The problem of diagnosis and treatment of autoimmune diseases is particularly relevant in the modern world. Their prevalence is growing every year, and methods that can completely cure patients have not been developed. A characteristic feature of these diseases is consistency. They rarely affect a single organ. Various systems of the body are involved in the pathological process directed against their own cells and tissues. The organ of vision is no exception. Lesions of the choroid of the eye or uveitis, is a frequent companion of various autoimmune processes.
In this article, we will look at exactly why uveitis develops in such patients, how it manifests itself and how to treat it.
- What is uveitis?
- Why it occurs in autoimmune diseases
- Main symptoms
- How it is diagnosed
- How is it treated
- Which doctor should I contact
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What is uveitis?
In a narrow sense, uveitis is an inflammation that occurs directly in the choroid of the eye, in a broader sense-any intraocular inflammation. The reasons are diverse. These may include infections, toxic effects, autoimmune and allergic reactions, endocrine disorders, eye injuries, etc.
The choroid of the eye is located between the outer capsule of the eye and the retina, so it is also called the middle one. It consists of the anterior part – the iris, the ciliary body and the posterior-represented by the vascular membrane itself. These structures can be involved in the pathological process together or separately. Accordingly, anterior, posterior and generalized uveitis are distinguished.
Why it occurs in autoimmune diseasesAntigens and immune complexes settle on the choroid of the eye, are fixed there and initiate inflammation
The special structure and functioning of the choroid leads to its defeat in systemic diseases:
- rheumatoid arthritis;
- Reiter's syndrome;
- ankylosing spondylitis;
- non-specific ulcerative colitis;
- psoriasis, etc
The following points play a particularly important role in these processes::
- rich blood supply;
- multiple vascular ramifications and anastomoses;
- slow blood flow;
- lack of normal lymph outflow;
- participation of vascular endothelial cells and retinal pigment epithelium in immune responses.
This creates conditions for the deposition and fixation of various antigens and immune complexes in the choroid, which easily penetrate the vessels of the eye, accumulate in the choroid and trigger a local inflammatory reaction there, having a damaging effect on the surrounding tissues. With inflammation in the eye, uveitogenic antigens begin to be released, which further worsens the situation.
Also, the choroid of the eye can act as a depot of immunoactive cells and under certain conditions becomes the center of immune responses. It stores memory cells for a long time, represented by t-and b-lymphocytes. They can be activated:
- due to extraocular stimulation;
- due to molecular mimicry, in which the infectious agent (chlamydia, shigella, yersinia) has the same antigenic determinants with the host cells.
Recognizing its own cells as foreign substances, the body begins to produce antibodies to them.
Uveitis in an autoimmune disease can occur secondarily against the background of already existing signs of damage to various organs and systems. Such persons should be periodically examined by an ophthalmologist to avoid missing the onset of the disease. But in some cases, the autoimmune process debuts from the signs of uveitis, or patients simply do not pay attention to their existing other symptoms. Therefore, when uveitis is initially detected, it is necessary to exclude systemic diseases in the patient.
Uveitis can start acutely or imperceptibly for the patient. Clinically, it manifests itself in the following signs::
- pain in the eye radiating to the corresponding half of the head;
- pain on palpation of the eyeball;
- his redness;
- photophobia and lacrimation (corneal involvement);
- "fog" or "floating flies" in front of your eyes;
- reduced visual acuity;
- constriction and immobility of the pupil;
- curvature of objects.
With various autoimmune diseases, the patient may be disturbed:
- joint pain;
- they have restricted movement;
- skin rash;
- headaches, etc.
During the examination, the doctor reveals the characteristic signs of inflammation of the choroid:
- pericorneal injection (hyperemic vessels in the form of a pink-cyanotic ring around the limb);
- swelling, thickening of the iris and constriction of the pupil;
- changing the color of the iris (dirty green, rusty hue);
- non-granulomatous precipitates (deposition of small pigment particles glued together by fibrin on the posterior surface of the cornea);
- adhesions of the pupillary edge of the iris with the lens;
- edema of the macular area of the retina and optic disc;
- accumulation of exudate in the ciliated body;
- hypopion (accumulation of pus in the anterior chamber of the eye, which due to gravity settles in its lower part).
How it is diagnosedIf uveitis is suspected, a full eye examination is performed, including ophthalmoscopy
The diagnosis of uveitis is made by a doctor based on the patient's complaints, medical history, and objective data. Its presence should be excluded in all persons suffering from autoimmune diseases. The examination plan includes an optometrist's examination and additional diagnostic methods:
- determination of visual acuity and fields;
- measurement of intraocular pressure;
- external eye examination;
- direct and reverse ophthalmoscopy;
- fundus biomicroscopy using a three-mirror lens;
- fluorescent fundus angioscopy;
- laboratory tests (blood and urine tests).
How is it treated
Treatment of patients with uveitis regardless of their etiology sent:
- to eliminate signs of inflammation;
- preserving or restoring visual functions;
- if possible, prevent complications and relapses of the disease.
The scope of activities carried out depends on the activity and severity of the process, its prevalence and nature. But it is possible to distinguish general principles of providing assistance to such patients:
- use of immunosuppressive drugs-corticosteroids (methylprednisolone) and cytostatics (methotrexate, azathioprine, cyclophosphamide) in severe inflammation;
- oral administration of nonsteroidal anti-inflammatory drugs (meloxicam, diclofenac, acyclofenac);
- use of angioprotectors (anginin, parmedin, vitamin P) and neurotrophic agents (sermion, cerebrolysin, cavinton);
- topical use of corticosteroids (dexamethasone) and NSAIDs (diclofenac) in the form of eye drops and retrobulbar injections;
- instillation of adrenomimetics (phenylephrine) and cholinolytics (cyclopentolate)into the conjunctival sac;
- enzyme therapy (performed by electro-and phonophoresis, installation of drops, injections under the conjunctiva and parabulbar).
In complicated treatment of uveitis (secondary glaucoma, cataract, hemophthalmos, retinal detachment), conservative therapy is supplemented by surgical methods.
Which doctor should I contactTreatment of autoimmune uveitis is primarily aimed at reducing inflammation. For this purpose, glucocorticoids or cytostatics are prescribed
If signs of uveitis appear, you should consult an ophthalmologist. After examination and treatment, the doctor may assume a systemic nature of the disease. In this case, the doctor will refer the patient to a rheumatologist, gastroenterologist, or dermatologist.
The prognosis for uveitis associated with an autoimmune disease depends on the severity of the latter, the timeliness of diagnosis,and the adequacy of therapy. Against the background of treatment, most patients manage to achieve good results and achieve remission. But if uveitis is detected at the stage of complications, then this threatens the patient with vision loss.