Purpose: To investigate the prevalence and pattern of uveitis in patients with multiple sclerosis (MS). Patients and Methods: This is a cross-sectional, observational, descriptive clinical study of patients with MS who had complete ophthalmological examination. Data collected comprised demographics of the patients and complete ocular examination findings. Exclusion criteria were history of ocular surgery, trauma or diagnosis of any other ocular pathology. Results: Seventy-five patients with a mean age of 32.64 years (ranging from 16 to 50) diagnosed with MS of the relapsing-remitting type were included in this study. There were 34 males and 41 females, a ratio of 5:6. The mean duration of the MS disease was 5.6 years. Eight eyes of 7 patients with a mean age of 20 years had intermediate uveitis, of which 5 were males. Out of the 7 patients, 5 had exacerbated MS, and 2 were in remission; 4 had relative afferent pupillary defect. In the 8 eyes with uveitis, 6 had a best spectacle-corrected visual acuity (BSCVA) of 1, 1 had a BSCVA of 0.5 and 1 had a BSCVA of 0.25. Conclusion: Uveitis occurs in about 10% of patients with MS affecting younger males with exacerbated disease. Most inflammations of the uveitic MS patients were in the form of intermediate uveitis that was controlled with medication with no visual threatening complications.

Keywords:
Uveitis, Intermediate uveitis, Pars planitis, Multiple sclerosis
1.
Breger BC, Leopold IH: The incidence of uveitis in multiple sclerosis. Am J Ophthalmol 1966;62:540–545.
2.
Porter R: Uveitis in association with multiple sclerosis. Br J Ophthalmol 1972;56:478–481.
3.
Bachman DM, Rosenthal AR, Beckingsale AB: Granulomatous uveitis in neurological disease. Br J Ophthalmol 1985;69:192–196.
4.
Lim JI, Tessler HH, Goodwin JA: Anterior granulomatous uveitis in patients with multiple sclerosis. Ophthalmology 1991;98:142–145.
5.
Rothova A, Buitenhuis HJ, Meenken C, Brinkman CJ, Linssen A, Alberts C, Luyendijk L, Kijlstra A: Uveitis and systemic disease. Br J Ophthalmol 1992;76:137–141.
6.
Acar MA, Birch MK, Abbott R, Rosenthal AR: Chronic granulomatous anterior uveitis associated with multiple sclerosis. Graefes Arch Clin Exp Ophthalmol 1993;231:166–168.
7.
Biousse V, Trichet C, Bloch-Michel E, Roullet E: Multiple sclerosis associated with uveitis in two large clinic-based series. Neurology 1999;52:179–181.
8.
Towler HM, Lightman S: Symptomatic intraocular inflammation in multiple sclerosis. Clin Experiment Ophthalmol 2000;28:97–102.
9.
Zein G, Berta A, Foster CS: Multiple sclerosis-associated uveitis. Ocul Immunol Inflamm 2004;12:137–142.
10.
Le Scanff J, Sève P, Renoux C, Broussolle C, Confavreux C, Vukusic S: Uveitis associated with multiple sclerosis. Mult Scler 2008;14:415–417.
11.
Rathinam SR, Krishnadas R, Ramakrishnan R, Thulasiraj RD, Tielsch JM, Katz J, Robin AL, Kempen JH, Aravind Comprehensive Eye Survey Research Group: Population-based prevalence of uveitis in Southern India. Br J Ophthalmol 2011;95:463–467.
12.
Suhler EB, Lloyd MJ, Choi D, Rosenbaum JT, Austin DF: Incidence and prevalence of uveitis in Veterans Affairs Medical Centers of the Pacific Northwest. Am J Ophthalmol 2008;146:890–896.e8.
13.
Chang JH, Landers J, Henderson TR, Craig JE: Prevalence of uveitis in indigenous populations presenting to remote clinics of Central Australia. Clin Experiment Ophthalmol 2011;2:1442–9071.
14.
Gritz DC, Wong IG: Incidence and prevalence of uveitis in Northern California; the Northern California Epidemiology of Uveitis Study. Ophthalmology 2004;111:491–500.
15.
Mattapallil MJ, Sahin A, Silver PB, Sun SH, Chan CC, Remmers EF, Hejtmancik JF, Caspi RR: Common genetic determinants of uveitis shared with other autoimmune disorders. J Immunol 2008;180:6751–6759.
16.
Lindner E, Weger M, Steinwender G, Griesbacher A, Posch U, Ulrich S, Wegscheider B, Ardjomand N, El-Shabrawi Y: IL2RA gene polymorphism rs2104286 A>G seen in multiple sclerosis is associated with intermediate uveitis: possible parallel pathways? Invest Ophthalmol Vis Sci 2011;52:8295–8299.
17.
Rucker CW: Sheathing of the retinal veins in multiple sclerosis. Review of pertinent literature. Mayo Clin Proc 1972;47:335–340.
18.
Bamford CR, Ganley JP, Sibley WA, Laguna JF: Uveitis, perivenous sheathing and multiple sclerosis. Neurology 1978;28:119–124.
19.
Malinowski SM, Pulido JS, Folk JC: Long-term visual outcome and complications associated with pars planitis. Ophthalmology 1993;100:818–824.
20.
James DG, Friedmann AI, Graham E: Uveitis. A series of 368 patients. Trans Ophthalmol Soc UK 1976;96:108–112.
21.
Bloch-Michel E, Nussenblatt RB: International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease. Am J Ophthalmol 1987;103:234–235.
22.
Mohan N, Edwards ET, Cupps TR, Oliverio PJ, Sandberg G, Crayton H, Richert JR, Siegel JN: Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides. Arthritis Rheum 2001;44:2862–2869.
23.
Wakefield D, Jennings A, McCluskey PJ: Intravenous pulse methylprednisolone in the treatment of uveitis associated with multiple sclerosis. Clin Experiment Ophthalmol 2000; 28:103–106.
24.
Becker MD, Heiligenhaus A, Hudde T, Storch-Hagenlocher B, Wildemann B, Barisani-Asenbauer T, Thimm C, Stübiger N, Trieschmann M, Fiehn C: Interferon as a treatment for uveitis associated with multiple sclerosis. Br J Ophthalmol 2005;89:1254–1257.
25.
PRISMS Study Group, University of British Columbia MS/MRI Analysis Group: PRISMS-4: long-term efficacy of interferon-beta-1a in relapsing MS. Neurology 2001;56:1628–1636.
26.
CHAMPS Study Group: Interferon beta-1a for optic neuritis patients at high risk for multiple sclerosis. Am J Ophthalmol 2001;132:463–471.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.