Inflammation in the eye, also known as ocular inflammation, can affect many structures and significantly impact vision. In this article, ophthalmologist Dr. Ajeet Madhav Wagle sheds light on the current understanding and management of complex eye conditions, particularly uveitis.
Ocular inflammation refers to the body’s immune response within the eye, which can affect various parts, from the surface (like the conjunctiva and cornea) to deeper structures such as the retina, optic nerve, and the uveal tract. The uvea, composed of the iris, ciliary body, and choroid, is particularly vulnerable. When these structures become inflamed, patients may experience symptoms such as redness, pain, light sensitivity, blurred vision, floaters, or in serious cases, even vision loss.
Uveitis is the umbrella term for these inflammatory processes within the uvea. It is a major focus in the study of ocular inflammatory diseases due to its frequency and potential severity.
Dr. Ajeet explained that uveitis is typically classified in a variety of ways based on factors such as: the location of the inflammation (anterior, intermediate, posterior, or if affecting the entire uvea, pan-uveitis), its underlying cause (infectious or non-infectious), and whether the presentation is acute, chronic, or recurrent.
Infectious causes include viruses like CMV, HSV, and VZV; bacterial infections such as tuberculosis and syphilis; as well as parasitic diseases like toxoplasmosis. These infections can target different areas of the eye and may require highly specific treatments such as antivirals, antibiotics, or anti-tuberculosis medications, often combined with steroids to control inflammation. On the other hand, non-infectious uveitis is often autoimmune in nature.
Conditions like HLA-B27-associated uveitis and Vogt-Koyanagi-Harada (VKH) syndrome (an autoimmune disease that leads to inflammation in the eyes) result from the immune system attacking the body’s own eye tissues. Additionally, some modern cancer therapies, particularly immune checkpoint inhibitors, can also trigger ocular inflammation as a side effect.
The symptoms of uveitis differ depending on which part of the eye is affected. Anterior uveitis typically presents with red, painful eyes and sensitivity to light, while intermediate and posterior forms are more likely to cause floaters and blurred or lost vision. Importantly, systemic symptoms may accompany eye signs and suggest underlying conditions such as autoimmune diseases or infections.
If left untreated or improperly managed, uveitis can lead to serious complications including cataracts, glaucoma, macular oedema (a build-up of fluid in the central part of the retina that can blur vision), and permanent vision loss.
Accurate diagnosis is essential, and clinicians rely on a combination of patient history, laboratory tests, and increasingly sophisticated imaging techniques.
Dr. Ajeet introduced emerging diagnostic tools that enhance the evaluation of ocular inflammation, particularly through multimodal imaging, which includes:
These technologies not only help in diagnosis but also play a crucial role in monitoring disease progression and guiding treatment.
With a diagnosis in hand, the next step is choosing the right treatment. It is imperative to have ocular inflammation treated as soon as possible, due to the possible complications associated with the disease. According to Dr. Ajeet, there are several effective treatment options depending on the patient’s underlying cause.
The first step in managing uveitis is to determine whether the cause is infectious. If so, appropriate antimicrobial treatment is initiated alongside steroids to control inflammation. In non-infectious cases, corticosteroids are the main treatment. They can be given as eye drops, tablets, or local injections. To reduce long-term reliance on steroids, which carry risks like cataracts and high eye pressure, immunosuppressive medications are often introduced.
Dr. Ajeet highlighted advances in management such as the use of biologic therapies for refractory non-infectious uveitis, intravitreal steroid implants (such as Ozurdex), which provide sustained drug delivery with fewer systemic side effects, and anti-vascular endothelial growth factor (VEGF) injections, which are particularly useful in managing associated macular oedema.
Dr. Ajeet also emphasises the importance of early diagnosis and referral.
Timely intervention can prevent permanent damage and preserve vision. Moreover, many cases of uveitis often require a multidisciplinary approach, often involving rheumatologists, infectious disease specialists, and oncologists to address both ocular and systemic disease components.
With the emergence of advanced imaging tools and targeted biologic treatments, the outlook for patients with ocular inflammatory diseases is more promising than ever. As understanding grows, so does the potential to offer patients more personalised and effective care with fewer side effects.
If you experience persistent eye redness, pain, or vision changes, don’t delay. Early evaluation by an eye specialist can make a big difference in preserving your sight.
