Uveitis and Glaucoma
Chat Highlights
June 16, 2004

Norma Devine, Editor

On Wednesday, June 16, 2004, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Uveitis and Glaucoma."

Moderator:  Good evening, Dr. Wilson.  Congratulations on receiving recognition for this chat room and support group at the meeting of the Association of International Glaucoma Societies.  

Dr. Rick Wilson:  Good evening, everyone. Thanks, but we all achieved it together.  The Chairman of the Patient Support Committee commended us for being at the forefront of glaucoma virtual patient support groups.  As I remember, he said we were the best in the world.

P:  I don't think there's another such chat room in cyberspace.  We are all grateful for it, Dr. Wilson.

Dr. Rick Wilson:  I provide the knowledge and you provide the support.  Any questions about tonight's topic, uveitis?

P:  Yes.  What is it?

Dr. Rick Wilson:  Uveitis is an inflammation of the uvea, the middle coat of the eye.  It includes the iris and the ciliary body, the part that makes aqueous.  Fifty percent of the time we never find out what is causing the inflammation.

P:  What is the cause the rest of the time?  

Dr. Rick Wilson:  Autoimmune disease and infections, such as toxoplasmosis or syphilis, are the main causes.

P:  What are the symptoms of uveitis?

Dr. Rick Wilson:  Red eye, eye ache, hazy vision

P:  How is uveitis graded? 

Dr. Rick Wilson:  Usually, we grade uveitis in the anterior chamber from 0 to 4, depending upon both the leakage of serum from diseased vessels into the clear watery aqueous of the eye, and upon the amount of white cells in the front of the eye.

Moderator:  Does uveitis always lead to optic nerve damage?

Dr. Rick Wilson:  Uveitis, itself, does not lead to optic nerve damage.  The inflammation damages the lens in the eye and can cause cataracts.  It damages the part of the eye that makes the fluid, can cause chronic low pressure, and can damage the retina.  The optic nerve is not commonly affected.

P:  Is iritis inflammation of the iris?

Dr. Rick Wilson:  Yes, and since the iris is part of the uvea, iritis is a form of uveitis.

P:  If a patient has uveitis and must take steroids, how is that handled?  

Dr. Rick Wilson:  Uveitis is treated with topical steroid drops if the inflammation is in the front of the eye.  It is treated with steroid shots or pills if it is serious and in the back of the eye.

P:  Is uveitis an infection?

Dr. Rick Wilson:  No, uveitis can be caused by an infection, but it is not an infection.  It is an inflammation of the uvea.

P:  Could blepharitis lead to uveitis?

Dr. Rick Wilson:  No.

P:  Is uveitis worse for glaucoma in the aphakic eye (no internal lens) than in an eye with either a natural lens or a lens implant?

Dr. Rick Wilson:  Uveitis is most worrisome in someone with a lens implant.  The lens implant is a foreign body in the eye, which in itself can sometimes cause inflammation.

Moderator:  Can blepharitis lead to uveitis?

Dr. Rick Wilson:  To my knowledge, the only kind of blepharitis that might lead to uveitis is viral.

P:  Can pink eye turn to uveitis?

Dr. Rick Wilson:  The common pink eye is caused by an infection.  However, uveitis causes a pink eye, as the inflammation causes dilation of the vessels on the surface of the eye.

P:  Do uveitis and glaucoma go hand in hand? Can you have uveitis without glaucoma?

Dr. Rick Wilson:  Absolutely.  Among the first things that happens with inflammation in the eye is the elaboration of prostaglandins.  That increases the outflow of the eye through the uveal scleral mechanism six times, which causes the intraocular pressure (IOP) to drop.  It is only after the serum leaking from the iris vessels causes the aqueous to get thicker and the white cells to block up the trabecular meshwork that the IOP rises.

P:  What does "elaboration" of prostaglandins mean?

Dr. Rick Wilson:  The eye makes prostaglandins in response to inflammation.

P:  Quite a while ago, someone here mentioned a treatment for uveitis, a drug that had an "X " in its name.  I got the impression it was not a steroidal type drug.  Any ideas?

Dr. Rick Wilson:  Lotemax?

P:  Do steroid shots to the back of the eye tend to raise IOP?  What about in aphakic eyes?

Dr. Rick Wilson:  In both types of eyes, phakic and aphakic, steroids can cause IOP elevations.  With six weeks of steroid use, 95% of patients with primary open-angle glaucoma would get an IOP increase, whereas only 5% of the general population would get an increase.

P:  If a lens implant causes inflammation, is that uveitis? 

Dr. Rick Wilson:  Yes.

P:  I was treated for iritis in the left eye.  About eight years later the IOP in that eye became elevated, and I have to take drops.  I was treated with Pred Forte.  Would the elevated IOP that developed be a result of the iritis or the treatment?

Dr. Rick Wilson:  If the iritis was eight years earlier, then that would be due to the iritis, not the treatment.

P:  My Mom has one "good" eye.  She has had four surgeries in the last year, including removal of a shunt.  Her IOPs ranged from 1 to 9 to 5 mm Hg and are now 7.5 mm Hg. She continues to lose vision.  The doctors seems to say, "Go home and accept your legal blindness." Would you try to increase her pressures?  I hate to see her lose all vision.  

Dr. Rick Wilson:  If the low IOP is due to the uveitis, which has injured the ciliary body, that usually makes it difficult for the aqueous to increase the eye pressure.  Occasionally, a vitreous substitute can be injected into the back of the eye.  However, that only lasts a limited time. 

P:  I have a glaucoma history question.  The recently deceased Ray Charles supposedly went blind from undiagnosed glaucoma.  What was the prognosis for someone with glaucoma in the 1930's and 1940's?  Were eye drops and surgery available then?  

Dr. Rick Wilson:  Surgery was available, but it  was gross filtering surgery; that is, just a hole drilled or punched in the eye under the conjunctiva.  Side effects were expected. The only drops may have been pilocarpine, epinephrine, and phospholine iodide.

Moderator:  Good night, Dr. Wilson.  Thank you, again.

End of highlights for June 16, 2004.

On June 23, Dr. Wilson discussed "Traumatic Glaucoma" in the Chat room. Click here for highlights of that meeting.

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