By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Uveitis is the inflammation of the tissues making up the middle layer of the eye wall. Uvea = middle layer of the eye wall, Itis = inflammation.
Uvea, the middle eye layer – The middle layer of the eye consists of iris, ciliary body and choroid. Iris is the black of the eye through the cornea. Ciliary body is located behind the iris and is in continuation with it. Choroid is a layer of blood vessels placed between the sclera and retina. The term uveitis, apart from referring to inflammation of uvea, also applies to inflammation to any part of the inside of the eye. Therefore it is not a single disease and has different causes. It presents with redness of the eye, pain and blurred vision in either one eye or both. It affects all age groups but mainly affects people from the 20-60 years age group.
If not addressed at proper time, uveitis can cause serious symptoms and also permanent loss of vision. To prevent complications and loss of vision, this condition needs to be diagnosed as early as possible and promptly treated.
Read more – Modern view of Uveitis
Table of Contents
Types of Uveitis
- Anterior uveitis / iritis
- Intermediate uveitis
- Posterior uveitis
In the majority of cases of uveitis, specific etiological factors will not be clear. If causes are not tracked down and if the disease is not systemic and afflicts only the eye or eyes it will be considered and diagnosed as autoimmune disorder.
In other cases, uveitis may be caused by one of the below mentioned causes –
- Autoimmune or inflammatory diseases – Ex – Systemic Lupus Erythematosus (SLE), Ankylosing spondylitis, Rheumatoid arthritis, Crohn’s disease, Juvenile arthritis, Psoriasis etc
- Inflammatory conditions – like Crohn’s disease, Ulcerative Colitis etc
- Infection – Ex – Herpes zoster, Herpes simplex, syphilis, tuberculosis, Brucellosis, toxoplasmosis, Lyme disease etc
- Eye injury
- Eye surgeries
- Side effects of certain medications
- Cancers like lymphoma which affects the eye
- AIDS / HIV
- Any diseases that weaken the immune system
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A complete history of the patient’s health and eye examination will help the doctor or ophthalmologist to diagnose this condition. The following tests are conducted to make a diagnosis –
- Vision assessment
- Tonometry – to measure the pressure inside your eyes
- Opthalmoscopy – to examine the back of the eyes
- Slit lamp examination
- Color photography of retina
- OCT (Optical Coherence Tomography) – to find out inflammation in retina and choroid
- Fluorescein angiography (Indocyanine Green Angiography) – to read and find out inflammation of blood vessels inside the eyes
- Aqueous / vitreous fluid analysis
- Imaging tests – radiography, CT, MRI
- Blood tests
- Gene mutations
- Smoking cigarette
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- Swelling, scarring and detachment of retina
- Damage to optic nerve
- Permanent vision loss
- Macular edema
Goal of the treatment is to reduce inflammation in the eye. Treatment needs to be done for many months or years in many cases.
- Anti-inflammatory drugs
- Drugs to control spasms
- Antibiotics / antiviral medications
- Immunosuppressive drugs
Surgery and other options
Vitrectomy – to remove vitreous in the eye
Medication releasing implant in the eye
Fate of uveitis
Recovery from uveitis depends on –
- Type of uveitis
- Severity of symptoms
Anterior uveitis heals better and sooner than posterior uveitis. Similarly mild inflammation heals better and sooner than severe inflammation. Uveitis shows recurrence. If this happens, or if the symptoms of your uveitis worsen see your doctor as soon as possible.
Uveitis in Ayurveda
The below mentioned conditions can be considered in comparison to uveitis. Uvea comprises iris, the black of the eye along with ciliary body which is muscular and choroid which is the vascular layer.
In Ayurveda, the black of the eyes has been mentioned as krishna bhajan of Krishna mandala. But the disorders mentioned to occur in this part of the eye also covers the corneal disorders. But cornea is a transparent shield through which the black of the eye i.e. iris with pupil can be seen. Therefore according to Ayurveda, the black of the eye is the iris with pupil and cornea.
The first tunic (prathama patala) explained in Ayurveda covers cornea and aqueous humor while the second layer (dwitiya patala) comprises muscular layer which probably correlates with the ciliary body along with iris. Therefore the diseases of the uvea are covered under the heading krishnagata rogas in Ayurveda.
From the perspective of diseases afflicting the krishnabhaga i.e. black of the eye
The diseases mentioned to afflict the black of the eye though afflict cornea, will have their impact on the uvea in a direct or indirect way. There are 4 diseases that afflict the black of the eye, including cornea.
Signs and symptoms of Akshipakatyaya
- whitish doshas / layer covers the entire black of the eye i.e. cornea – looks like an explanation of cataract, which is a complication of uveitis
- severe pain in the eyes – may occur due to glaucoma, a complication of uveitis,
This condition is compared to hypopyon, a condition presenting with inflammatory changes in the anterior chamber of the eye. Anterior chamber of the eye too is a part of the black of the eye as per Ayurveda explanation. Leukocytic exudates occur in the anterior chamber and are accompanied by redness of conjunctiva and the underlying episclera. It is a sign of inflammation of the anterior uvea and iris i.e. iritis. Iritis is a form of anterior uveitis. Long standing hypopyon can cause close-angle glaucoma and anterior synechiae.
2. Savrana Shukra
It is said to be caused due to vitiated blood. Choroid is a vascular layer of the uvea and this condition probably correlates with inflammation of choroid, though this condition has been compared to corneal ulcer. On the other hand, a corneal ulcer may have its impact on the layers of uvea.
Signs and Symptoms of Savrana Shukra eye disorder
- an ulcer is formed in the depth of the black of the eye i.e. cornea which is feebly visible or visible with difficult
- excessive discharge of hot tears from the eyes
- severe pain in the eye
- inability to see things
- redness of white of the eye
Though ulcer is not a sign of uveitis, severe pain and inability to see things and redness are seen. Inability to see things also defines complete loss of vision which is a complication of uveitis.
This condition is compared to Ulcerative Keratitis / Corneal ulcer. A corneal ulcer is loss of corneal tissue, often associated with inflammation. Group of disease processes leading to corneal ulceration is called Ulcerative keratitis. They are either caused by infection or non-infections in nature. Non-infections ulcers are caused by chemical burns, autoimmune, toxic or other causes. It is an emergency condition which may cause permanent impairment of vision or perforation. Even this condition can have its impact on the parts of uvea leading to uveitis. Modern medicine has mentioned permanent loss of vision as a complication of uveitis, Ayurveda too has considered savrana shukla as incurable.
Most of these ulcers of the cornea are caused by infection. Non-infectious forms of ulcers are generally Corneal ulcer is considered as an ophthalmologic emergency since it tends to impair the vision permanently or progress to perforation. Ayurveda too has explained this condition as incurable.
Ajakajata is a condition wherein a protrusion resembling the feces of goat is seen to be coming out of the eyeball. This is compared to Anterior Staphyloma.
Staphyloma means thinning of the uvea and sclera layers of the globe of the eye (eyeball). This results in enlargement of the globe with a focal bulge, usually in the posterior wall. In simple terms, staphyloma is ‘an abnormal protrusion of the uveal tissue through a weak point in the eyeball’.
Symptoms explained in Ajakajata are not seen in uveitis, but uvea is involved in ajakajata. It is said to be an incurable condition.
4. Avrana Shukra
Signs and symptoms
- whiteness of the black of the eye i.e. cornea
- no severe pain
- no excessive discharge of tears from the eye
Avrana Shukra is said to be a complication of conjunctivitis. It has been compared to the opacity of the cornea. Conjunctivitis leads to formation of an ulcer on the cornea which heals leaving behind a coating of whiteness of cornea. When the ulcer is healed, a scar tissue is formed which changes the configuration of the cornea. The cornea loses its transparency and becomes opaque. This probably correlates with a cataract-like condition which has been mentioned as a complication of uveitis. This may lead to loss of vision or inability to see things.
Summing up –
The above said 4 conditions, though are mostly disorders of cornea, they have an impact on uveal tract in the long run and may hence cause uveitis. On the other hand they can also be complications of uveitis.
Though not accurately, these diseases can be considered to be causes, effects (complications) or part and parcel of uveitis itself.
From the treatment perspective
Among the 4 diseases mentioned above, only the last condition i.e. avrana shukra is said to be curable. The other 3 conditions may be indicating the complicated stages of uveitis wherein treatment is not possible and there is permanent loss of vision.
Treatment of Uveitis through Ayurveda
When uveitis is within the bracket of curability and complications have not occurred, it shall be treated on the lines of –
- general treatment principles of eye disorders
- treatment of principles of avrana shukra
- treatment principles of conjunctivitis (abhisyanda)
- treatment principles of timira – curable form of blindness or loss of ability to see
- pitta pacifying remedies including purgation – to combat inflammation
- Triphala formulations – which are useful for eye disorders