Uveitis and Eye Inflammation
Knowing the common comorbidities that can occur with conditions on the AxSpA spectrum is important and can help with prompt diagnosis and appropriate treatment. One of the comorbidities that commonly occurs with these conditions is uveitis. Uveitis can be serious if left untreated, so early diagnosis and treatment is crucial.
What is uveitis?
The middle layer of tissue in the eye wall is called the uvea. It includes the iris, ciliary body, and choroid.1 This layer of the eye also enables blood flow to the retina.1 When the uvea is inflamed, this is called uveitis.1 Uveitis tends to come on quickly and get bad quickly as well. Symptoms include eye redness, pain, light sensitivity, dark floating spots in the line of vision, and blurry vision.1 Uveitis can affect one or both eyes.
Figure 1. The parts of the eye uveitis affects
It is estimated that uveitis occurs in 25 to 40 percent of people with spondyloarthritis (SpA).2 SpA-related uveitis typically has an acute onset, is present in only one eye, and tends to recur.2 It is also typically responsive to treatment without any adverse events.2
Figure 2. A normal eye versus an eye with uveitis
Why uveitis occurs
In approximately half of all uveitis cases, the exact cause isn’t known.1 If a cause is found, it is often one of the following:1
- Eye injury or surgery
- Autoimmune disorder
- Inflammatory disorder (including Crohn’s disease or ulcerative colitis)
- Infection like Lyme disease
- Cancer that affects the eye
Since conditions on the AxSpA spectrum are systemic, meaning they affect the entire body, it is not surprising that the inflammation that is part of AxSpA can affect they eye.
How uveitis is diagnosed and treated
An eye doctor can generally examine the eye and diagnose uveitis. Other tests may also be done, including specialized eye photography, fluid analysis, or blood tests.1 If the eye doctor suspects an underlying disease associated with uveitis, they might refer you to a specialist like a rheumatologist – especially if you already have a diagnosis of a condition on the AxSpA spectrum. If you have AxSpA, a rheumatologist’s opinion is highly recommended in addition to the eye doctor’s examination.2
Treating uveitis when it is comorbid with conditions on the AxSpA spectrum can consist of a variety of options, depending on the severity of the uveitis. Treatment options can include:2
- Topical therapies like corticosteroid eye drops or ointment
- Periocular corticosteroid injections
- Intraocular corticosteroids
- Systemic nonsteroidal anti-inflammatory drugs (NSAIDs)
- Systemic corticosteroids (like oral prednisone)
- Immunosuppressive drugs
- Biologic therapy
Some of these treatments should be tried only if other, first-line treatments are not effective. This is because they typically have more potential for adverse effects and are stronger treatments. Topical corticosteroids are usually the first treatment to be used.2 Some treatments, like NSAIDs, can be used alongside other treatments like topical treatments.2
Treatment can also vary if your uveitis is chronic or recurrent, and thus it may require stronger, more targeted therapies.
If the uveitis is caused by an infection, treating the underlying infection may be done in addition to treatment for the uveitis. This can include antibiotics or antiviral medication.1If you have uveitis, getting prompt evaluation and diagnosis is crucial, since uveitis can cause permanent vision loss if left untreated. If you have any symptoms that could be uveitis, call your doctor immediately. Your eye doctor can do a thorough exam and consult with your health care provider who treats your AxSpA, and can come up with a treatment plan.