Bright Sight

Oliver Backhouse, Consultant Eye Surgeon www.cataract.org.uk

Vasculitis

Vasculitis means inflammation of the blood vessels. Vasculitis inside the eye is often part of a general inflammation process that can affect other parts of the body. There are over 20 different types of vasculitis of the eye and body and they are catagorised into those that affect large, medium and small arteries and veins. The resulting damage can cause reduced / absent blood flow (ischaemia) and bleeding due to leakage from the damaged wall of the vessel. The eye can respond to ischaemia by growing new blood vessels. While this sounds a sensible idea these new vessels are thin and can leak causing a sudden loss of vision due to a bleed inside the eye. They can also cause a form of glaucoma which can result in a painful eye. Laser therapy can reduce the risk of getting this type of glaucoma but is only needed when there has been a lot of ischaemic change in the eye.

Because one is able to view inside the eye at the slit-lamp microscope in the clinic it is possible to see if it is predominantly the arteries or veins that are affected and also observe associated inflammation areas. Certain clusters of signs and symptoms, supported with investigations such as blood tests and X-rays, can help identify the type of vasculitis. This is important as it then gives the clinician the chance to explain the possible future of how the inflammation may behave and direct appropriate anti-inflammation medication. An example of this is the inflammation of the veins and not the arteries of the retina in conditions such as Sarcoidosis. Other vasculitis conditions such as Wegners Granulomatosis and Behcets can affect the arteries and veins while Systemic Lupus Erythematosus affects the small arteries. As Vasculitis can be part of a more generalised inflammation disorder it is important that the problem is correctly identified. Some Ophthalmologists have a special interest in these disorders and have a dedicated Inflammation (Uveitis) clinic. A Rheumatologist may also be in this clinic as well to help with the management.

Some cases of Vasculitis resolve quickly but there are other forms that will run a chronic course and so the need for medication may be prolonged, sometimes even for several years. Control of the inflammation is usually obtained by taking steroid medication in slow release injection or tablet form, but if too high a dose of steroid is required for too long a period then the use of 'steroid sparing' medication will be discussed.

Do let your doctor know of other symptoms such as aching joints, new headaches, mouth ulcers, skin rashes, genital ulcers, shortness of breath and diarrhoea which can all be connected with the eye inflammation.