What is uveitis in multiple sclerosis (MS)?

Updated: Feb 21, 2019
  • Author: Fiona Costello, MD, FRCP; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Answer

Patients with MS are known to experience various forms of ocular inflammation, including uveitis, retinal perivascular sheathing (periphlebitis), and retinitis. [35, 36] Uveitis refers to inflammation of the uveal tract and is 10 times more common in patients with MS (incidence of 1%-2%) than in the general population. [35, 36] Intermediate uveitis or pars planitis is the most frequent form of uveitis seen in MS. Among patients with pars planitis, 8%-12% will be diagnosed with MS. [36]

Patients with uveitis report blurred vision, floaters, photophobia, pain, and eye redness. Ocular complications include retinal neovascularization, cystoid macular edema, cataracts, retinal detachment, and epiretinal membrane formation. While uveitis and complications thereof can occur as part of MS itself, they may also arise as a consequence of MS therapy. Specifically, patients with MS who use fingolimod, a sphingosine-1-phosphate receptor modulator, may develop fingolimod-associated macular edema (FAME).

The clinical features of FAME typically manifest within months of therapy initiation, although patients may or may not have symptomatic vision loss. [37] Patients with MS who have coexisting diabetes or a history of uveitis may be at an increased risk of developing FAME. [37] Dilated fundus examination, OCT, and fluorescein angiography (see image below) are the primary diagnostic tests in the evaluation of FAME. Affected individuals may be treated with cessation of fingolimod therapy, observation, nonsteroidal anti-inflammatory agents, and/or corticosteroids. [37]


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