Oral Immunosuppression for Uveitis

What is Oral Immunosuppression for Uveitis?

Ocular inflammation refers to swelling and inflammation of the eye tissue. The part of the eye that is commonly affected is the middle layer of the eye known as the uvea. Inflammation of the uvea is known as uveitis.

If the underlying cause of uveitis is said to be an autoimmune disease, then oral immunosuppressants are employed as a treatment option. An autoimmune disorder is a medical condition in which your body’s immune system mistakenly attacks and destroys healthy body tissue. Immunosuppressants are a class of medications which inhibit the immune system and disrupt inflammation by suppressing the overreactive immune system from causing damage to the host, as in hypersensitivity or autoimmunity.

Causes of Uveitis

Uveitis is triggered by an inflammatory reaction inside the eye. Inflammation is the natural reaction of the body to germs, toxins, or tissue damage. Inflammation causes redness, warmth, swelling, and destruction of tissues as certain white blood cells migrate to the affected region of the body to suppress or destroy the insult.

Uveitis may be caused by:

  • Eye trauma
  • Infections
  • Cancer (a rare occurrence)
  • Inflammatory disorders 
  • Autoimmune disorders

Some of the autoimmune or inflammatory diseases that may trigger uveitis include:

  • Systemic lupus erythematosus
  • Ankylosing spondylitis
  • Sarcoidosis
  • Crohn’s disease
  • Psoriatic arthritis
  • Rheumatoid arthritis
  • Behcet's disease (BD)
  • Vogt-Koyanagi-Harada (VKH) disease

Signs and Symptoms of Uveitis

Characteristic signs and symptoms of uveitis include: 

  • Eye pain
  • Eye redness
  • Sensitivity to light
  • Blurring of vision
  • Dark spots or floaters in your vision field
  • Decreased vision

Diagnosis of Uveitis and Ocular Inflammation

A diagnosis of uveitis would be based on your signs and symptoms, a complete eye examination, blood tests, analysis of fluid from the eye, specialized photography to evaluate retinal blood flow, and the presence or absence of fluid within the eye.

Complications of Uveitis if Left Untreated

If left untreated, uveitis can cause complications, such as:

  • Vision loss
  • Macular oedema
  • Retinal detachment
  • Scarring of the cornea
  • Cataract formation
  • Glaucoma
  • Optic nerve damage

Oral Immunosuppression Treatment for Uveitis

To treat uveitis corticosteroid medication is usually recommended. These medications can have side effects and may not be effective in treating the inflammation, so your doctor may prescribe Immunosuppressants either alone or in combination with steroid therapy.

Immunosuppressants usually take a few weeks to take effect. Your doctor will start treatment with a high dose of corticosteroids to control symptoms and then gradually taper the dose down as the immunosuppressants become effective.

The immunosuppressive drugs most commonly utilized as a treatment for uveitis include azathioprine, methotrexate, chlorambucil, and cyclophosphamide. Your doctor will choose the medication that is most appropriate for you based on various factors such as its efficacy, side effects, and ease of administration.

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