Uveitis is the inflammation of the uveal region of the eye, most commonly by an infection. Uvea is a group of pigmented and non pigmented tissues lying in the middle among the three layers that make the eye. Uvea again consists of three layers: iris, cilliary body and the choroid. The uvea is also known as the uveal tract in some medical circles, this tract is necessary for the nutrition of the eye and also to reduce glare of the light that enters by absorbing the light and reducing internal reflection within the eye. In addition the uvea also helps in generating the aqueous humour and in controlling the focus of the eye lens. The uvea also consists of lymphocytes and is therefore prone to respond to inflammation by developing lymphocytic infiltrates. Uveitis is therefore a condition that requires urgent response from an ophthalmologist and immediate treatment.
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Anterior Uveitis mainly includes iritis, which is known as the inflammation of the anterior chamber and the iris, and iridocyclitis, which is inflammation of the iris anterior chamber and the vitreous cavity. Anterior uveitis presents itself as redness of the eyes, irregular pupils, photophobia, blurred vision, eye pain/pressure, floaters visible to the patient, headaches, iridocyclitis induced cataract/glaucoma or synechia (attachment of iris to cornea or lens). The causative factors for uveitis has not yet been confirmed, however in half of the anterior uveitis cases a correlation was observed with the presence of HLA-B27 gene, which is a type of human leukocyte antigen (HLA) that increases the probability of an individual to contract uveitis by 15%.
Anterior uveitis or acute anterior uveitis is the most common form of uveitis. Uveitis is primarily found to be systemic immune based; however possible causative factors in many cases also include infections from: Brucellosis, Leptospirosis, Lyme disease, Tuberculosis, Syphilis, Toxoplasmic chorioretinitis, Toxocariasis, or ocular histoplasmosis syndrome. Besides these drug interactions like rifabutin can also cause uveitis. Basically Uveitis occurs from the failed or hyperactive ocular immune response, this results in tissue destruction and inflammation, followed by buildup of mucus in extreme cases, hence the increased pressure.
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The treatment for uveitis is mainly symptom specific, with steroids and non-steroidal anti inflammatory drugs ins the form of eye drops, or oral medications. Corneal ulcers if present may pose as complications hence anti-inflammatory medication is prescribed only after ruling out this disorder. Cyclopegics or ciliary muscle relaxants are administered for diagnosis or certain surgical treatment if necessary. Anti TNF agents and other anti metabolite medications may prove helpful in cases of severe uveitis, e.g. infliximab.
Certain drugs like metformin, which is generally used as anti-diabetic drug has also been found to reduce inflammation in uveitis. Recent drugs like gevokizumab have undergone trials to for uveitis without infectious origin. The treatments given vary with the causative factor of uveitis, but overall the condition usually recedes after proper care and procedures are followed. In severe adverse cases, vision loss or cataract/glaucoma may occur, such cases however occur in very rare occasions. The incidence rate is as high as one in 4500 individuals globally according to a medical journal on ocular immunology. The incidence rates in developed countries of the west are higher than the developing countries in Asia and Africa. The anterior uveitis market is therefore restricted to North American and European region, followed by Asia, South America and Rest of the World.
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Some of the companies involved in the production of uveitis related drugs include: Novartis AG, Amdipharm Mercury Company Limited, Santen pharmaceuticals, etc.