Panuveitis (Diffuse Uveitis): Causes, Symptoms, Diagnosis, and Treatment

By: Mohan Garikiparithi | Eye Health | Friday, March 09, 2018 - 02:00 PM

panuveitisPanuveitis or diffuse uveitis is part of a group of diseases that affect the part of the eye called the uvea. Sadly, it can lead to vision loss.

Uveitis that impacts all regions of the uvea, including the iris, ciliary body, and choroid is the best panuveitis definition. Panuveitis is actually one of four types of uveitis. There is anterior uveitis, intermediate uveitis, and posterior uveitis. The type is dictated by which part of the uvea is involved. With panuveitis, surrounding eye structures including the lens, optic nerve, and retina can be affected.

Uveitis essentially means someone has inflammation of the uvea. The uvea is a pigmented layer that encloses and protects the eyeball. It is made up of thick, fibrous tissue.

What Are the Causes, Symptoms, and Complications of Panuveitis?

Sometimes panuveitis causes can be hard to pinpoint. For instance, there are situations where the cause remains unknown. This is referred to as idiopathic panuveitis uveitis. Still, there are common causes of panuveitis, including infectious and non-infectious causes listed here.

Infectious causes

  • Bacteria that cause tuberculosis, Lyme disease, and other infections
  • Fungi that leads to histoplasmosis
  • Viruses that cause herpes infection, cytomegalovirus retinitis, and AIDS
  • Parasites causing toxoplasmosis

Non-infectious causes

  • Vogt-Koyanagi-Harada syndrome, which is a disease that impacts multiple body systems.
  • Sympathetic ophthalmia, which occurs following trauma to the eye
  • Behcet’s disease that creates blood vessel inflammation throughout the body
  • Sarcoidosis, which is an inflammatory disease impacting various organs
  • Inflammatory bowel diseases
  • Allergies
  • Malignancies, such as large cell lymphomas
  • Autoimmune conditions like lupus, psoriasis, and rheumatoid arthritis

As you can imagine, panuveitis symptoms vary from one person to the next. For some individuals, the condition is acute (short-term) and others experience chronic (long-term) uveitis.

The following are typical panuveitis symptoms:

  • Eye pain and inflammation
  • Floaters or small specks in the field of vision
  • Photophobia or light-sensitivity
  • Eye redness
  • Blurred vision

Usually, both eyes are affected and getting an early diagnosis can be important since this enables a doctor to make the most accurate diagnosis in terms of the type of uveitis. When people first show signs of uveitis, their symptoms are usually unaffected by any interventions, giving doctors a truer picture of what is happening.

It’s unfortunate, but there are complications with panuveitis uveitis.

  • Glaucoma
  • Cataracts
  • Retinal detachment
  • Cystoid retinal edema (retina swelling)
  • Permanent blindness

Also read: Getting rid of eye floaters: Home remedies and exercise

How to Diagnose Panuveitis

Determining whether or not there is an infectious or non-infectious cause involved is important in the diagnostic process. Medical experts diagnose panuveitis using a number of different approaches. The first step is a physical exam and analyzing previous medical history. Below we outline some other tests and procedures that are used.

  • General eye examination
  • Fundoscopic examination
  • Visual acuity test
  • Slit-lamp exam – examines the structure of the eye using a special lamp
  • Tonometry – measures intraocular pressure in the eye
  • Fundus fluorescein angiography (FFA) – an eye blood vessel exam
  • Fundus autofluorescence (FAF) – an invasive exam using fluorescent dye
  • Indocyanine green angiography (ICG) – a test that examines the blood vessels of the choroid using dye.
  • B-scan ultrasonography – a special ultrasound scan of the eye
  • Electroretinogram (ERG) – measures electrical activities in the retinal cells
  • Optical coherence tomography (OCT) – a radiological imaging test that looks at eye structure.
  • Blood test – these include checking for antibodies in blood, as well as infections

There are situations where certain signs and symptoms prompt a doctor to order other tests, such as a chest X-ray, MRI scan of the brain, or a lumbar puncture, which is a procedure that involves taking fluid from the spine in the lower back by using a hollow needle.

Treatment Options for Panuveitis

There are a few different objectives for panuveitis treatment: to prevent vision complications, to relieve discomfort, and to address the underlying cause. Think of it as a four-step approach that includes diagnosis and treatment of the specific cause, nonspecific treatment, treatment of any related conditions, as well as supportive therapy.

Here’s a look at some specific treatment options:

  • Corticosteroids: These inhibit inflammation, but the type and dose depend on the severity of the condition. Often times, when corticosteroids are prescribed and symptoms have improved, a lower maintenance dose will be suggested. In cases where the uveitis recurs, the frequency of topical drops is increased, raising the oral corticosteroids to the initial high-dose levels. Corticosteroids are not without side effects though. Those potential side effects include secondary glaucoma and infection.
  • Immunosuppressive agents: This is an option when corticosteroid therapy isn’t sufficient. They have a tendency to kill lymphocytes, which cause inflammation. They should be used only after infectious agents have been ruled out as the cause of the uveitis. Before any immunosuppressive drug is prescribed, the patient goes through blood tests as well as a liver and renal function evaluation. As is the case with most drug therapies, there can be side effects with immunosuppressive agents, which is something that should be discussed with a doctor.
  • Supportive therapy: Cycloplegics, in the form of eye drops, can relieve pain, particularly due to ciliary spasm. Ciliary spasm is when the eye is in a constant state of contraction.

Prevention and Prognosis of Panuveitis

While it can be hard to prevent panuveitis uveitis, you can lower your risk by avoiding contact with people who have infections. Taking steps like wearing protective eye gear if you do industrial work or play aggressive sports is also a good idea since it can reduce the chances of eye trauma. Treating any underlying infections or immunologic conditions as early as possible is another way to prevent panuveitis.

If you have been diagnosed with the condition, it is important to maintain long-term follow-ups with your doctor so that they can watch out for any signs of recurrence.
The prognosis for panuveitis uveitis largely depends on the underlying cause, the time of the diagnosis, and how quickly treatment is administered. A late diagnosis can be further complicated by side effects due to therapies like corticosteroids.

Research shows that in about 20 percent of cases, the cause of panuveitis uveitis is undetermined. Studies also show that panuveitis can begin as anterior or posterior uveitis then the inflammation spreads to include all intraocular structures.

In cases where the symptoms of panuveitis uveitis are not severe and there are no complications, people usually respond really well to treatment and the chance of vision loss is low.

If you or someone you care about has any of the symptoms we have outlined, there should be no hesitation—medical attention should be sought immediately to assess the eyes.

Related:

Uveitis, autoimmune eye disease linked to gut bacteria and smoking

Red bloodshot eyes: Causes and cures


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What causes burning eyes and how to get rid of it

Scleritis (inflammation of the white of the eye) causes, symptoms, and treatment

Sources:

https://nei.nih.gov/health/uveitis/uveitis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841373/
https://books.google.co.in/books?id=IfNeCwAAQBAJ&pg=PA563&dq=Panuveitis&hl=en&sa=X&ved=0ahUKEwjNj_ubstnZAhUX57wKHQMZCtUQ6AEIKzAB#v=onepage&q=Panuveitis&f=false

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