disease and its symptoms

The main morphological forms of pathology: anterior uveitis, median, posterior, peripheral and diffuse. The anterior, in turn, is divided into iritis, cyclitis and iridocyclitis. The posterior one is called choroiditis, and the diffuse one is called panuveitis or iridocyclochoroiditis.
Depending on the nature of the course, acute, chronic and recurrent uveitis are distinguished.
Each form of uveitis has a number of its features. Anterior uveitis is characterized by the following symptoms:

• redness of the pupils;
• fear of light;
• chronic lacrimation;
• constriction of the pupils;
• Pain in the eyes;
• increased intraocular pressure.

Peripheral uveitis of the eye, symptoms:

• eye damage, which is symmetrical;
• the appearance of "flies" before the eyes;
• marked deterioration in visual acuity and quality.

With posterior uveitis, symptoms appear later. A person will have the following symptoms:

• blurred vision;
• everything visible around is distorted;
• impaired perception of colors;
• the patient constantly sees "flies" floating before his eyes, there may often be peculiar flashes;
• sharply reduced visual acuity.

The severity of the inflammatory process also differs in different forms of the disease. It is most intense in anterior uveitis. The iris at the same time becomes greenish or rusty-brown, the pupil is greatly narrowed and almost does not react to light. Tiny plaques appear on the cornea, freely moving in the eye fluid. They arise as a result of the appearance of a large number of pigment proteins along with lymphocytes.
The acute form lasts up to 1.5-2 months. If left untreated, it passes into the chronic stage, which begins to recur with the onset of cold weather.
Peripheral uveitis is indolent and has the most vague symptoms, so it is difficult to diagnose. When it affects such structures of the eye, which are very difficult to examine. But if the necessary measures are not taken, serious complications and the development of secondary eye diseases are possible.

Diagnosis of the disease

To make an accurate diagnosis, you need to conduct a complete analysis of the organs of vision. Diagnostic tools include:

• examination by an ophthalmologist;
• determining how sharp the patient's vision is;
• microscopic examination of the retina;
• ultrasound diagnostics;
• angiography - examination of blood vessels and identification of the cause of blood flow;
• biopsy followed by examination of the sample taken.

Ways to treat uveitis

If the course of the disease has been started, then treatment should have an integrated approach. Drug therapy involves the use of external agents and decoctions.

traditional medicine

These drugs include:

• mydriatics - cyclopentol, atropine and others. These drugs eliminate muscle spasm and eliminate the effects of adhesions;
• steroids - prednisolone, dexamethasone and others. If there is no benefit from them, the doctor may prescribe immunosuppressive drugs;
• eye drops;
• antihistamines if an allergic reaction occurs;
• in the presence of infections, antimicrobial and antiviral drugs.

Traditional medicine

Various herbs help in the fight against uveitis, treatment is carried out using these recipes:

• a decoction of calendula, chamomile, birch buds and sage. To prepare it, you need to mix 1 tsp. crushed plants, brew in 100 ml of boiling water and rinse with a warm solution 2-3 times a day;
• aloe drops. They need to be diluted in warm water in a ratio of 1:10, and then instilled into each eye 3 times a day, 2-3 drops;
• grind fresh marshmallow root to a state of gruel, wrap in clean gauze and apply to the eyes for half an hour. After the procedure, they must be washed with herbal decoction.

Prevention of uveitis

Complete relief from uveitis will occur in a few weeks if treatment is started on time. If the course of the disease was started or the patient did not complete the course of treatment, then there is a high probability that uveitis will become chronic. To cure it, you will need a long and difficult therapy, so it is better to avoid the appearance of the disease.
To do this, you need to observe simple hygiene of the organs of vision, to avoid injuries and the penetration of bacteria. It is very important to immediately begin treatment of allergic diseases, since some of them can provoke the development of uveitis.

Anatomy of the choroid

vascular tract (uvea) consists of three sections: the iris ( iris), ciliary or ciliary body ( corpus ciliare) and the choroid proper ( chorioidea).

iris- anterior, visible part of the choroid, has an extensive network of sensitive innervation from n. ophthalmicus(first branch of the trigeminal nerve). The vascular network of the iris is formed by the anterior ciliary and posterior long ciliary arteries. The iris is divided into anterior (mesodermal) and posterior (ectodermal) sections. The mesodermal layer consists of the outer boundary layer, which is covered with endothelium, and the stroma of the iris. The ectodermal layer consists of muscular, inner boundary and pigment layers. There are two muscles in the iris - the dilator and the sphincter of the pupil. The first is innervated by the sympathetic nerve, the second by the oculomotor. The color of the iris depends on its pigment layer and the presence of pigment cells in the stroma.

The function of the iris is to regulate the amount of light entering the retina by changing the size of the pupil, that is, the function of the diaphragm. It also, together with the lens, separates the anterior and posterior sections of the eye, and together with the ciliary body produces intraocular fluid. Through the pupil there is an outflow of aqueous humor from the posterior chamber to the anterior.

Ciliary (ciliary) body not available for inspection. Palpation examines its pain, with gonioscopy - a small area of ​​its surface is partially visible, passing into the root of the iris. The ciliary body is a ring about 6-7 mm wide. Its front part has about 70 processes, it is called the ciliary crown ( corona ciliaris). The back is flat, called the ciliary circle, the flat part ( orbiculus ciliaris or pars plana). Zinn ligaments are attached to the lateral surfaces of the ciliary processes, which hold the lens.

As in the iris, in the ciliary body, the mesodermal part is distinguished, which consists of 4 layers (suprachoroid, muscle layer, vascular layer, basal plate) and the ectodermal part, which is represented by two layers of the epithelium: outer pigmented and inner non-pigmented.

In the thickness of the ciliary body there is an accommodative muscle, which has a double innervation: parasympathetic ( n. oculomotorius) and cute. Sensory innervation is carried out n. ophthalmicus.

The accommodative muscle consists of three parts: meridial (Brücke muscle), circular (Müller muscle) and radial (Ivanov muscle).

There are many vessels in the ciliary body - branched anterior ciliary and posterior long ciliary arteries and veins of the same name.

The function of the ciliary body: accommodation and production of intraocular fluid.

choroid- the back of the vascular tract, lines the fundus of the eye, shines through the transparent retina. It consists of 5 layers: suprachoroidal, layer of large vessels, layer of medium vessels, choriocapillary layer, basal plate (Bruch's vitreous membrane). The choriocapillary layer is closely associated with the retinal pigment epithelium, therefore, in diseases of the choroid, the retina is involved in the process.

The blood supply to the choroid is carried out by the posterior short ciliary arteries, the outflow of blood occurs through the vorticose veins, which pass through the sclera at the equator. Has no sensory innervation. Function - retinal trophism.

Thus, the iris and the ciliary body have a common blood supply, innervation, therefore, they are usually affected simultaneously. Features of the blood supply to the choroid determine the isolation of its lesions. However, all three sections of the choroid are anatomically closely related, there are anastomoses between the systems of the anterior and posterior ciliary vessels, so the pathological process can capture the entire uveal tract.

Diseases of the choroid

There are the following types of pathological conditions of the choroid:

1) developmental anomalies;

2) inflammatory diseases (uveitis);

3) dystrophic diseases (uveopathy);

4) neoplasms.

Anomalies of development

Albinism complete absence of pigment in the skin, hair, eyebrows, eyelashes. The iris is very light, translucent with red light, sometimes the sclera is translucent. The fundus of the eye is light, the vessels of the choroid are visible. There is low vision, photophobia, nystagmus.

Treatment: correction of refractive errors, pleoptics.

Aniridia no rainbow. Complaints about low vision, photophobia.

Treatment: contact lenses, surgery - iridoprosthetics.

Polycoria the presence of multiple pupils. Complaints of low vision, monocular diplopia.

corectopia pupil repositioning .

Treatment: contact lenses, surgery - closed iridoplasty.

Iris coloboma defect of the iris, always located below, the pupillary border and the sphincter of the pupil are preserved.

Treatment: operation - closed iridoplasty, contact lenses.

Choroidal coloboma localized in the lower part of the fundus, in this area the retina is underdeveloped or absent.

Treatments no.

Residual pupillary membrane in the pupil area there are white opaque threads that do not start from the edge of the pupil, but from the projection of the small arterial circle of the iris.

Treatment: removed only when vision is reduced.

Inflammatory diseases of the vascular tract (uveitis)

There are anterior uveitis (iritis, cyclitis, iridocyclitis), posterior uveitis (choroiditis) and panuveitis, depending on which part of the vascular tract is affected.

Iridocyclitis. The inflammatory process in the anterior vascular tract can begin from the iris (iritis) or from the ciliary body (cyclitis). But due to the common blood supply and innervation of these departments, the disease quickly passes from the iris to the ciliary body or vice versa, and iridocyclitis develops. Allocate acute and chronic forms of the disease. The patient complains of photophobia, lacrimation, eye pain and decreased vision.

Clinical signs:

- pericorneal or mixed injection;

- pain on palpation of the eye (ciliary pain) and decreased accommodation;

- edema and hyperemia of the iris, heterochromia;

 the pupil is narrowed, weakly reacts to light;

 posterior synechia - fusion of the iris with the anterior surface of the lens;

- clouding of the vitreous body;

 Presence of precipitates on the corneal endothelium.

In severe cases, purulent exudate may appear in the anterior chamber of the eye (hypopion) or blood (hyphema). After the use of mydriatics, the pupillary edge may acquire jagged contours, as a result of the presence of posterior synechiae. If mydriatics are not used, a circular synechia may form, and then a film that can completely close the pupil lumen.

Complications. If the posterior synechiae form along the entire pupillary edge of the iris, the aqueous humor secreted by the ciliary body cannot get into the anterior chamber from the posterior chamber, bombardment (protrusion into the anterior chamber) of the iris occurs. The root of the iris also shifts forward, adhesions appear between the anterior surface of the iris and the posterior surface of the cornea (anterior synechia), which block the angle of the anterior chamber, where the drainage zone of the eye is located. All this leads to an increase in intraocular pressure and the development of secondary glaucoma). In addition to secondary glaucoma, complications of anterior uveitis can be: ribbon-like corneal degeneration, complicated uveal cataract, hypotension, subatrophy of the eye).

Differential Diagnosis carried out with an acute attack of angle-closure glaucoma, acute conjunctivitis (Table 3).

Table 3 Differential diagnosis of acute iridocyclitis with acute attack of glaucoma and acute conjunctivitis

Choroiditis (posterior uveitis) - inflammation of the choroid itself, which is usually combined with inflammation of the retina and is called chorioretinitis.

Due to the absence of sensitive innervation typical for anterior uveitis, there are no complaints of pain in the eye, photophobia, lacrimation in choroiditis. On examination, the eyes are calm. Depending on the localization of the process, the complaints of patients differ. With central localization, closer to the posterior pole, patients complain of a significant decrease in visual acuity, flashes and blinking before the eye (photopsia), as well as metamorphopsia (curvature of objects and lines). These complaints indicate that the retina is involved in the process. Diagnosis is carried out using the method of ophthalmoscopy. In the case of peripheral forms of inflammation, depending on the size of the foci, patients may complain of photopsy and impaired twilight vision (hemeralopia), and in the presence of small and single foci, there are no functional subjective sensations. Inflammation can be focal (isolated) or disseminated. Fresh choroidal foci are a yellowish-gray cellular infiltrate with indistinct borders. The retina above the infiltrate is edematous, so the course of the vessels in places is not ophthalmoscoped.

Opacity develops in the posterior parts of the vitreous body, sometimes precipitates are visible on the posterior border membrane of the vitreous body.

As the inflammatory process subsides, the focus acquires a whitish-gray color with clear boundaries. In the zone of the focus, the stroma of the choroid atrophies, a dark brown pigment appears at the site of the infiltrate. In the chronic course of the process, gray-green granulomas with prominence can sometimes form, which can be the cause of exudative retinal detachment. In this case, it is necessary to carry out a differential diagnosis with a neoplasm of the choroid.

Etiology and pathogenesis of uveitis. The mechanisms of development of uveitis are predetermined by the action of infectious, toxic, allergic and autoimmune factors. Most often these are endogenous factors: infection from other foci of inflammation in the body, as well as in systemic diseases: collagenosis, especially in juvenile rheumatoid arthritis, ankylosing spondylitis, Reiter's disease; tuberculosis, secondary syphilis, sarcoidosis, Behcet's disease (hypopion-iridocyclitis, aphthous stomatitis, damage to the mucous membrane of the external genital organs), brucellosis, toxoplasmosis, herpes, etc. In the etiology of iridocyclitis, exogenous factors also play a significant role: the consequences of penetrating eye injuries, chemical burns, perforation of a corneal ulcer, etc.

Treatment. In order to identify and sanitize possible foci of infection, other etiological factors, it is necessary to conduct a complete examination of the body. Cycloplegics and mydriatics are used in anterior uveitis to reduce pain and prevent the formation of posterior synechiae. Prescribe antibiotics, sulfanilamide drugs, corticosteroids locally, parabulbarno, intramuscularly, non-steroidal anti-inflammatory drugs, desensitizing drugs, immunomodulators. If an etiological factor is established, appropriate specific therapy is prescribed. Be sure to use physiotherapeutic methods of treatment (magnetotherapy, laser irradiation, electrophoresis).

In the eye between the sclera and the retina is the most important structure - choroid, or, as it is also called, . It distinguishes anterior(iris and ciliary body) and back(choroid, from the Latin Chorioidea - the choroid itself). The main function of the iris is to regulate the amount of light reaching the retina. The ciliary body is responsible for the production of intraocular fluid, fixation of the lens, and also provides a mechanism for accommodation. The choroid performs the most important function of delivering oxygen and nutrients to the retina.

Uveitis This is an inflammatory disease of the choroid of the eye. Its causes, manifestations are so diverse that even hundreds of pages may not be enough to describe them, there are even ophthalmologists who specialize only in the diagnosis and treatment of this pathology.

The anterior and posterior parts of the choroid are supplied with blood from different sources, so isolated lesions of their structures are most common. The innervation is also different (the iris and the ciliary body are trigeminal, and the choroid has no sensory innervation at all), which causes a significant difference in symptoms.

The disease can affect patients regardless of gender and age and is one of the leading causes of blindness(about 10% of all cases) in the world. According to various sources, the incidence is 17-52 cases per 100 thousand people per year, and the prevalence is 115-204 per 100 thousand. The average age of patients is 40 years.

Interestingly, Finland has the highest incidence of uveitis, possibly due to the high incidence of HLA-B27 spondyloarthropathies (one of its causes) in the population.

Causes of uveitis

Often it is not possible to determine the cause of uveitis(idiopathic uveitis). Provoking factors can be genetic, immune or infectious diseases, injuries.

It is believed that the cause of uveitis after injury is the development of an immune response that damages the cells of the uveal tract in response to microbial contamination and the accumulation of decay products of damaged tissues. With the infectious nature of the disease, the immune system begins to destroy not only foreign molecules and antigens, but also its own cells. In the case when uveitis occurs against the background of an autoimmune disease, the cause may be damage to the own cells of the choroid by immune complexes, as a result of a hypersensitivity reaction.

The diseases that most often contribute to the occurrence of uveitis include: seronegative arthropathies (ankylosing spondylitis, Reiter's syndrome, psoriatic arthropathy, inflammatory bowel diseases (Crohn's disease, ulcerative colitis)), rheumatoid arthritis, systemic lupus erythematosus, Behçet's disease, sarcoidosis, tuberculosis, syphilis, herpes virus, toxoplasmosis, cytomegalovirus, AIDS.

According to Rodrigues A. et al. (1994), idiopathic uveitis prevails among other forms and makes up about 34%. Seronegative spondyloarthropathies cause the disease in 10.4% of cases, sarcoidosis - in 9.6%, juvenile rheumatoid arthritis - in 5.6%, systemic lupus erythematosus - in 4.8%, Behcet's disease - in 2.5%, AIDS - at 2.4%. According to the same author, anterior uveitis is most common (51.6%), posterior - in 19.4% of cases.

When identifying symptoms of uveitis in a patient, it is necessary to remember about the “masquerade” syndrome, which mimics the disease. It can be either non-tumor in nature (with intraocular foreign bodies, retinal detachments, myopic dystrophies, pigment dispersion syndrome, retinal dystrophies, circulatory disorders in the eye, reactions to drug administration), and tumor (with such oncological diseases as intraocular lymphomas, leukemia , uveal melanoma, metastases of tumors of other localization, paraneoplastic syndrome, cancer-associated retinopathy, retinoblastoma).

Classification

The International Working Group on the Standardization of the Nomenclature of Uveitis has developed recommendations for the classification of this disease.

So, according to localization, it is customary to single out

As you can see, both structures related to various parts of the choroid and surrounding tissues (sclera, retina, optic nerve) can be involved in inflammation.

By morphological picture is distinguished focal (granulomatous) and diffuse (non-granulomatous) uveitis.

The onset of the disease can be both sudden and hidden, almost asymptomatic. By duration, uveitis is divided into limited (up to 3 months) and persistent. According to the course, they can be: acute (sudden onset and limited duration), recurrent (exacerbations alternate with periods of remission without treatment for more than 3 months) and chronic (persistent uveitis with relapses less than 3 months after stopping treatment).

To determine the degree of activity of the inflammatory process, cellular opalescence and the presence of cellular elements in the anterior chamber of the eye are assessed.

Uveitis is also differentiated by many other parameters: morphological, age of patients, immune status, etc.

Symptoms

Symptoms of uveitis depend on many factors., the main of which are the localization of the inflammatory process (anterior, middle, posterior) and its duration (acute or chronic). Depending on the cause, specific manifestations characteristic of this form of the disease can be detected.

Anterior uveitis

The most common form - acute anterior uveitis - is usually accompanied by a sudden onset, severe pain on the side of the lesion (increased pain at night, when the light changes, pressing the eyeball in the limbus), photophobia, blurred or decreased vision, lacrimation, characteristic reddening of the eye (ciliary or mixed injection of the eyeball), constriction of the pupil and weakening of its reaction to light due to spasm of the sphincter. The symptoms of chronic anterior uveitis are similar but are usually mild and some may even be absent.

On examination, an ophthalmologist can detect the presence of cellular elements, purulent and fibrinous exudate (hypopion) in the moisture of the anterior chamber, its opalescence (Tyndall phenomenon); deposits (precipitates) on the posterior surface of the cornea; characteristic deposits on the pupillary edge of the iris (Keppe's nodules) or in its middle zone on the anterior surface (Boussac's nodules); posterior or anterior adhesions of the iris with surrounding structures (synechia), its atrophic changes; color difference between the right and left eyes (heterochromia); the appearance of pathological vessels in the iris (rubeosis). The level of IOP can vary from low to high.

Medium uveitis

Inflammation of the choroid of this localization is accompanied by floating opacities in the field of vision, visual impairment in the absence of pain (the clinic is similar to posterior uveitis), and mild photophobia.

Posterior uveitis

With such uveitis, patients note blurring, decreased visual acuity, the appearance of floating opacities, image distortion, photopsia in the absence of pain, redness, and photophobia. The appearance of pain in posterior uveitis may indicate involvement in the inflammatory process of the anterior chamber of the eye, bacterial endophthalmitis, posterior scleritis.

An ophthalmological examination can reveal the presence of cellular exudate in the vitreous body, of various shapes and types, exudative and hemorrhagic preretinal and intraretinal foci, which in the inactive stage can turn into atrophic areas with scarring, affecting the surrounding tissues.

Patients with panuveitis may experience all of the above symptoms.

Diagnosis of uveitis

The most important thing in the diagnosis of uveitis is the correct and complete collection of anamnesis. This saves the patient from unnecessary examinations. Many experts have even proposed various questionnaires containing key questions for implementation. They help to standardize the survey and avoid insufficient specification of the medical history.

There are no obligatory specific ophthalmic methods for diagnosing uveitis. A general complete examination will reveal certain characteristic signs of the disease. It is important to pay attention to the level of intraocular pressure, which, according to Herbert, is prone to increase in approximately 42% of patients. Inspection of the anterior segment is indispensable, which will help to identify precipitates on the posterior surface of the cornea, hypopyon or pseudohypopion, changes in the iris and other characteristic changes. To differentiate changes in the posterior segment of the eye, in addition to the standard examination of the fundus, FA and OCT can be used.

Laboratory diagnostics (PCR, HLA-typing and others), X-ray, MRI and cytological methods of research are carried out according to indications, depending on the alleged cause of uveitis.

In 2005, the working group on standardization of the nomenclature of uveitis developed recommendations on the scope of diagnostic measures for various forms of uveitis (see Appendix). They contain a list of the main examinations necessary in each specific clinical case and help to avoid the appointment of unreasonable ones.

A special place is occupied by the diagnosis of "masquerade" syndrome, which mimics the symptoms of uveitis. It should be suspected in cases of minimal response to ongoing aggressive drug therapy. The scope of diagnostic procedures depends on the suspected cause.

It is important to understand that purpose of examination for uveitis there may be not only the establishment of the cause of the disease, but also the exclusion of pathology, the treatment of which is excluded by certain drugs (for example, infectious, in particular, those that cannot be identified by specific tests, “masquerade” syndrome); systemic diseases that can worsen the general condition of the patient, the prognosis of recovery, require correction of the treatment regimen.

Treatment of uveitis

Medical treatment. Treatment of uveitis directly depends on the cause that caused the disease. Due to the fact that it is often not possible to establish it, the regimens contain symptomatic drugs or are prescribed empirically until the etiology of inflammation is established. Specific treatment should be applied after identifying the cause of the disease.

Corticosteroids are the gold standard for treating uveitis.. The main goals of the appointment are: reducing exudation, stabilizing cell membranes, inhibiting the production of inflammatory hormones and lymphocytic reaction. The choice of a specific drug in this group, as well as the method of administration, is carried out taking into account the activity of the inflammatory process, the tendency to increase IOP, etc. Currently, local and systemic use is possible, as well as the installation of an implant in the eyeball cavity or under the membranes of the eye that releases the drug into small doses for a long time.

The next most commonly prescribed for uveitis are cycloplegic and mydriatic drugs. Their use is due to the prevention of the formation of synechia (fusions) of the iris with surrounding structures, the reduction of pain by reducing the spasm of the pupillary and ciliary muscles, the stabilization of the hemato-ophthalmic barrier and the prevention of further sweating of the protein into aqueous humor.

Second-line drugs in the treatment of uveitis are NSAIDs. They have less anti-inflammatory activity than steroids, but may be useful for the relief of pain, inflammation, prevention and treatment of recurrence of the disease, as well as accompanying it in some cases, macular edema. When co-administered with corticosteroids, NSAIDs help to reduce the dose of the former, which is necessary to stop inflammation in the long-term treatment of some forms of chronically ongoing uveitis. The drug can be prescribed both in the form of eye drops and in tablet form.

Special attention should be paid a relatively new group of drugs - immunomodulators, which are now successfully used in some forms of uveitis (for example, caused by Behçet's disease, involving the posterior segment of the eye; Wegener's granulomatosis; necrotizing scleritis). This group includes antimetabolites (methotrexate, azathioprine, mycophenolate mofetil), T-lymphocyte inhibitors (cyclosporine and tacrolimus), alkylating agents (cyclophosphamide, chlorambucil). The purpose of this therapy is the targeted suppression of certain mechanisms of the immune inflammatory response that led to damage to the organ of vision (immunosuppression). The drugs can be used both with and without corticosteroids, allowing you to reduce the negative impact of the latter on the body.

Not so long ago, it has also become possible to use in special forms of uveitis (serpinginous choroiditis, shotgun chorioretinitis, sympathetic ophthalmia; caused by Behcet's disease, Vogt-Koyanagi-Harada, juvenile idiopathic arthritis, seronegative spondyloarthropathies) drugs-inhibitors of growth factor-α tumors, or so-called biological therapy. The most commonly used are adalimumab and infliximab. All biological agents are second-line drugs in the treatment of these diseases and are used in cases where previous therapy has been unsuccessful.

Surgery

The goals of this type of treatment are visual rehabilitation, diagnostic biopsy to clarify the diagnosis, removal of cloudy or altered structures that make it difficult to examine the posterior segment of the eye or contribute to the development of complications (cataract, destruction of the vitreous body, secondary glaucoma, retinal detachment, epiretinal membrane), the introduction of drugs directly to the site of inflammation. Also, the removal of the affected structures of the eye can contribute to the relief of the inflammatory process. The most commonly used surgical methods include vitrectomy, phacoemulsification, glaucoma filtering surgery, and intravitreal injections.

The success of these interventions directly depends on the timeliness of their implementation, the stage of the disease, the prevalence of irreversible changes in the eyeball.

Prognosis in the treatment of uveitis

Patients suffering from uveitis should be informed of the importance of following the prescribed treatment and examination regimen. This is the most important factor that determines the favorable prognosis of the outcome of the disease. However, some forms of uveitis are capable of recurrence, even despite adequate treatment.

Of course, uveitis by itself is not fatal, but if not adequately treated, it can cause blindness.

Application

Bibliography

1) Saadia Zohra Farooqui, MBBS Senior Resident, Singapore National Eye Centre, Singapore General Hospital, Singapore, Uveitis Classification, 2016. [Medscape ]
2) Monalisa N Muchatuta, MD, Iritis and Uveitis Clinical Presentation, 2016. [Medscape]
3) Herbert HM, Viswanathan A, Jackson H, Lightman SL. Risk factors for elevated intraocular pressure in uveitis. J Glaucoma. 2004;13(2):96–9
4) C. Stephen Foster, Albert T. Vitale. Diagnosis and treatment of uveitis. Jaypee Highlights, 2013.
5) Niaz Islam, Carlos Pavesio, Uveitis (acute anterior), 2009. [ Academy ]
6) Robert H Janigian, Jr, MD, Uveitis Evaluation and Treatment, 2016. [ Medscape ]
7) Monalisa N Muchatuta, MD, Iritis and Uveitis Follow-up, 2016. [ Medscape ]
8) George N. Papaliodis. Uveitis. A practical Guide to the Diagnosis and Treatment of Intraocular Inflammation. Springer, 2017
9) Kanski's Cinical Ophthalmology. A systematic approach. 8th edition. Eisevier, 2016
10) E.A. Egorov. Emergency ophthalmology: Proc. Pos. M.: GEOTAR-Media, 2005

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Uveitis of the eye is an inflammation of the choroid. This is a fairly common problem in ophthalmology, which in 25% of cases leads to a decrease in vision.

Anatomical features of the structure of the choroid

It is known that the choroid of the eye includes several sections:

• Anterior uveitis represented by the ciliary body (corpus ciliare) and the iris (iris);
• Posterior uveitis located under the retina. It is represented by the choroid itself, which is called the choroid (chorioidea).

The vascular network of the eyeball is very branched, and the speed of blood flow in it slows down. These conditions create a favorable environment for the spread of the inflammatory process.

The blood supply to the anterior and posterior sections of the choroid is carried out separately. That is why inflammation in them proceeds in isolation and practically does not pass from one department to another.

Remarkable is the fact that there is no sensitive innervation on the choroid itself, the choroid. In this regard, her defeat is not accompanied by pain.

Causes

In 43% of cases, the disease is infectious.

Most often, the cause of uveitis is infectious (about 43% of all cases of the disease). Streptococci, cytomegalovirus, tuberculosis mycobacteria, herpes simplex virus, streptococci, staphylococci, fungi, pale treponema can act as pathogens.

The second place in the frequency of occurrence is occupied by uveitis of an allergic nature.. Chemicals, plant pollen, household allergens usually act as provoking factors. Serum uveitis has been reported in response to vaccination.

Uveitis of the choroid often accompanies severe systemic diseases such as psoriasis, multiple sclerosis, autoimmune thyroid disease, glomerulonephritis, rheumatoid arthritis, and diabetes mellitus.

Sometimes uveitis occurs as a complication of certain eye diseases.(, corneal ulcer).

Disease classification

According to the nature of the course of the inflammatory process, uveitis of the eye is divided into:

• Acute (last no more than 3 months);
• Chronic (lasting more than 3 months).

Depending on the anatomical localization of the inflammatory process There are several types of uveitis:

Depending on the nature of the inflammatory reaction Uveitis is divided into the following forms:

• Purulent;
• Serous (with watery discharge);
• Fibrinous-plastic (with compaction of inflamed tissue);
• Hemorrhagic (accompanied by hemorrhages);
• Mixed.

Due to the occurrence uveitis can be:

• Exogenous (caused by burns, injuries);
• Endogenous (caused by infectious agents inside the body).

In addition, inflammation of the choroid can be primary (that is, appeared in a previously healthy eye) and secondary (appeared against the background of a systemic disease).

Symptoms of uveitis of the eye

The clinical picture of uveitis directly depends on the anatomical location of the inflammatory process.

Anterior uveitis

Anterior uveitis is accompanied by a feeling as if the person is looking through a thick fog. Hyperemia (redness) of the mucous membrane appears, pain increases.

Over time, the fear of light and profuse lacrimation join. Visual acuity gradually decreases. Anterior uveitis can cause an increase in intraocular pressure.

Posterior uveitis

Posterior uveitis is accompanied by less pronounced manifestations. This is largely due to the fact that the choroid does not contain nerve endings.

This form is characterized by a progressive decrease in vision and distortion of the contours of objects. Some patients may complain of floaters or spots appearing in their field of vision.

In posterior uveitis, the retina and even the optic nerve can be affected. It is manifested by symptoms of a sharp decrease in vision, loss of visual fields, photopsia (luminous dots in front of the eyes) and even a violation of color perception - the patient ceases to distinguish colors or their shades. This is due to hypoxia of the retina and nerve due to vascular damage.

Generalized uveitis

The most severe course is generalized uveitis. As a rule, it occurs against the background of severe sepsis (blood poisoning) and poses a serious threat to the life of the patient.

With generalized uveitis, the inflammatory process captures all structures of the eye. containing vessels: the iris, the choroid, and even the retina.

Therefore, the symptoms will be pronounced: pain in the eyes, decreased vision, lacrimation, photophobia. On examination, injections (dilations) of blood vessels are visible, redness of the eyes is expressed.

Diagnosis of the disease

For a comprehensive diagnosis of uveitis, the following examinations are necessary:

For certain indications, complex instrumental methods can be used: ultrasound examination of the eyes, electroretinography, angiography of retinal blood vessels, laser scanning tomography, biopsy.

If you suspect secondary uveitis, you may need to consult a phthisiatrician, neurologist, rheumatologist and other related specialists.

Eye uveitis treatment

Pupil dilation prevents spasm of the ciliary body and prevents adhesions between the lens capsule and the iris.

Depending on the origin of uveitis, the doctor prescribes antihistamines () or drugs (in the form of eye drops or ointments).

Steroidal anti-inflammatory drugs are prescribed, such as, betamethasone or.

In advanced cases, surgery may be needed.

Surgical intervention for uveitis is to remove the affected vitreous body- internal transparent environment of the eye. In modern clinics, today they are replacing it with a synthetic silicone-based gel.

If the process has spread to all structures of the eye, it is removed completely in order to save the second eye, because inflammation can be transmitted through the vessels.

In order not to negate the result of uveitis treatment, as well as to prevent the occurrence of relapse, the following measures must be observed:

Traditional medicine in the treatment of uveitis

Among folk remedies for the treatment of uveitis, medicinal herbs are used: chamomile, calendula, linden, sage. Of these, infusions are prepared at the rate of 3 tablespoons of chopped herbs per 1 cup of boiling water. Insist for an hour, cool. A soft cotton swab is moistened with infusion and the eyes are washed.

For this, you can purchase glass false eye trays at the pharmacy.. They must first be boiled, filled with infusion and applied to the eye for 3-5 minutes.

Aloe juice has a healing effect on the eyes, it relieves inflammation, improves blood circulation and stimulates recovery processes.

You can buy it at a pharmacy or cook it at home by squeezing it from a fresh plant.

In both cases, the juice must be diluted with boiled water in a ratio of 1:10. Instill 2 drops in each eye in the morning and evening.

Complications

If not treated promptly, anterior uveitis can cause the following complications:

• Keratopathy (violation of the cornea);
• Macular retinal edema;
• Synechia (fusion) between the lens and the iris);

Complications of posterior uveitis:

• Ischemia (malnutrition) in the area of ​​the yellow spot of the retina;
• Blockage of retinal vessels;
• Neuropathy (impaired functioning) of the optic nerve;
• Macular edema of the retina.

Forecast and preventive measures

It is better to start treatment immediately, otherwise there may be complications.

With timely treatment, absolute recovery occurs, as a rule, already in 3-4 weeks. The earlier complex therapy was started, the sooner the cure occurs. Otherwise, uveitis can become chronic and continuously recur.

During treatment, it is very important to follow all the recommendations of the doctor. and in no case prematurely stop taking medications. If this is neglected, the likelihood of developing complications, including loss of vision, is high.

As for the prevention of uveitis, it consists, first of all, in a timely visit to an ophthalmologist and regular annual preventive examinations. Compliance with the rules of personal hygiene also plays an important role.

One of the most common eye diseases is inflammation of the choroid. This is a set of eye diseases in which different parts of the choroid become inflamed. The disease develops due to infection, eye injuries and needs qualified help, as it causes serious complications.

The structure of the choroid of the eye consists of three sections: the iris, the ciliary body and the vascular part itself (the choroid).

This part of the eyeball is well supplied with blood due to the developed vascular system. At the same time, the vessels of the eye are very small, and the blood flow in them is slow. This creates conditions for the retention of microorganisms, which can cause an inflammatory process.

In addition to slow blood flow, the development of the disease is also facilitated by the features of the innervation of the eye. That is why inflammation usually affects one of the areas of the choroid: anterior or posterior.

The anterior section consists of the iris and the ciliary body. It is supplied with blood by the posterior long artery and the anterior ciliary branches. Innervation is provided by a separate branch of the trigeminal nerve.

The blood supply to the posterior part is provided by the posterior short ciliary arteries, and the nerve sensitivity of this area is absent.

Types of uveitis

According to the anatomical location, four types of the disease are diagnosed:

1. Anterior area.
2. Back department.
3. Intermediate.
4. Total.

With the development of the inflammatory process in the anterior section, the iris, the vitreous body, or both areas become inflamed. The patient is diagnosed with anterior cyclitis or iridocyclitis. This type of inflammation is the most common.

Posterior uveitis causes inflammation of the retina and damage to the optic nerve. The process in the middle section affects the vitreous and ciliary body, the retina and directly the choroid itself.

With simultaneous inflammation of all departments, total, or generalized, uveitis is diagnosed.

By the nature of the process, the presence of suppuration and fluid, uveitis is:

• serous;
• purulent;
• fibrous-plastic;
• mixed;
• hemorrhagic.

In the first type, the release of a liquid of a transparent type predominates. More severely, the disease manifests itself with suppuration of the eye. In fibrous uveitis, fibrin, a protein involved in blood clotting, is shed. With the hemorrhagic type, the walls of the capillaries are damaged, and blood is released.

The causes of inflammation of the choroid of the eye are endogenous (internal) and exogenous (external) factors. The endogenous form develops as a result of the introduction of microorganisms by blood flow from other sites of infection in the body.

The cause of exogenous inflammation is the introduction of microbes from the outside during eye injuries, burns, surgical interventions and other medical procedures.

According to the mechanism of occurrence, two types of the disease are distinguished:

• primary;
• secondary.

Primary uveitis is an independent pathology that develops without previous eye diseases.

Secondary uveitis occurs as a complication of various eye diseases during or after them. Examples are corneal ulcer, scleritis, bacterial conjunctivitis.

According to the phase of the course, uveitis is:

• sharp;
• chronic.

The acute course of the disease is diagnosed when it lasts up to three months. If recovery does not occur, the disease enters the chronic phase. Inflammation of the choroid of the eye is also congenital and acquired.

The reasons

The causes of the inflammatory process in the choroid are eye injuries, infections, allergic reactions. The disease develops as a result of metabolic disorders, hypothermia, immunodeficiency, and general diseases of the body.

The overwhelming cause of uveitis is infectious infection, which accounts for up to 50% of cases.

The causative agents are:

• treponema;
• Koch's wand;
• streptococci;
• toxoplasma;
• herpes infection;
• fungi.

The penetration of microbes occurs both directly and when bacteria and viruses are introduced from other places of inflammation: caries, foci of suppuration, tonsillitis.

With complicated drug and food allergies, allergic uveitis occurs.

The defeat of the choroid occurs in various diseases:

• tuberculosis;
• syphilis;
• arthritis;
• intestinal infections;
• rheumatism;
• skin diseases;
• kidney pathology.

Traumatic inflammation of the choroid occurs due to direct trauma to the eye, the presence of foreign bodies and burns. The causes are also endocrine pathologies (diabetes mellitus, menopause).

Symptoms

The clinic of different uveitis is somewhat different. Symptoms of anterior inflammation:

• redness of the eyes;
• lacrimation;
• increased sensitivity to light;
• loss of vision;
• painful sensations;
• narrowing of the pupil;
• rise in intraocular pressure.

The acute course of the disease causes severe symptoms, forcing the patient to see a doctor as soon as possible.

In chronic inflammation, the severity of manifestations is weak or barely noticeable: some redness of the eye, a feeling of red dots in front of the eyes.

Peripheral uveitis manifests itself:

• a feeling of flies flickering before the eyes;
• bilateral eye damage;
• decrease in visual acuity.

Inflammation in the posterior region disturbs the distorted perception of objects. The patient complains that he sees "through the fog", he has dots before his eyes, visual acuity decreases.

Diagnostics

The appearance of symptoms of uveitis is a reason for immediate medical attention. Delaying the visit is fraught with serious consequences up to blindness.

The doctor conducts an external examination, determines the visual acuity and fields, measures eye pressure.

The reaction of pupils to light is studied in the light of a slit lamp, retinitis is visible in the study of the fundus. Additionally, ultrasound, angiography and MRI are used.

Treatment

Uveitis therapy should be carried out only by a qualified specialist, and self-medication is unacceptable.

To relieve spasm of the ciliary muscle, mydriatics are prescribed: atropine, cyclopentol. Inflammation is stopped with the help of steroid drugs for local and general use (ointment injections): betamethasone, dexamethasone, prednisone.

Taking into account the pathogen, antimicrobial or antiviral drugs are used.

Be sure to prescribe drops that reduce intraocular pressure. With the help of antihistamines, allergic symptoms are removed.

With a mild course of the disease, the symptoms disappear after 3-5 weeks. In severe forms resort to surgical treatment.

Conclusion

Uveitis is a serious pathology of the eye that needs qualified treatment. It is unacceptable to self-medicate and delay a visit to the doctor. Timely treatment is the key to a favorable prognosis.