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Ocular Inflammatory Disease, Eye Inflammation & Uveitis at Doctor & Associates serving Fairfield County Norwalk Wilton Westport Connecticut

Ocular Inflammatory Disease (OID) is a generic description for inflammation that affects any part of the eye or surrounding tissue. Inflammation is a characteristic reaction of tissue to injury or disease.  Inflammation results from the body’s attempt to eliminate a foreign body, toxin, substance, microorganism or its effects and helps to prevent further injury. Normal healthy tissue can be injured by inflammation. If the inflammation and resulting damage occurs in or around the eyes, the affected area including the eyelids, the sclera, the iris, the uvea, the retina or the optic nerve can becomes inflamed and potentially damaged. Ocular inflammation can be observed by your eye doctor using specialized instruments and lenses and even the slit lamp microscope during a routine examination. If eye inflammation is allowed to persist for a significant length of time or if it is severe, tissue damage can occur resulting in vision loss. 

Inflammation of the many structures of the eye be can include the fairly common allergic conjunctivitis that patients experience during the spring, as well as the more potentially serious conditions such as Uveitis, Choroiditis, Retinitis, Iritis, Scleritis, Episcleritis, Cellulitis, Optic Neuritis, Keratitis, Orbital Pseudotumor, Retinal Vasculitis and Chronic Conjunctivitis.  

About Eye Anatomy & Uveitis
The middle layer of the eye is called the Uvea or Uveal Tract. The Uvea consists of a number of ocular structures including the Iris, the Ciliary Body and the Choroid. The Uvea lines the inner eye like a tunic and the only visible element of the Uvea is the Iris or the colored part of the eye.The Uvea provides most of the blood supply to the Retina. Inflammation in any of the parts of the Uveal tract is called Uveitis. Uveitis specifically refers to inflammation of the middle layer of the eye but is often used to describe any inflammatory process involving the interior of the eye. Uveitis can be caused by Autoimmune Disorderautoimmune disorders such as Rheumatoid Arthritisrheumatoid arthritis or Ankylosing Spondylitisankylosing spondylitis, infection, or exposure to toxins. However, in many cases the cause is unknown.

Inflammation Inside the Eye is a Medical Emergency Because If Untreated It Will Lead to Vision Loss
Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States. Uveitis requires an urgent referral and thorough examination along with urgent treatment to control the inflammation.

Uveitis is classified into Anterior, Intermediate, Posterior and Panuveitic forms, based on which part of the eye is primarily affected by the inflammation.

Anterior Uveitis
The most common type of Uveitis is Anterior Uveitis. In fact, between 65-90% of Uveitis is Anterior Uveitis, affecting the Iris and/or Anterior Chamber of the eye and thus called Iritis. Iritis can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature. Signs and symptoms of Iritis may include a red eye and conjunctiva, light sensitivity, blurred vision, pain, floating spots and upon examination of the eye, inflammatory cells in the Anterior Chamber and possibly precipitates on the back surface of the Cornea. Anterior Uveitis or Iritis may be associated with Autoimmune Diseases, but often occurs in healthy people. The disorder may affect only one eye. It is most common in young and middle-aged people.

Intermediate Uveitis
Intermediate Uveitis affects the Pars Plana and/or Vitreous Cavity with the presence of inflammatory cells causing Vitritis, an inflammation of the Vitreous Body and sometimes what is referred to as “snowbanking” as a result of inflammatory cells and material on the Pars Plana structure. Pars Planitis affects the narrow area between the colored part of the eye (Iris) and the Choroid. Pars Planitis usually occurs in young men and is generally not associated with any other disease. However, some evidence suggests it may be linked to Crohn's disease and possibly Multiple Sclerosis.

Posterior Uveitis
Posterior Uveitis is an inflammation of the back part of the eye and affects either the Choroid and/or Retina. Often it involves primarily the Choroidchoroid, the layer of blood vessels and connective tissue in the middle part of the eye. This type of Uveitis is called Choroiditis. If the Retina is also involved it is called Chorioretinitis. You may develop this condition if you have had a body-wide or systemic infection or if you have an Autoimmune Disease such as Rheumatoid Arthritis, Inflammatory Bowel Disease or Sarcoidosis.

Panuveitis
Panuveitis is the inflammation of all of the layers and structures of the Uvea.

Causes of Ocular Inflammatory Disease, Eye Inflammation & Uveitis
Ocular Inflammatory Disease, Eye Inflammation and Uveitis can be caused by a number of infectious diseases, non-infectious causes including autoimmune diseases, trauma or injury, malignancies and even induced by certain drugs or medications.

Some of the infectious causes may include bacteria, parasites, fungus, viruses such as rubella, HIV-AIDS, sexually transmitted diseases such as Syphilis, Chlamydia or Gonorrhea and unusual infections, such as Tuberculosis, Toxoplasmosis or Lyme Disease. 

Of the non-infectious causes, autoimmune disease-such a Rheumatoid Arthritis, Lupus Erythymatosis, Crohn’s & Inflammatory Bowel Disease, Behcet’s Disease-is a more common cause of eye inflammation.

Drugs and medications that can cause ocular inflammatory disease include bisphosphonates, a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases, Cidofovir, an antiviral medication for the treatment of Cytomegalovirus (CMV) Retinitis in patients with AIDS, Rifabutin, an antibiotic used in HIV and Tuberculosis, and sulfonamides-a common antibacterial-or topical corticosteroids. In addition, certain vaccines and even skin tattoos can cause Ocular Inflammatory Disease.

Finally, certain Cancers can cause Ocular Inflammatory Disease such as Lymphoma, Lung Cancer and Breast Cancer.

Treatment of Ocular Inflammatory Disease, Eye Inflammation & Uveitis
Generally, the prognosis for those who are diagnosed and treated quickly is good but guarded. Most attacks of Anterior Uveitis go away in a few days to weeks. However, relapses are common. Inflammation related to Posterior Uveitis may last from months to years and may cause permanent vision damage, even with treatment. Even with prompt clinical care serious complications such as Cataracts, Glaucoma, Retinal Edema and Corneal Band Keratopathy may occur. Specifically, the type of Uveitis, as well as its severity, duration, and responsiveness to treatment or any associated illnesses, all play a role in to the outlook.

Typically the treatment of Ocular Inflammatory Disease, Eye Inflammation or Uveitis is approached in a stepwise manner. The first step is steroid medication.  A steroid is an anti-inflammatory immunosuppressive medication that can be administered in many forms: drops, oral, injection, or intravenous infusion.  The form of steroid that is prescribed depends on the severity and type of ocular inflammatory disease being treated. Steroid medication can be effective in rapidly stopping acute inflammation. However, when steroids are used for long term treatment they often result in their own set of complications and side effects such as stomach ulcers, osteoporosis (bone thinning), diabetes, cataract, glaucoma, cardiovascular disease, weight gain, fluid retention, and possibly even Cushing’s syndrome.

If the inflammation continues after slowly discontinuing the steroid medication, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) such as Motrin®, Celebrex® or Naprosyn. NSAIDS are another type of medication that works to suppress inflammation. Oral NSAIDS require monitoring of your liver and kidney function and if used for long periods of time may require some additional medication to prevent stomach ulcers.

If the inflammation persists even after the use of NSAIDs, it is possible that your doctor will prescribe immunosuppressive chemotherapy medications or Immunomodulatory Therapy (IMT) including such medications as Methotrexate, CellCept, Imuran, Cytoxan, Leukeran and Cyclosporin. The use of such medication requires special, regular monitoring and blood tests in order to avoid side effects.

A newer category of medications employed for the treatment of autoimmune diseases called biologic response modifiers (BRM). This category of medications may more effectively target components of the immune system and thus avoid some of the potential risks of the more conventional IMT medications. Such medications include Humira® and Remicade®.

The use of most, if not all of the medication mentioned here as being used for treatment of Ocular Inflammatory Disease is considered “Off Label” by the United States Food and Drug Administration (FDA). This means that the pharmaceutical companies who manufacture these medications have never conducted the randomized clinical trials required by the FDA in order for the companies to include treatment of Ocular Inflammatory Disease in the package insert or “label” for the medication. Therefore, physicians who employ such medications for treating Ocular Inflammatory Disease do so “off-label.”  Off-label use is perfectly legal and appropriate, if, in the physician’s opinion, it is in the patient’s best interest to proceed with such treatment.  One can find numerous clinical reports and studies in the medical literature that demonstrate the success of the use of these types of medications for treating Ocular Inflammatory Disease.

In conjunction with immunosuppressant medication and/or antibiotics, additional medications may be used as well. These may include eye drops that dilate the pupil and reduce spasm of the Ciliary Body if inflammation is in the Iris. By preventing Ciliary Body contraction and spasm it will reduce the pain or discomfort you might otherwise experience. However, with a dilated pupil, it may be necessary to wear sunglasses because bright light may cause discomfort. 

Doctor & Associates is conveniently located for patients from located for Connecticut patients from Danbury, Stamford, Greenwich, Westport, Weston, Wilton, New Canaan, Norwalk, Fairfield, Bridgeport, Cannondale, Aspetuck, Redding, Trumbull, Shelton, Monroe, Darien, Glenbrook and Ridgefield Connecticut. To schedule an appointment for a Uveitis or Ocular Inflammation Consultation please call us at 203-227-4113.

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