Uveitis is a group of diseases characterized by inflammation of the intraocular contents. Its name is due to the pigment that gives us eye color and the content, which is the vitreous humor, which is similar to the pulp of a grape.
Dr. Enzo Castiglione, ophthalmologist at the Clinical Hospital of the University of Chile, explains that “the immune system is responsible for generating inflammation and usually inflaming tissues to eliminate germs, that is, it eliminates infections. And occasionally there are infections that reach the ocular tissue through the blood and the immune system enters the eye to eliminate these germs, which occurs with herpes viruses, tuberculosis, toxoplasmosis and a number of infectious causes.
“However, infections are not responsible for more than 20 to 25% of uveitis in Chile. The vast majority of cases are generated by errors of the immune system that enters the eye to eliminate a non-existent enemy, sometimes the enemy is the same eye that the immune system wants to eliminate and sometimes the eye is the battlefield or innocent victim of collateral damage,” he adds.
Uveitis are rare diseases and are grouped together because their causes are multiple.
In middle-income countries like Chile, it is estimated that probably 70% of ophthalmology consultations are due to the need for lenses and the rest have different, much more common diseases such as cataracts, glaucoma, strabismus.
“Uveitis is a small fraction of those diseases, but with great disabling potential, because they attack the most fragile intraocular tissues,” highlights Dr. Castiglione.
Diagnosis
The specialist points out that the diagnosis is difficult, “because not everyone allows a piece of their eye to be removed to make the diagnosis of a benign disease, in other words.”
“When the ocular wall is inflamed it is serious for the eye, but not as serious for the human being as when what is inflamed is the intraocular tissue, what we call the orbital contents, that is, that soft part that cushions the eye and occupies the space between the eye and the bone wall, there is a risk of mortality, of there being a hematological cancer behind it called lymphoma,” he points out.
Treatment
When uveitis is infectious, the specific germ must be found and maximum efforts must be made to give it specific anti-infective treatment, for example, in cases of herpes retinitis or toxoplasmosis, which have specific treatments.
“But when uveitis is due to an immunological error, something inflammatory or autoimmune, the treatment consists of giving corticosteroids systemically, that is, oral prednisone to be taken with all its undesirable side effects, or intravenous corticosteroids in patients who are hospitalized, and then The corticosteroid is being replaced by immunosuppressive agents that are safer for long-term treatment,” says the ophthalmologist.
“Patients who undergo treatment with corticosteroids gain weight, their metabolism is disturbed, their blood sugar increases, they have erosive gastritis, tremors, high blood pressure, insomnia; “There are a number of adverse side effects that are a high price to pay to defend your vision,” he adds.
“The most common uveitis is of the acute anterior type, which is a very intense and very symptomatic unilateral condition, but it heals in 8 to 12 weeks and, if managed well, the patient is free of any sequelae. On the other hand, chronic uveitis is a little more difficult to cope with, because some will need treatment for life, some after several years allow the doses to be gradually reduced and eventually reach zero treatment without reactivation and that is a very good scenario”, points out Dr. Castiglione.
Recommendations for patients
“It is necessary for the patient to adhere to therapy, to fight to make his therapy bearable, when he is tempted to abandon treatment, to approach his doctor and seek support. He should tell you about his fears, for example, that he does not want to continue taking a certain medication because his stomach hurts, so we are going to give him something to protect his gastric mucosa. We are going to help him so that he reaches a successful conclusion. With good motivation, he can move forward,” highlights the specialist.
Source: Hospital Clínico Universidad de Chile.
