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Uveitis

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Following Up
• Supporting Research

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, therefore, can affect the cornea, the retina, the sclera, and other important parts of the eye. Uveitis occurs in acute and chronic forms, and affects men and women equally. It can happen at any age, but occurs primarily between the ages of 20 - 50, and most commonly in the 20s.

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. They represent 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?

Although the exact cause of uveitis is often unknown, it may result from trauma to the eye, as in the case of 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's 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 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.
• Those taking certain medications, such as those mentioned in the section.

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with uveitis, you should see your health care provider. Your provider will do a complete physical examination and take your history, checking for signs of underlying disease such as joint problems, mouth sores, rash, and nail pitting. In addition, the 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 required 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.

Always 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), 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 tablespoonful oil two to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources.
• Vitamin C, 500 - 1,000 mg one to three 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. You should refrigerate your probiotic supplements for best results.
• Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant and antiviral effects.
• Melatonin, 2 - 5 mg one 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 get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should 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 ( Cameilia 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 three times daily, for antioxidant and blood vessel support.
• Bilberry ( Vaccinium myrtillus ) standardized extract, 80 mg two to three 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 three times daily, for inflammation and antioxidant support.

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

Homeopathy

Currently, 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.

Supporting Research

Berkow R, Fletcher AJ, Beers MH, eds. The Merck Manual . Rahway, NJ: Merck & Co.; 1992:2380-2382.

Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs . Newton, Mass: Integrative Medicine Communications; 2000:18, 165-166.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99.

Carillo-Vico A, Reiter RJ, Lardone PJ, et al. The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs . 2006;7(5):423-31.

Dunn JP, Nozik RA. Uveitis: role of the physician in treating systemic causes. Geriatrics . 1994;49(8):27-32.

Fraunfelder FW, Rosenbaum JT. Drug-induced uveitis: incidence, prevention, and treatment. Drug Saf. 1997;17(3):197-207.

Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev . 1996; 1(1):11-17.

Granado F, Olmedilla B, Blanco I. Nutritional and clinical relevance of lutein in human health. Br J Nutr . 2003;90(3):487-502.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide . Hudson, OH:LexiComp; 2000: 452-454.

Lal B, Kapoor AK, Asthana OP, et al. Efficacy of curcumin in the management of chronic anterior uveitis. Phytother Res . 1999;13(4):318-322.

Maheshwari RK, Singh AK, Gaddipati J, Srimal RC. Multiple biological activities of curcumin: a short review. Life Sci . 2006;78(18):2081-7.

Drug-induced uveitis can usually be easily managed. Drugs Ther Perspect . 1998;11(10):11-14.

Nussenblatt RB, Fortin E, Schiffman R, et al. Treatment of noninfectious intermediate and posterior uveitis with the humanized anti-Tac mAb: a phase I/II clinical trial. Proc Natl Acad Sci. USA 1999;96(13):7462-7466.

Romero J, Marak GE Jr, Rao NA. Pharmacologic modulation of acute ocular inflammation with quercetin. Ophthalmic Res . 1989;21(2):112-117.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin . 2001;17(1):239-47.

Shi J, Yu J, Pohorly JE, Kakuda Y. Polyphenolics in grape seeds-biochemistry and functionality. J Med Food . 2003;6(4):291-9.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr . 2002;21(6):495-505.

Sowka JW, Gurwood AS, Kabat AG. Anterior Uveitis. In: Handbook of Ocular Disease Management . Review of Optometry Online. Accessed on February 8, 2000.

Thiagarajan G, Chandani S, Harinarayana Rao S, et al. Molecular and cellular assessment of ginkgo biloba extract as a possible ophthalmic drug. Exp Eye Res . 2002;75(4):421-30.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Tarcher/Putnam; 1995.

van Rooij J, Schwartzenberg SG, Mulder PG, Baarsma SG. Oral vitamins C and E as additional treatment in patients with acute anterior uveitis: a randomised double masked study in 145 patients. Br J Ophthalmol . 1999;83(11):1277-1282.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs . 2000;9(9):2103-19.

West AL, Oren GA, Moroi SE. Evidence for the use of nutritional supplements and herbal medicines in common eye diseases. Am J Ophthalmol . 2006;141(1):157-66.

Xie J, Zeng Q, Wang L. The protective effect of L-carnitine on ischemia-reperfusion heart. J Huazhong Univ Sci Technolog Med Sci . 2006;26(2):188-91.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J . 2005;46(5):585-96.

• Review Date: 9/8/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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