Transcription:
Eye Inflammation

Prakash Chandran: Your eyes are one of the most important organs in your body. Outside of getting corrective lenses or contacts for vision, we can sometimes take them for granted. But what happens when your eyes become blurry, red, teary, and inflamed? It might be a small irritant, or it might be something more concerning like uveitis.

Joining us to discuss is Dr. Ahmed Sallam, an ophthalmologist and researcher at the Jones Eye Institute at UAMS. This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. My name is Prakash Chandran. So Dr. Sallam, thank you so much for joining us today. I guess I wanted to just start by asking what exactly is uveitis?

Ahmed Sallam, MD, PhD: Thank you, Prakash, for having me. This is a great question. Uveitis means inflammation of the uvea, which is a part of the tissues inside the eye. It's one of the coats of the eye. There's an outer layer and inner layer, which is the retina and the middle layer, which is the uvea. And that part can become inflamed and that's called uveitis.

Prakash Chandran: And what symptoms does someone experience when they have it?

Ahmed Sallam, MD, PhD: So it depends on which part of this middle coat of the eye is inflamed. So if the front of the eye is inflamed, patients would come usually with pain and red eye. They may also have decreased vision, but the prominent symptoms would be pain and red eye, and it can be so painful. If the back of the eye is involved, then they usually don't have much pain, but the presentation would be with floaters and decreased vision. It's less painful, but more serious because it has more impact on the vision. And sometimes patients present with a combination of the two, so they will have pain, decreased vision and floaters.

Prakash Chandran: Okay. Understood. And how common is uveitis?

Ahmed Sallam, MD, PhD: So uveitis is very uncommon. So the prevalence is about 1%, and that's the problem. Actually, it can cause significant loss of vision. And you might be interested to know that 10% of blindness is caused by uveitis. Although the prevalence is just 1%, but it really can cause blindness.

Prakash Chandran: So my sense is that as soon as you start experiencing symptoms, you need to get it treated right away because that treatment, that early treatment, is what can prevent a person from becoming blind. Is that correct?

Ahmed Sallam, MD, PhD: Exactly. So, you know, sometimes we get red eye and you go to an optometrist who are great for eyes screening. But one thing that is good to know if you're having a red eye and the eye is painful, like painful or you have decreased vision, this is serious. And you need to see an ophthalmologist for this, because this is serious. It's not just the usual red eye where you might be just prescribed some drops by your primary care physician or by optometrists. This is serious.

Prakash Chandran: Okay. So just to be clear, for patients that are experiencing symptoms where they have red eye, it's painful, they have decreased vision, then they absolutely need to go see an ophthalmologist, right?

Ahmed Sallam, MD, PhD: Yes. Red eye with pain or decreased version or both, this is serious. It can be uveitis or it can be other serious things. For example, a corneal ulcer or something called acute glaucoma. There is some differential diagnosis here, but the most important message, this needs to go to an ophthalmologist.

Prakash Chandran: Okay. So who exactly does this affect? Does it affect a certain demographic, a certain age group? Can you talk about that for a little bit?

Ahmed Sallam, MD, PhD: Yeah. So it can affect all age groups. It's more in the working age group, like young adults. And that's, again, one of the problems we see is that, you know, it can cause significant vision issues in the working age group. But it can present in children. It can present in like adults and also it can present for the first time in elderly. But the most common group involved is the young adults groups.

Prakash Chandran: And Dr. Sallam, what exactly causes uveitis? Is it genetic? Is it environmental? Is it something else entirely?

Ahmed Sallam, MD, PhD: So this is really the million-dollar question. So what do we know? We know that this is inflammation inside the eye. It can be caused by just inflammation or autoimmune inflammation. The body's reacting to the eye as a foreign material similar to how rheumatoid arthritis, for example, happens. And that can be restricted to the eye only, just uveitis or it can be part of more of a systemic disease involving the whole body. For example, rheumatoid arthritis can also affect the eye or a disease called lupus. That's one part. The second part is an infection and that's not common, an infection affecting the eye. A third part is it could be due to tumors just manifesting with the inflammation inside the eye.

But the most common we see is first group, which is inflammation. And under that, the most common we see is just affecting the eye and under that we cannot find any other cause. So the most common is auto-immune just restricted to the eye, autoimmune inflammation just restricted to the eye.

Prakash Chandran: So you talked about going in to see an ophthalmologist right away if you're experiencing some of these symptoms. But how treatable is this and what exactly are you doing to treat it?

Ahmed Sallam, MD, PhD: So the good news is it's treatable, and that treatment can differ really depending on where and how severe the uveitis is. For example, if you have only uveitis in the front of the eye, then you mainly get treatment with topical steroid drops and that can range from just a six weeks course to a longer course if the inflammation becomes what we call chronic or means like longer taking.

Then, if you have more of a posterior or the back of the eye problem, then you would imagine the drops would not reach back there. So then you may need treatment by mouth or in the form of injections around or in the eye. It depends.

Prakash Chandran: So we talked earlier about not really understanding the reason around why uveitis happens, but is there a way to actually prevent it?

Ahmed Sallam, MD, PhD: I think that's the second million-dollar question really, because is stress really a factor? Is diet really a factor? Personally, I think, yes. There's maybe an element for dietary, maybe there's an element for stress. But there's no clue. So I would say, but this was really unproven and I think this is just my thinking, a healthy diet, exercise, not smoking, you know, avoiding like preserved foods, I'm sure that this prevents, or I'm not sure, I think strongly that this may prevent inflammation and many eye diseases. But is this proven? No.

So maybe the message really on this part is I think seek help if you have one of the symptoms discussed, but there's no definite preventative treatment.

Prakash Chandran: So I think the major takeaway that I certainly get out of this conversation is if you or a loved one, has inflammation, red eye that's painful or you have decreased vision or both, you should really go to an ophthalmologist immediately. And I think the reason this is so important is that typically when we experience these symptoms, it's very easy to write off as, you know, something that is going to clear up in a couple of days. But it really feels like time is of the essence when it comes to treating what might potentially be uveitis. Is that correct?

Ahmed Sallam, MD, PhD: Exactly. I would totally second this, I think this was really the main point.

Prakash Chandran: So Dr. Sallam, is there anything else that you would like to leave our audience with today with regards to eye inflammation or uveitis?

Ahmed Sallam, MD, PhD: I think we covered most of the important points. Again I mean, I think the message we just talked about, if you have those, then do get in touch with us. We'd be very happy to review the patients. But otherwise, I think we've covered all the elements.

Prakash Chandran: Okay. Well, I really appreciate your time again. Thank you so much for being here, Dr. Sallam.

Ahmed Sallam, MD, PhD: Oh, thank you. Thank you so much.

Prakash Chandran: That's Dr. Ahmed Sallam, an ophthalmologist and researcher at the Jones Eye Institute at UAMS. Thanks for checking out this episode of UAMS Health Talk. You can visit eye.uams.edu to find out more about the expertise and services offered at the UAMS Jones Eye Institute. And for more generalized information, you can visit uamshealth.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks again for listening. My name is Prakash Chandran, and we'll talk next time.