Uveitis / Iritis – Chronic Eye Inflammation

The uvea or uveal tract is the middle layer of the eye.  The mid to back part of the uveal tract, nearer where the optic nerve comes into the eyeball, is the choroid area.  At the front the uvea forms into your colored iris, behind which is the ciliary body which secretes fluids and controls the shape of your eye lens.

Any inflammation inside the eye is called uveitis.  Depending on where the inflammation predominates, it is termed iritis (iris), pars planitis (ciliary body), and choroiditis (choroid).  Because these areas are linked together and fed by the same vessels, they can be treated as a group.  Patients often report seeing floaters, and complain of blurred vision as well as light sensitivity and redness, usually only in one eye.  The eye doctor sees redness just outside the cornea, and detects cells floating in the anterior chamber.  These are either white cells (inflammatory cells) that have leaked out of blood vessels or pigment from the iris.

The most frequent known cause is trauma to the eye, including surgical trauma.  Other causes include connective tissue disorders (CTD’s such as lupus and rheumatoid arthritis), and sarcoidosis.  From the natural medicine perspective, uveitis or iritis can also occur as a complication digestive or liver problems.  Many uveitis patients also complain of dry eyes.  As in CTD’s, conventional use of steroids is important during flare-ups to prevent vision loss.

Ophthalmologists are seeing more and more cases of uveitis with no apparent origin, which currently is stumping Western physicians. This is one reason why my colleague Dr. Abel moved into the fields of nutritional biochemistry and herbal medicine. He and I feel strongly that there are answers to be found. For one thing, we have both found that there are almost always systemic problems associated with uveitis and iritis.  We look for signs and symptoms–especially dry skin, digestive disturbance, nervousness, constipation, coated tongue, fatigue– and treat accordingly.  Using these strategies we have put many patients into prolonged remissions.

Treatment of Chronic Eye Inflammation

This sort of treatment should be done by a trained herbalists. A basic formula for chronic uveitis consists of two parts, which should be 70-80% of the formula:

• For reducing the inflammation choose from chrysanthemum flower, turmeric root, buddleia flower,  gentiana root, elderberry, eclipta, dandelion root, conch shell and triphala.

• There is always some blood congestion in chronic uveitis.  For this, use tien chi root (high doses), red peony root, bromelain, salvia root (high doses), persica seed (tao ren or Prunus persica), and other herbs from the blood moving group. (note – Chrysalis clinic has developed a combination called iFolia which contains many of these herbs)

Modifications to the Basic Formuola

•  If there are signs of deficiency, add tortoise shell, cooked and raw rehmannia, wild asparagus root and dang gui.

• If there is an excess of sticky mucus exudation, add pinellia tuber and tangerine peel.

• If there is edema and swelling around the eye socket and eyelid, add poria mushroom, coix (yi yi ren / Coix lachryma), and honeysuckle flower.

• If the inflammation is severe, add coptis rhizome, boswellia gum, scute root, forsythia fruit (lian qiao (or F.  suspensa), and gardenia fruit (zhi zi or G.  jasminoides).

Adjunct but Necessary Therapies

• Beneficial oils found in fish (EPA and DHA) reduce inflammation.  This can be duplicated in the diet by eating fish, three or four servings per week of mackerel, salmon, tuna (especially albacore), cod or halibut.  To help assimilate the oils, make sure you take at least 100 iu of vitamin E each day.

• Blueberries (and  bilberries) contain anti-inflammatory plant pigments that are good for the eye.  Eat about 1/2 cup of blueberries per day on average, or about 1 bag of frozen blueberries per week.  You can use other berries as well, but 75% should be blueberries.  These can be fresh, cooked or frozen, as the pigments are relatively heat and cold resistant. Freezing actually makes them somewhat more bioavailable.

• Use one of the eye vitamins found in health food stores to provide antioxidant support.  Typically these contain antioxidant vitamins A, C, and E, as well as riboflavin, zinc, lutein, selenium, rutin, bilberry extract and NAC (N-acetyl-cysteine).

Research Highlights

• The book Chinese Medicine Secret Recipes (in Chinese language only) reported on a clinical trial at one of the TCM hospitals in Shangha that claimed a success rate greater than 99% using the following formula for uveitis: tien chi root 100 grams, dang gui root 15, red peony root 12, cnidium rhizome (chuan xiong or Ligusticum wallichii) 10, persica seed 6, carthamus flower 8, salvia root 20, conch shell 30, and tortoise shell 15 (Hu et al., 1991). The equivalent dose to that used in the study, if you use commercially available dried decoction powders, would be about 9-12 grams per day.

• In a study of 32 patients with chronic eye inflammation (anterior chamber uveitis), a 375-mg dose of curcumin (turmeric root extract) three times per day for three months showed improvement comparable to the effects seen with a similar cortisone dose (Lal et al., 1999).

• Vitamin E has been shown beneficial to prevent trauma-initiated uveitis in animal models.  Because trauma often initiates uveitis, it makes good preventative sense to use this antioxidant vitamin to protect yourself in case of accidental eye injury (Pararajasegaram et al., 1991).

• A controlled animal trial showed marked reduction in uveal and retinal inflammation and swelling in experimentally induced uveitis by interperitoneal injection with quercetin (Romero et al., 1989).