Intermediate Uveitis
Disease Details
Family Health Simplified
- Description
- Intermediate uveitis is an inflammation of the uveal tract, primarily affecting the vitreous and peripheral retina.
- Type
- Intermediate uveitis is primarily a non-infectious, inflammatory condition affecting the eye. It involves the vitreous humor and the peripheral retina. The condition is not typically associated with a specific mode of genetic transmission, as it is more commonly linked to immune-mediated processes and sometimes associated with systemic diseases like multiple sclerosis and sarcoidosis. However, a genetic predisposition may exist in association with these underlying conditions.
- Signs And Symptoms
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Clinical signs include redness of the eye, pain, blurring of vision, photophobia and floaters.
However, some individuals, particularly children, can present with few to no symptoms. - Prognosis
- Prognosis for intermediate uveitis varies depending on the underlying cause, timely diagnosis, and effectiveness of treatment. Generally, with proper medical intervention, many patients can manage symptoms and prevent severe complications. However, the condition can be chronic and may require long-term treatment. Potential complications may include cataracts, glaucoma, and macular edema, which can affect vision. Regular monitoring by an ophthalmologist is essential to improving the long-term outlook.
- Onset
- Intermediate uveitis typically has an insidious onset, meaning it develops gradually over time, often without immediate or clearly identifiable symptoms. This can make early detection challenging. It mainly affects the vitreous humor and peripheral retina. If you have more specific questions or need detailed information, feel free to ask!
- Prevalence
- The prevalence of intermediate uveitis is relatively low. It accounts for about 15-20% of all uveitis cases. Intermediate uveitis primarily affects individuals in the second to fourth decades of life and can be associated with systemic diseases such as multiple sclerosis and sarcoidosis.
- Epidemiology
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Although intermediate uveitis can develop at any age, it primarily afflicts children and young adults. There is a bimodal distribution with one peak in the second decade and another peak in the third or fourth decade.
In the United States the proportion of patients with intermediate uveitis is estimated to be 4-8% of uveitis cases in referral centers. The National Institutes of Health reports a higher percentage (15%), which may indicate improved awareness or the nature of the uveitis referral clinic. In the pediatric population, intermediate uveitis can account for up to 25% of uveitis cases.
== References == - Intractability
- Intermediate uveitis can be intractable in some cases, meaning it can be challenging to manage and resistant to standard treatments. The course and outcome can vary significantly among individuals. Persistent inflammation can lead to complications such as cystoid macular edema, cataracts, and glaucoma, which may require long-term treatment and careful management by a specialist.
- Disease Severity
- Intermediate uveitis is characterized by inflammation of the middle part of the eye and can vary in severity. It may be categorized as mild, moderate, or severe, based on the extent and impact of inflammation. Mild cases may exhibit minimal symptoms and require less aggressive treatment, while severe cases can cause significant vision problems and may necessitate more intensive management. Prompt diagnosis and treatment are crucial to prevent complications and preserve vision.
- Healthcare Professionals
- Disease Ontology ID - DOID:12732
- Pathophysiology
- Pars planitis is considered a subset of intermediate uveitis and is characterized by the presence of white exudates (snowbanks) over the pars plana or by aggregates of inflammatory cells in the vitreous (snowballs) in the absence of an infectious or a systemic disease. Some physicians believe that patients with pars planitis have worse vitritis, more severe macular edema, and a guarded prognosis compared to other patients with intermediate uveitis.
- Carrier Status
- Intermediate uveitis is an inflammatory condition affecting the middle part of the eye, specifically the vitreous and peripheral retina. It is not typically associated with a carrier status, as it is not a hereditary disease. Its exact cause is often unknown, but it can be linked to autoimmune disorders, infections, or other systemic diseases.
- Mechanism
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Intermediate uveitis is a form of uveitis predominantly affecting the vitreous and peripheral retina. The exact mechanism is not fully understood, but it involves immune-mediated processes targeting ocular tissues.
### Mechanism
Intermediate uveitis is considered an autoimmune condition. It involves:
1. **Immunologic Factors**: Abnormal immune response where T-cells and other immune cells mistakenly attack the eye's tissues.
2. **Infectious Triggers**: While not directly causing intermediate uveitis, certain infections like Lyme disease, tuberculosis, or viral infections can act as triggers.
3. **Systemic Diseases**: Often associated with systemic conditions such as multiple sclerosis and sarcoidosis.
### Molecular Mechanisms
1. **Cytokines and Chemokines**:
- Elevated levels of pro-inflammatory cytokines (e.g., TNF-α, IL-6) and chemokines in the ocular fluids suggest their role in recruiting immune cells to the eye.
2. **T-cell Activation**:
- Autoreactive T-cells might recognize retinal antigens, leading to an inflammatory cascade. Both CD4+ and CD8+ T-cells are implicated.
3. **Blood-Retinal Barrier Breakdown**:
- Inflammation can compromise the integrity of the blood-retinal barrier, allowing immune cells and mediators to infiltrate ocular tissues.
4. **Autoantibody Formation**:
- Some patients may develop autoantibodies against retinal proteins, contributing to the disease process.
5. **Genetic Susceptibility**:
- Certain genetic factors, including specific HLA associations, may predispose individuals to intermediate uveitis.
These mechanisms interact to sustain chronic inflammation and tissue damage in the eye leading to the symptoms observed in intermediate uveitis. - Treatment
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Peri-ocular injection of corticosteroids (injection of corticosteroids very close but not into the eye). In resistant cases oral administration of corticosteroids, immunosuppressive drugs, and laser or cryotherapy of the involved area may be indicated.
Steroid implants have been explored as a treatment option for individuals with non-infectious uveitis. Research comparing fluocinolone acetonide intravitreal implants to standard-of-care treatments (prednisolone with immunosuppressive agents) found that while the steroid implant treatment possibly prevents the recurrence of uveitis, there may be adverse safety outcomes, such as the increased risk for needing cataract surgery and surgery to lower intraocular pressure. - Compassionate Use Treatment
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Intermediate uveitis, an inflammatory condition affecting the eye, can be challenging to treat, particularly in severe cases. For compassionate use, off-label, or experimental treatments, consider the following options:
1. **Biologic Agents**:
- **Adalimumab**: This anti-TNF (tumor necrosis factor) agent is FDA-approved for uveitis but can be used off-label for intermediate uveitis.
- **Infliximab**: Another anti-TNF agent, often used off-label for various types of uveitis.
2. **Immunosuppressive Drugs**:
- **Methotrexate**: Although traditionally used for rheumatoid arthritis, methotrexate can be used off-label for intermediate uveitis.
- **Mycophenolate mofetil**: Commonly used in organ transplant patients, this drug has shown efficacy in treating uveitis off-label.
- **Azathioprine**: Used off-label for its immunosuppressive properties in uveitis management.
3. **Interleukin Inhibitors**:
- **Tocilizumab**: An anti-IL-6 receptor monoclonal antibody, used off-label in some cases of uveitis.
4. **Experimental Treatments**:
- **Clinical Trials**: Patients with intermediate uveitis may participate in clinical trials exploring new medications or treatment modalities. These trials offer access to cutting-edge therapies under investigation.
Consultation with an ophthalmologist specializing in uveitis is crucial to determine the best treatment plan tailored to individual patient needs. - Lifestyle Recommendations
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For intermediate uveitis:
Lifestyle Recommendations:
1. **Regular Eye Check-ups:** Frequent monitoring by an ophthalmologist is crucial.
2. **Healthy Diet:** Include foods rich in omega-3 fatty acids, antioxidants, and vitamins A, C, and E.
3. **Hydration:** Drink plenty of water to maintain overall eye health.
4. **Avoid Triggers:** Identify and avoid potential allergens or environmental triggers that may exacerbate the condition.
5. **Stress Management:** Practice stress-reducing activities like yoga, meditation, or deep-breathing exercises.
6. **Exercise:** Engage in moderate physical activity to boost overall health and reduce inflammation.
7. **Smoking Cessation:** Avoid smoking and exposure to secondhand smoke.
8. **Eye Protection:** Use protective eyewear in situations that could expose your eyes to trauma or irritants.
9. **Chronic Disease Management:** Properly manage any underlying health conditions, such as autoimmune disorders, that can affect uveitis.
If you have specific questions or symptoms, consulting a healthcare professional is crucial. - Medication
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Intermediate uveitis is an inflammation of the middle part of the eye. Treatment often involves medications to control inflammation and manage symptoms. Common medications include:
1. **Corticosteroids**: These can be administered as eye drops, oral medication, or injections around the eye to reduce inflammation.
2. **Immunosuppressive agents**: Medications such as methotrexate, mycophenolate mofetil, or cyclosporine may be used if corticosteroids are not effective or cause significant side effects.
3. **Biologic agents**: Drugs like infliximab or adalimumab are considered in cases where other treatments are not effective or if the uveitis is associated with systemic inflammatory diseases.
Always consult a healthcare provider to determine the most appropriate treatment plan. - Repurposable Drugs
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Intermediate uveitis (IU) refers to inflammation primarily affecting the vitreous and peripheral retina. For managing IU, certain drugs initially approved for other conditions have been repurposed. Some of these include:
1. **Methotrexate**: Originally used for cancer and autoimmune diseases, it helps in reducing inflammation.
2. **Adalimumab**: A TNF-alpha inhibitor initially used for rheumatoid arthritis and Crohn's disease.
3. **Mycophenolate mofetil**: An immunosuppressive agent originally for preventing organ transplant rejection.
These drugs are utilized to manage inflammation and prevent complications in IU patients. - Metabolites
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Intermediate uveitis refers to inflammation occurring in the vitreous and peripheral retina. In this condition, changes in metabolite levels can be observed, including cytokines and other inflammatory markers involved in the immune response. Specific metabolites associated with inflammation, such as interleukins and tumor necrosis factor-alpha (TNF-α), may be elevated.
Current advancements in nanotechnology have led to the exploration of nanomedicine for intermediate uveitis. Nanoparticles can be designed to deliver drugs more effectively to the inflamed tissues, potentially reducing side effects and improving therapeutic outcomes. These nanoparticles can be engineered to target specific cells or tissues, providing a more localized and sustained release of anti-inflammatory or immunosuppressive agents. - Nutraceuticals
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There is limited evidence on the use of nutraceuticals specifically for intermediate uveitis. Generally, nutraceuticals like omega-3 fatty acids, vitamin D, and antioxidants such as vitamins C and E may support overall eye health and reduce inflammation. However, their direct benefit for intermediate uveitis remains unclear, and they should not replace standard medical treatments. Always consult a healthcare professional before starting any new supplement regimen.
As for nanomedicine, it is an emerging field exploring the use of nanoparticles for targeted drug delivery to the eye. This approach may improve the efficacy and reduce the side effects of treatments for ocular conditions, including uveitis. However, such applications are still largely in the research phase and not yet widely available in clinical practice. - Peptides
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Intermediate uveitis is an inflammation of the uveal tract in the eye, primarily affecting the vitreous humor and the peripheral part of the retina. This condition is often associated with autoimmune diseases and can lead to vision loss if not effectively managed.
Research into using peptide-based therapies and nanomedicine for intermediate uveitis is still in its early stages. Peptides have potential as therapeutic agents due to their specificity and ability to modulate immune responses. Nanotechnology offers targeted drug delivery systems, which can enhance the concentration of medications in the affected area while minimizing systemic side effects.
Current treatments primarily include corticosteroids, immunosuppressive drugs, and biological agents. Advances in peptide and nanotechnology-based treatments hold promise for more targeted and effective management of intermediate uveitis in the future.