Uveitis

Technically speaking, uvea is the collective term for the three different elements that form the pigmented tissue of the eye: the iris, ciliary body, and choroid. These tissues are joined together throughout the eye, and together they are known as the uveal tract.

Uveitis is the general name given to any inflammation that strikes the uvea. Such an inflammation can be blinding. While it normally strikes young adults or middle-aged people, it can happen at any time in life.

While uveitis is a general term, there are more specific ones. An inflammation that strikes the iris is called iritis. When it hits the ciliary body it is cyclitis. If the choroid is targeted, the result is choroiditis.

If the inflammation hits two areas, the names are combined. Iridocyclitis, for example, is an inflammation of the iris and the ciliary body, and chorioretinitis is an inflammation of the choroid and retina. If the entire eye is inflamed, it is called panuveitis.

There are numerous causes for the different types of uveitis. They include injuries; infections such as tuberculosis, herpes, and syphilis; illnesses such as chronic intestinal diseases and juvenile rheumatoid arthritis as well as other forms of arthritis; and problems with the immune system that cause the body to attack its own healthy tissues.

There is one common form of uveitis that mothers pass on to their unborn babies. It is caused by a parasite called toxoplasma that is found in cat feces. A pregnant woman can pick up the parasite by cleaning out a cat's litter box or by coming in contact with contaminated soil. The infection is then passed to the fetus.

When examining patients with uveitis, doctors usually look for a disease in another part of the body—such as an infection or arthritis—to determine if the eye inflammation is a side effect. Sometimes uveitis is the first—and occasionally the only—indication that something else is wrong. Treating the primary disease may lead to an improvement of the eye problem. Then again, it may not. In any event, doctors normally run a series of laboratory tests and take x-rays to rule out any contributing factor in patients with uveitis.

The symptoms of uveitis can include blurry vision, red eyes, photophobia (sensitivity to light), floating spots, and pain or an aching feeling around the eyes. Not everyone suffers all the symptoms, and some patients suffer no symptoms at all during the early stages.

Children with juvenile rheumatoid arthritis are in the high-risk category for uveitis. They are also among those victims very likely not to show any obvious symptoms of uveitis in the early stages. They should have their eyes checked on a regular basis.

As with other diseases, the earlier uveitis is spotted and treated, the better the chances are for a full recovery with no permanent loss of vision. Untreated uveitis can lead to a large number of even more serious eye problems such as cataracts, glaucoma, and damage to the retina, cornea, and optic nerve. Even though some forms of uveitis cannot be cured, prompt treatment can prevent further damage.

The most common treatments for uveitis involve antibiotics and other drugs that suppress inflammation, such as cortisone and anti-cancer drugs. Sometimes the doctor will dilate the pupil of the affected eye, or eyes, during this treatment. While this may temporarily blur vision, it also reduces pain and lessens the chances of further damage.

Scleritis

Like uveitis, scleritis is an inflammation. But as its name suggests, scleritis hits the sclera, the white part of the eye. It is accompanied by a deep, throbbing pain and redness.

A person may develop scleritis by itself, but it may also be a side effect of other conditions, such as rheumatoid arthritis. Scleritis is usually treated with anti-inflammatory drugs, either eyedrops or medication that can be swallowed. If untreated it can lead to thinning—or even perforation—of the sclera.

Keratitis

When the cornea is inflamed, it's called keratitis. It's also called a serious problem. Keratitis is a leading cause of blindness throughout the world.

The symptoms can include any or all of the following: a loss of sharpness of vision, redness, watery eyes, and a feeling that there's something in your eyes even when you know there isn't. One of the most common forms of keratitis is caused by the herpes simplex virus, the same one that causes cold sores around your mouth. One of the simplest ways to give yourself herpes keratitis is to rub your eyes right after scratching a cold sore.

Another common cause of keratitis is contact lenses. If you wear contact lenses and develop any sort of eye problem, stop wearing them until you can check with your doctor. Keratitis is usually treated with medicated eyedrops.

Using Eyedrops Correctly

There are two problems with using any sort of eyedrops: getting them into the eye and getting them to stay in the eye long enough to do you some good.

Both problems are easy to solve—once you know how And learning how is also easy, if you're willing to practice.

Since nonprescription eyedrops are not very expensive, you might want to buy a bottle and practice using them property when there isn't an emergency. That way, you'll be ready to handle a real problem if it arises.

First let's practice getting the drops in the eye. The process is simple when you follow these steps.

1. Either lie down or sit down with your head tilted back and hold the open squeeze bottle a few inches above your eye. Use your other hand to pull the lower eyelid down so you don't blink when—or just before—the drops hit your eye.
2. Squeeze a drop or two inside your lower eyelid.
3. Close your eyes.

Now that you have the drops in your eye, you have to keep them there. The natural reaction is to open the eye as soon as the drops are in. But that lets the drops drain away before they can do your eye any good. Try one of these two techniques instead.

• Keep your eyes closed for 2 minutes.
• Place your finger at the point where the upper and lower eyelid meet near the nose and hold it there for a few minutes. Try not to blink. This blocks the passageway to the tear drainage ducts leading to the nose. It also allows drops to penetrate into the eye and prevents them from getting into the bloodstream.

Endophthalmitis

Endophthalmitis is a devasting but rare type of infection that can develop inside the eye after a serious eye injury or eye operation. Sometimes, however, it will develop for no known reason.

Endophthalmitis is a medical emergency that must be diagnosed and treated rapidly. An infection inside the eye can destroy the delicate retinal tissue within a matter of hours. When it does occur, the doctor must take a culture from the fluid inside the eye to identify the infecting microbe. Then an appropriate antibiotic must be administered for several days. The antibiotic may be given as eyedrops or intravenously. Sometimes it must be injected directly into the eye. It may sound like a drastic measure, but it's not nearly as drastic as blindness.

Fortunately endophthalmitis is a rare condition.

Yellow Eyes (Jaundice)

If the whites of your eyes are turning into the yellows, you probably have jaundice. That usually means a liver disease.

The yellow tint to your eyes—and to the rest of your body—is produced by excess production of a red-yellow pigment called bilirubin. When your liver is working properly, bilirubin is safely gotten rid of.

Jaundice can be the result of a number of different conditions, including all types of hepatitis, cirrhosis of the liver, a bile duct blockage, and certain types of anemia. Some medications can also trigger it. The only way you can get the yellow out of your eyes permanently is to get the problem causing the jaundice out of your body.

Graves' Disease

Graves' disease, also known as thyroid eye disease, isn't really an eye disease at all. It's an eye socket disease that affects the eyes.

It starts in the eye socket, or orbit—the bony cavity that holds the eye. The tissue inside the socket becomes enlarged, forcing the eyes to move over to make room. As an added complication, the muscles that move the eyes can become swollen and may not function properly.

With some people, the eyes are thrown out of alignment by the increased pressure. This can cause crossed eyes and double vision. For others, the eyes are just pushed out a bit farther, giving the patient protruding eyes and a very wide-eyed or "pop-eyed" look. While many people consider this condition to be a disfigurement, a number of actors and actresses, such as Marty Feldman, Eddie Cantor, Peter Lorre, and Bette Davis, managed to use their bulging (exophthalmic) eyes to help develop and enhance their acting and comedic skills.

People with bulging eyes sometimes also develop abnormally large eyelid openings. This means that the eyelid has more eye to clean, bathe, and cover when it blinks.

Sometimes there is a part of the eye just below center—the exposure region—that the eyelids just can't cover. This can cause the cornea to become dry and lead to eventual scarring and vision loss.

The Medication Dilemma

A dilemma is a situation in which the right answer to a question can also be the wrong one. Take, for example, medication.

Sometimes medication is the patient's best friend. Other times it's the worst enemy. And often neither you nor your doctor will know which it will be in your case until it's been tried.

Doctors prescribe eyedrops to clear up eye problems, but sometimes they can make matters worse. Most eyedrops are meant to be used for brief periods. When they are used for weeks or months, allergies or toxicity can develop. But sometimes that new problem is seen as a continuation or worsening of the original problem the eyedrops were meant to cure instead of a new problem caused by the medication itself. So the medication may be continued—or even increased—in a vain attempt to clear up the problem.

That's why it is so important to reevaluate treatment periodically. After all, if you're faced with a question to which the right answer might also be the wrong answer, sometimes the best thing you can do is ask a different question.

Regardless of how Graves' disease makes a person's eyes look, the condition can also cause increased pressure in the eyes themselves, which in turn can damage the optic nerve.

Graves' disease can hit one or both eyes and can affect each eye to a different degree. It also tends to hit women more than men.

Most—but not all—people who develop the condition have a history of an overactive thyroid gland. Graves' disease can develop years after the thyroid condition has been treated and taken care of. Why? No one knows.

We also don't know why it often lasts a year or two and then disappears—returning the eyes to their normal condition and position. Some people respond well to medication. Some don't. Others are cured without the benefit of any treatment whatsoever.

The main complaint of some people with the condition is swollen eyelids. One way to help this is to elevate the head of the bed about 6 inches. This puts gravity to work reducing the accumulation of fluid in the eyelids during the night.

For the self-conscious person with slightly protruding eyes, lightly tinted glasses will make it harder for people to notice the problem. If you already wear eyeglasses, you can have another pair made with a light tint added. If you don't need prescription glasses, you can get a pair of tinted lenses without any prescription at all.

If the eyes protrude so much that the cornea is becoming dry, you can use a soothing ophthalmic ointment at night and "artificial tears" during the day.

In cases where a great deal of the cornea is being exposed, a surgeon might put a stitch or two at the corners of the eyelids to prevent the eyes from opening all the way. This is usually a temporary measure to prevent damage to the cornea.

In extreme cases where a person's sight is at stake, cortisone tablets are prescribed to reduce the pressure on the optic nerve and other vital ocular structures. A surgeon might also have to remove some of the bony wall lining the eye socket to give the swollen tissue a place to safely expand until the swelling can be brought under control. When this procedure is performed, the bony areas below the eyes—toward the nose—are usually the ones chipped away so that the swollen tissue can expand into the sinus cavities. Radiation therapy is sometimes used instead of surgery, but the results are usually slower and less predictable.

Some surgery might be required even after the condition is cured. If the eye muscles have been thrown permanently out of alignment by the disease, they might have to be realigned to uncross the eyes or correct double vision. Surgery might also have to be performed on the eyelids to remove excess skin or tissue or readjust their height.

No matter what treatment—if any—is needed to correct the eye problems stemming from thyroid eye disease, the patient's thyroid must also be monitored.

AIDS-Related Eye Diseases

Thanks to new discoveries and treatments, patients with acquired immune deficiency syndrome (AIDS) are living longer. But many of them are also going blind.

Recent developments in AIDS treatment have allowed patients to live longer, and doctors are seeing more effects of the deadly AIDS virus on the eyes. AIDS patients have a compromised immune system, and have difficulty defending themselves against even minor infections. As a result, certain eye infections that will not threaten the sight of healthy people can blind an AIDS patient.

The most common cause of blindness among AIDS sufferers is cytomegalovirus (CMV) retinitis, a progressive disease that destroys the retina. Foscarnet (trisodium phosphonoformate) is a relatively new drug developed in France that has been proven effective against CMV in a number of clinical tests. Another promising drug is Gancyclovir.

As doctors learn more about AIDS and how it can affect the eyes, many of them are advising people who have been exposed to the virus to have their eyes checked every two or three months.

Dry Eyes

When your eyes are dry and itchy, it usually means that you're not producing enough of the right kind of tears, the kind that lubricate your eyes.

Normally there is a slow, steady production of tears that flow evenly over the eye from top to bottom. This lubricating "basal" tear secretion comes from tear glands located just above the eyes or in the upper conjunctiva. They are known as the lacrimal glands and accessory lacrimal glands. (There is also a "reflex" tear secretion, which enables you to produce tears when you see Bambi's mother die—or when there is sand or a fist in your eyes.)

Without basal tear lubrication, the whites of your eyes can become dry, bloodshot, and just plain sore. That's because your tears are more than just water. They are actually complex substances that form three different layers of protection across the eyes.

The outer layer is an oily liquid that spreads out over the entire surface of the eyes and helps prevent the watery layer of tears beneath it from evaporating too fast. The oily layer is produced by small glands at the edge of the eyelids called the meibomian glands. If these oil glands are plugged up, you may develop a chalazion.

The watery layer, which is what we normally think of when we say tears, is beneath the oily layer. Produced by the small glands in the upper conjunctiva as well as the large lacrimal glands—the major tear glands—this watery layer keeps the eyes moist and clean and washes away most irritants and foreign particles such as sand or pollen.

Closest to the eye itself is the mucin layer. This mucin, which is produced by cells in the conjunctiva known as goblet cells, spreads the tears evenly over the entire surface of the eye and helps hold the watery layer in place. Without it, the watery layer would break up quickly, leaving dry spots on the surface of the eye.

Most cases of dry eyes are caused by a lack of watery tears. There are many reasons for this lack. Medications such as antihistamines and diuretics can be responsible. Two other common causes are a lack of moisture in the air and old age. As the body gets older, tear production decreases. Vitamin A deficiency also can cause severe dry eyes; a lack of this nutrient is a leading cause of blindness in less-developed countries.

Sjögren's syndrome is characterized by dry eyes, dry mouth, and an autoimmune disease, especially rheumatoid arthritis. An inflammation of the tear-producing glands and the salivary glands can reduce tear production as well as cause dryness in the mouth, nose, and throat. Rheumatoid arthritis or lupus also often accompany the condition. Sjögren's syndrome is considered an autoimmune disease, one in which the body's immune system attacks the moisture-producing glands as well as the joints.

While dry eyes can affect men or women at any age, the most likely victim is a woman either at or past middle age.

While you can probably figure out for yourself if you have dry eyes—the dry, scratchy sensation should be the first clue—you might not be able to tell what's causing it. An ophthalmologist can.

If the dry eyes are caused by a temporary condition—a visit to the desert, a long flight in an airplane, a reaction to a drug—the condition should disappear when the reasons for it do. But most people with dry eyes have the problem all their lives.

Drugs That Can Cause Dry Eyes

The American Academy of Ophthalmology says the following drugs can cause dry eyes. If you already have dry eyes, these medications can make the condition even worse. The drugs are listed here by their generic names, but brand names may be different, so check with your doctor or pharmacist if you are concerned about a particular drug that has been prescribed for you.

If you are taking one of these drugs for only a short time, using artificial tears while you are on the drug should take care of your dry eye problem. If, however, you are taking one of them on a long-term basis, talk it over with your doctor.

• Acetophenazine
• Chlorpheniramine
• Amitriptyline
• Chlorpromazine
• Antazoline
• Clemastine
• Atropine
• Cyroheptadine
• Azatadine
• Dexbrompheniramine
• Belladonna
• Dexchlorpheniramine
• Beta blockers
• Diethazine
• Brompheniramine
• Dimethindene
• Carbinoxamine
• Doxylamine
• Carphenazine
• Ethopropazine
• Chlorisondamine
• Fluphenazine
• Hexamethonium
• Homatropine
• lmipramine
• Isoretinoin
• Mesoridazine
• Methdilazine
• Methotrimeprazine
• Methscopolamine
• Methyldopa
• Methylthiouracil
• Metoprolol
• Morphine
• Nitrous oxide
• Nortriptyline
• Oxprenolol
• Perazine
• Periciazine
• Perphenazine
• Pheniramine
• Piperacetazine
• Practolol
• Prochlorperazine
• Promazine
• Promethazine
• Propiomazine
• Propranolol
• Protriptyline
• Pyrilamine
• Scopolamine
• Tetrahydrocannabinol (THC)
• Thiethylperazine
• Thiordazine
• Thirpropazate
• Trichloroethylene
• Trifluoperazine
• Trifupromazine
• Trimeprazine
• Tripelennamine
• Triprolidine

The most common solution for the lack of the liquid is a solution of the liquid you lack—artificial tears. There are numerous brands of artificial tears available, and you don't need a prescription. Try several different ones and then stick with the one you like best. You may use them as often as necessary; once or twice a day, once or twice an hour—whatever helps.

Another way to help alleviate the condition is to keep your surroundings from being too dry. Use a humidifier to add moisture to your home. When you go outside on a dry day, wear wraparound sunglasses to prevent the moisture in your eyes from evaporating. And if you use a hair dryer, aim it at your hair, not your eyes.

You can also try various ointments, especially at night when the ointment film won't disturb your vision too much. One application of lubricating ointment before bed has more staying power than several drops of tears, and you won't have to get up during the night to put more in.

Your doctor may suggest sealing the tear drainage to prevent the tears that are produced from draining away too fast. Because the tears leave the eyes through the tiny openings at the inner lid margins and then flow down into the nose, closing off their escape route to help keep your eyes moister longer can be done on either a temporary or permanent basis.

Whatever the approach, the important thing is to reduce the dryness and irritation so that your eyes are once again moist and "see-worthy."

Eric Rost

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