Panuveitis

Last updated
Panuveitis
Other namesDiffuse uveitis, Total uveitis
Specialty Ophthalmology
Complications Permanent vision loss [1]
Diagnostic method Eye examination

Panuveitis also known as Diffuse uveitis or Total uveitis is an eye disease affecting the internal structures of the eye. This inflammation occurs throughout the uveal tract, with no specific areas of predominant inflammation. In most cases, along with the uvea, the retina, vitreous humor, optic nerve or lens are also involved.

Contents

Definition

Panuitis is a type of uveitis in which inflammation occurs throughout the uveal tract, with no specific areas of predominant inflammation. [2] In most cases, along with the uvea, the retina, vitreous humor, optic nerve or lens are involved. [3] [4]

International Uveitis Study Group (IUSG) defines panuveitis as generalized inflammation of all three parts (iris, ciliary body and choroid) of the uvea. [3]

Causes

In many cases the cause of panuveitis is unknown. [5] Possible causes include exogenous or endogenous infection, injury, or an autoimmune disease. Endogenous infections caused by syphilis, tuberculosis, mumps, smallpox, influenza, toxoplasmosis, lupus, sarcoidosis, and immune-related inflammations such as Behcet syndrome or Vogt–Koyanagi–Harada disease causes panuveitis. [2] [1]

Infections from a perforating wound or ulcer in the eye, secondary infections from other ocular tissues, or a surgical trauma from intraocular procedures such as cataract surgery, glaucoma surgery or vitreoretinal surgery can also cause panuveitis. [2]

Signs and symptoms

Symptoms of panuveitis include eye pain, redness, sensitivity to light, discharge, blurring of vision, flashes and floaters. [2] There will be signs of inflammations of all the uveal parts.

Diagnosis

Diagnosis of panuveitis is based on the clinical signs of inflammations of all the uveal parts. There will be evidence of anterior uveitis (iris, Cyclitis and iridocyclitis) and choroiditis. Slit lamp examination may reveal vitreous cells, aqueous cells and flare and keratic precipitates. [3]

Treatment

If there is an underlying cause, treatment should be given based on the disease. Non specific treatment measures include cycloplegics, corticosteroids and immunosuppressive drugs. [2] The biologic drugs that are currently used in treatment of panuveitis include anti tumor necrosis factor, cytokine receptor antibodies and interferon-α. [3]

Related Research Articles

<span class="mw-page-title-main">Chorioretinitis</span> Medical condition

Chorioretinitis is an inflammation of the choroid and retina of the eye. It is a form of posterior uveitis. Inflammation of these layers can lead to vision-threatening complications. If only the choroid is inflamed, not the retina, the condition is termed choroiditis. The ophthalmologist's goal in treating these potentially blinding conditions is to eliminate the inflammation and minimize the potential risk of therapy to the patient.

The National Eye Institute (NEI) is part of the U.S. National Institutes of Health (NIH), an agency of the U.S. Department of Health and Human Services. The mission of NEI is "to eliminate vision loss and improve quality of life through vision research." NEI consists of two major branches for research: an extramural branch that funds studies outside NIH and an intramural branch that funds research on the NIH campus in Bethesda, Maryland. Most of the NEI budget funds extramural research.

<span class="mw-page-title-main">Choroid</span> Vascular layer of the eye

The choroid, also known as the choroidea or choroid coat, is a part of the uvea, the vascular layer of the eye. It contains connective tissues, and lies between the retina and the sclera. The human choroid is thickest at the far extreme rear of the eye, while in the outlying areas it narrows to 0.1 mm. The choroid provides oxygen and nourishment to the outer layers of the retina. Along with the ciliary body and iris, the choroid forms the uveal tract.

This is a partial list of human eye diseases and disorders.

<span class="mw-page-title-main">Uvea</span> Pigmented middle of the three concentric layers that make up an eye

The uvea, also called the uveal layer, uveal coat, uveal tract, vascular tunic or vascular layer, is the pigmented middle layer of the three concentric layers that make up an eye, precisely between the inner retina and the outer fibrous layer composed of the sclera and cornea.

<span class="mw-page-title-main">Uveitis</span> Inflammation of the uvea of the eye

Uveitis is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and includes the iris, ciliary body, and choroid. Uveitis is described anatomically, by the part of the eye affected, as anterior, intermediate or posterior, or panuveitic if all parts are involved. Anterior uveitis (iridocyclitis) is the most common, with the incidence of uveitis overall affecting approximately 1:4500, most commonly those between the ages of 20–60. Symptoms include eye pain, eye redness, floaters and blurred vision, and ophthalmic examination may show dilated ciliary blood vessels and the presence of cells in the anterior chamber. Uveitis may arise spontaneously, have a genetic component, or be associated with an autoimmune disease or infection. While the eye is a relatively protected environment, its immune mechanisms may be overcome resulting in inflammation and tissue destruction associated with T-cell activation.

<span class="mw-page-title-main">Cytomegalovirus retinitis</span> Medical condition

Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the retina of the eye that can lead to blindness. Caused by human cytomegalovirus, it occurs predominantly in people whose immune system has been compromised, including 15-40% of those with AIDS.

<span class="mw-page-title-main">Photopsia</span> Presence of perceived flashes of light in ones field of vision

Photopsia is the presence of perceived flashes of light in the field of vision.

Sympathetic ophthalmia (SO), also called spared eye injury, is a diffuse granulomatous inflammation of the uveal layer of both eyes following trauma to one eye. It can leave the affected person completely blind. Symptoms may develop from days to several years after a penetrating eye injury. It typically results from a delayed hypersensitivity reaction.

<span class="mw-page-title-main">Dilated fundus examination</span> Method of viewing the interior of the eye

Dilated fundus examination (DFE) is a diagnostic procedure that uses mydriatic eye drops to dilate or enlarge the pupil in order to obtain a better view of the fundus of the eye. Once the pupil is dilated, examiners use ophthalmoscopy to view the eye's interior, which makes it easier to assess the retina, optic nerve head, blood vessels, and other important features. DFE has been found to be a more effective method for evaluating eye health when compared to non-dilated examination, and is the best method of evaluating structures behind the iris. It is frequently performed by ophthalmologists and optometrists as part of an eye examination.

<span class="mw-page-title-main">Hypopyon</span> Medical condition with inflammatory cells inside the front of the eye

Hypopyon is a medical condition involving inflammatory cells in the anterior chamber of the eye.

<span class="mw-page-title-main">Intermediate uveitis</span> Medical condition

Intermediate uveitis is a form of uveitis localized to the vitreous and peripheral retina. Primary sites of inflammation include the vitreous of which other such entities as pars planitis, posterior cyclitis, and hyalitis are encompassed. Intermediate uveitis may either be an isolated eye disease or associated with the development of a systemic disease such as multiple sclerosis or sarcoidosis. As such, intermediate uveitis may be the first expression of a systemic condition. Infectious causes of intermediate uveitis include Epstein–Barr virus infection, Lyme disease, HTLV-1 virus infection, cat scratch disease, and hepatitis C.

<span class="mw-page-title-main">Equine recurrent uveitis</span> Eye disease of horses

Equine recurrent uveitis (ERU) – also known as moon blindness, recurrent iridocyclitis, or periodic ophthalmia – is an acute, nongranulomatous inflammation of the uveal tract of the eye, occurring commonly in horses of all breeds, worldwide. The causative factor is not known, but several pathogeneses have been suggested. It is the most common cause of blindness in horses. In some breeds, a genetic factor may be involved.

<span class="mw-page-title-main">Vision disorder</span> Medical condition

A vision disorder is an impairment of the sense of vision.

<span class="mw-page-title-main">Serpiginous choroiditis</span> Medical condition

Serpiginous choroiditis, also known as geographic helicoid peripapillary choroidopathy (GHPC), is a rare, chronic, progressive, and recurrent bilateral inflammatory disease involving the retinal pigment epithelium (RPE), the choriocapillaries, and the choroid. It affects adult men and women equally in the second to seventh decades of life.

<span class="mw-page-title-main">Vogt–Koyanagi–Harada disease</span> Medical condition

Vogt–Koyanagi–Harada disease (VKH) is a multisystem disease of presumed autoimmune cause that affects melanin-pigmented tissues. The most significant manifestation is bilateral, diffuse uveitis, which affects the eyes. VKH may variably also involve the inner ear, with effects on hearing, the skin, and the meninges of the central nervous system.

<span class="mw-page-title-main">Atul Kumar (ophthalmologist)</span> Indian ophthalmologist

Atul Kumar is an Indian ophthalmologist who is currently the Chief & Professor of Ophthalmology at Dr. Rajendra Prasad Centre for Ophthalmic Sciences (RPC-AIIMS), the national apex ophthalmic centre at All India Institute of Medical Sciences, Delhi. He was awarded the Padma Shri award in January 2007 for his services to the medical field. He specializes in vitreoretinal surgery and also heads the Vitreo-Retinal, Uvea and ROP services at RPC-AIIMS.

<span class="mw-page-title-main">Intravitreal injection</span> Method of administration of drugs into the eye by injection with a fine needle

Intravitreal injection is the method of administration of drugs into the eye by injection with a fine needle. The medication will be directly applied into the vitreous humor. It is used to treat various eye diseases, such as age-related macular degeneration (AMD), diabetic retinopathy, and infections inside the eye such as endophthalmitis. As compared to topical administration, this method is beneficial for a more localized delivery of medications to the targeted site, as the needle can directly pass through the anatomical eye barrier and dynamic barrier. It could also minimize adverse drug effects on other body tissues via the systemic circulation, which could be a possible risk for intravenous injection of medications. Although there are risks of infections or other complications, with suitable precautions throughout the injection process, chances for these complications could be lowered.

<span class="mw-page-title-main">Secondary glaucoma</span> Eye disorder

Secondary glaucoma is a collection of progressive optic nerve disorders associated with a rise in intraocular pressure (IOP) which results in the loss of vision. In clinical settings, it is defined as the occurrence of IOP above 21 mmHg requiring the prescription of IOP-managing drugs. It can be broadly divided into two subtypes: secondary open-angle glaucoma and secondary angle-closure glaucoma, depending on the closure of the angle between the cornea and the iris. Principal causes of secondary glaucoma include optic nerve trauma or damage, eye disease, surgery, neovascularization, tumours and use of steroid and sulfa drugs. Risk factors for secondary glaucoma include uveitis, cataract surgery and also intraocular tumours. Common treatments are designed according to the type and the underlying causative condition, in addition to the consequent rise in IOP. These include drug therapy, the use of miotics, surgery or laser therapy.

<span class="mw-page-title-main">Uveitic glaucoma</span> Glaucoma caused by uveitis or its treatments

Uveitic glaucoma is most commonly a progression stage of noninfectious anterior uveitis or iritis.

References

  1. 1 2 "Uveitis: Symptoms, Causes, Treatment & Types". Cleveland Clinic. Archived from the original on 2023-02-05. Retrieved 2023-02-05.
  2. 1 2 3 4 5 "Panuveitis". eyewiki.aao.org. Archived from the original on 2023-02-05. Retrieved 2023-02-05.
  3. 1 2 3 4 Bansal, Reema; Gupta, Vishali; Gupta, Amod (2010). "Current approach in the diagnosis and management of panuveitis". Indian Journal of Ophthalmology. 58 (1): 45–54. doi: 10.4103/0301-4738.58471 . ISSN   0301-4738. PMC   2841373 . PMID   20029145.
  4. Anjum, Zauraiz; Tariq, Zemal; Anjum, Zauraiz; Tariq, Zemal (2019-09-06). "Non-infective Unilateral Panuveitis: Topical Steroids and Posterior Vitrectomy as a Cheap and Safe Alternative to Modern Treatment Modalities". Cureus Journal of Medical Science. 11 (9): e5587. doi: 10.7759/cureus.5587 . ISSN   2168-8184. PMC   7053792 . PMID   32181063.
  5. "Panuveitis". rarediseases.org. National Organization for Rare Disorders. 2022-06-16. Archived from the original on 2023-02-05. Retrieved 2023-02-05.