Introduction:

Uveitis is inflammation of the uvea, the middle layer of the eye between the sclera (white outer coat of the eye) and the retina (the back of the eye). The uvea contains many of the blood vessels that nourish the eye. Inflammation of this area can affect the cornea, the retina, the sclera, and other important parts of the eye.

Signs and Symptoms:

Uveitis is often accompanied by the following signs and symptoms:

• Painful eye(s)
• Redness of the conjunctiva, the membrane covering the surface of the eyeball
• Sensitivity to light
• Blurred or decreased vision
• Tearing
• Redness
• Floaters: experienced as spots in front of your eyes from the movement of protein deposits that accumulate with age on the vitreous body (a transparent substance that fills the area of the eye between the lens and the retina).

What Causes It?:

Uveitis occurs in acute and chronic forms, and affects men and women equally. It can happen at any age, but occurs primarily at ages 20 - 50, and most commonly in the 20s.

Although the exact cause of uveitis is often unknown, it may result from trauma to the eye, such as chemical exposure. In addition, uveitis may be caused by a viral infection (for example, cytomegalovirus, as seen in patients with AIDS), a fungal infection (such as histoplasmosis), or an infection caused by a parasite (such as toxoplasmosis -- a newborn may develop uveitis if the mother was exposed to toxoplasmosis during pregnancy).

Uveitis is also associated with underlying immune-related disorders, including Reiter syndrome, multiple sclerosis, juvenile rheumatoid arthritis, Crohn's disease, and sarcoidosis. Certain diseases, including leukemia, lymphoma, and malignant melanoma, may have symptoms that resemble uveitis. Some medications, such as rifabutin, cidofovir, pamidronic acid, and sulfonamides, may cause uveitis. In many cases, an underlying cause is not identified.

Who's Most At Risk?:

People with the following conditions or characteristics are at risk for developing uveitis:

• History of an autoimmune disease such as ankylosing spondylitis, juvenile rheumatoid arthritis, and Crohn's disease.
• Infections such as syphilis, tuberculosis, cytomegalovirus, and Lyme disease.
• Other eye diseases.
• Location in geographic areas that are prone to certain organisms such as histoplasmosis and Lyme disease.
• In the case of toxoplasmosis, pigs and mice carry the parasite and can transmit it to humans. Cat owners are at increased risk of toxoplasmosis because the litter contains spores of the parasite. Pregnant women should not change cat litter.

• People who take certain medications, such as rifabutin.

What to Expect at Your Provider's Office:

If have symptoms associated with uveitis, you should see your health care provider. Your provider will do a complete physical examination and check for signs of underlying disease, such as joint problems, mouth sores, rash, and nail pitting. In addition, your health care provider will perform an eye examination and may order laboratory tests and imaging.

Treatment Options:

Prevention

Your health care provider can screen for uveitis during a regular eye exam. Treatment of any of the underlying diseases discussed above may help prevent the onset of uveitis. Avoiding drugs associated with uveitis, such as rifabutin, may also help prevent this condition.

Treatment Plan

Prompt treatment is necessary to preserve your eyesight. Warm compresses may help relieve symptoms. Sunglasses can protect your eyes if they are sensitive to light.

Drug Therapies

Your health care provider may prescribe the following medications:

• Corticosteroids to reduce swelling and pain
• Cycloplegics (such as cyclopentolate and homatropine) to reduce pain
• Antimicrobials to treat infection
• Anti-inflammatories to reduce swelling
• Medications to suppress the immune system

Surgical and Other Procedures

Surgery may be needed to repair any damage to the eyes, such as cataracts, glaucoma, or a detached retina -- each a potential complication from uveitis.

Complementary and Alternative Therapies

CAM therapies may help reduce the severity of diseases that can lead to uveitis. Specifically, herbs and nutrients may reduce the effects of free radicals (unstable molecules that may play a role in inflammation and cell damage). In this way, these substances may prevent or slow the advance of uveitis when used together with conventional medical care.

Tell your health care provider about the herbs and supplements you are using or considering using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Try to eliminate all suspected food allergens, including dairy, wheat (gluten), soy, chocolate, corn, preservatives, and food additives. Your health care provider may want to test you for food allergies.
• Eat more antioxidant-rich foods (such as green, leafy vegetables, and peppers) and fruits (such as blueberries, tomatoes, and cherries).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present), or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately, if tolerated, at least 30 minutes daily, 5 days a week.

You may be able to address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoon of oil 2 - 3 times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources. Avoid taking omega-3 fatty acids before surgery for uveitis as they may increase the risk of bleeding.
• Vitamin C, 500 - 1,000 mg 1 to 3 times daily, as an antioxidant, and for blood vessel support.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune support.
• Lutein, 2 - 6 mg daily, for antioxidant support in eye health.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate your probiotic supplements for best results.
• Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant and antiviral effects.
• Melatonin, 2 - 5 mg 1 hour before bedtime, for sleep and immune protection.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. If you're being treated for uveitis, inform all of your health care providers of any herbal remedies you're considering taking. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Cameillia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg 3 times daily, for antioxidant and blood vessel support.
• Bilberry (Vaccinium myrtillus) standardized extract, 80 mg 2 - 3 times daily, for antioxidant and vascular system support.
• Holy basil (Ocimum sanctum) standardized extract, 400 mg daily, for anti-stress and antiviral protection.
• Turmeric (Curcuma longa) standardized extract, 300 mg 3 times daily, for inflammation and antioxidant support.

Traditional Chinese Medicine (TCM) uses many herb combinations to strengthen and tone the immune system, and as antiviral agents. Check with your health care provider for more information on TCM.

Homeopathy

No known scientific literature supports the use of homeopathy for uveitis. An experienced homeopath could consider your individual case and may recommend treatments to help relieve your specific symptoms.

Acupuncture

Acupuncture may help relieve pain and inflammation and support immune function.

Prognosis/Possible Complications:

Prognosis is good with early diagnosis and treatment. Treatment may be short-term or long-term, depending on the cause. The success of treatment depends on any underlying condition you may have. Possible complications include glaucoma, cataracts, vision loss, and detached retina.

Following Up:

Your health care provider may use a slit lamp to examine structures within the eye one layer at a time. Your health care provider will also measure the pressure within your eye every 1 - 7 days during the acute phase. A follow-up appointment every 1 - 6 months is generally recommended. Your health care provider will instruct you on the exact frequency of visits.