FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

UVEITIS NEEDS BOTH EYE DOCTOR'S AND FAMILY DOCTOR'S CARE

Question: I saw my eye doctor because I have been having eye pain, particularly when I'm in bright light. He said that I had uveitis and has treated me for it, but he also wants me to see my family doctor because he said the back pain I've been experiencing might be related to my eye problems. Are these doctors in cahoots, or could my back pain and eye problems really have the same cause?

Answer: It is certainly possible to have uveitis and back pain as a consequence of the same illness, but you might also simply have two different problems that are producing symptoms at the same time. I'm sure that your eye doctor wants to work with your family physician to find out the specific cause or causes of your symptoms so that the proper treatment can be used.

Uveitis, the particular type of eye trouble you have, deserves a bit of explanation. I'll start with the way the eye is built. The eye has a tough outer wall that is composed of three major layers, and a center that is filled with a clear and colorless fluid. The tough outer layer of the eye includes the transparent cornea over the pupil as well as the white of the eye, called the sclera, around the remainder of the eyeball. The inner layer consists of the light-sensitive optic nerve. Between these two -- in the layer called the uvea -- is the location of your eye trouble.

The uvea contains the iris, that colored part that controls the amount of light entering the eye, the coroid plexus that is a collection of many small blood vessels, and an organ named the ciliary body that produces the fluid filling the eye.

Inflammation of the uvea is called uveitis, the condition you have. This causes general eye discomfort as well as the pain you experience in bright light. As you know, bright light causes the pupil -- the opening in the center of the iris through which light enters the eye -- to contract. The way light causes this automatic response is rather complex, but ultimately the pupil constricts because the small muscles of the iris make it do so. These muscles become inflamed and sore with uveitis. Therefore, it hurts as they contract as an automatic response to being in bright light.

Now, your back pain poses an interesting dilemma. Back pain is a normal characteristic of the human species. More than 80 percent of the population will lose at least some time off the job during their work career because of back pain. Perhaps your back pain is simply this common disorder involving a disturbance in the smooth coordination between the muscles, nervous system, bones and circulation of the back. However, your back pain may also be the consequence of a special type of arthritis that strikes from five to 500 out of every 1,000. You may have what we doctors call a spondylarthropathy (yes, it's another terrible doctor name).

Spondylarthropathies are specific types of arthritis that predominantly attack the joints of the spine. Ankylosing spondylitis is the most prevalent of these, but Reiter's syndrome and psoratic arthritis are also fairly common. These conditions attack about 1.5 percent of whites, 4 percent of American blacks, 18 percent of Pima Indians, 50 percent of Haida Indians in Canada and almost no one of Asian ancestry. All spondylarthropathies can also cause uveitis. In fact, in some individuals the first symptom of these types of arthritis is eye pain, and it may take months or years for joint pain to "show up" and make the diagnosis possible.

I think your eye doctor is trying to take good care of you -- not just your eyes, but all of you. He wants to be sure that your uveitis does not indicate a more serious underlying illness such as a spondylarthropathy. Your doctors are not in cahoots, because that word indicates a questionable motive for their collaboration. Instead, they appear to be working together for an honorable goal -- your good health.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.