Introduction

In medicine, there are many health conditions that can mirror or mask one another due to their very similar presentations, only being distinguished by very specific tests ordered by medical professionals. Eales disease and uveitis are two of those conditions that can often be confused or mistaken when being diagnosed, leading to concerns over management planning and better quality of life for the individual suffering. Understanding whether Eales disease and uveitis coexist or if they are entirely separate entities is important in better managing those patients often misunderstood in these circumstances.

Eales Disease

Eales disease is a condition of the eye that involves inflammation of the eye and surrounding blood vessels. It is predominantly found in young people assigned male at birth (AMAB), but can be seen in people assigned female at birth (AFAB), particularly those from India and Southeast Asia.¹ In some cases, people with a history or susceptibility to hypersensitivity reactions, as well as those with exposure to tuberculosis are also more likely to develop the disease than those without. It is a relatively uncommon disease that isn’t often diagnosed in the Western world, making it more difficult to distinguish between other presentations of the eye involving inflammation.²

The inflammation of the blood vessels in the eye typically begins in the front of the eye and progresses to the back as the disease worsens. Over time, the high levels of inflammation can cause ischaemia (blood vessel blockage) and retinal neovascularisation (a process where newer, more fragile vessels form that are easily damaged). These inflammatory changes can present themselves in many ways depending on the individual. These include vitreous haemorrhage, macular oedema, fibrosis (thickening and scarring of the tissue) and retinal detachment. All eventually leads to increased pain in the eyes and a reduction in vision.³

Uveitis

Uveitis is also an inflammatory eye condition affecting a part of the eye called the uvea, a name given to a group of eye parts that includes the iris, ciliary body and choroid. However, any part of the eye can be affected by inflammation depending on the extent of the disease. Oftentimes, uveitis can occur randomly, without any predisposing features. However, there have been associations with trauma, infection and inflammatory autoimmune conditions. These conditions include inflammatory bowel disease, arthritis, multiple sclerosis and sarcoidosis. It is commonly found in people between the ages of 30 and 60 and in any gender. People with uveitis will usually present with a very painful, red eye alongside a reduction in vision, double vision and an increase in eye floaters. 

Diagnostic Differences

As both conditions cause inflammation of the eyes and therefore similar symptoms, it is crucial for medical professionals to have very accurate and up-to-date methods of determining the correct diagnosis. This is quite accessible in the modern day, especially in Western medicine. However, those suffering in more deprived countries may find it hard to obtain adequate treatment and diagnosis. In uveitis, a specific type of ultrasound scan, blood tests to determine any autoimmune or infective cause, as well as biopsies in very specific cases are performed.⁴ Eales disease is a diagnosis based on ultrasonography to detect internal changes and thickening within the eye.⁵

For treatment purposes, Eales disease and uveitis also differ. Commonly, Eales disease needs to be treated with a combination of treatments that include surgery, laser treatment and oral steroids. The special combination of surgery and laser therapy often needed for this condition is laser photocoagulation and vitrectomy in order to reduce the inflammation buildup within the eye.⁶ Uveitis is controlled better with more systemic therapies due to the immune link to the disease. These systemic therapies include both oral and intravenous steroids to reduce inflammation, intravitreal implants to replace the fluid in the eye with healthy fluid, as well as some new types of immunosuppressants, including monoclonal antibodies.⁷ This is a clear reason as to why accurate diagnosis is necessary due to the major differences in treatment options.

Occasionally, both diseases can coexist, usually if the immune system is overactive and vulnerable to systemic diseases. It isn’t very common to have both occur together, and during early disease, misdiagnosis is very apparent due to the similarities in presentations. 

Summary

Eales disease and uveitis are conditions that affect the eye and cause similar symptoms. Thus, correct diagnosis and appropriate treatment are essential for the patients’ well-being. Hopefully, with the advancements in funding and research in modern-day medicine, diagnosis and identification of inflammatory eye diseases should become more accessible and understandable. It is essential that people have an awareness of the common early symptoms of inflammatory eye diseases, as well as having regular eye check-ups, so that diagnosis can be made at an earlier interval. If treatment is initiated at an appropriate stage, it is quite likely that eyesight will remain intact, with very low likelihood of major visual impairments. 

Misdiagnosis is relatively uncommon due to the high quality of Western medicine. However, it can still happen in very complex cases. It is essential that public health schemes are tailored to patient education on common symptoms and adequate eye care techniques in order for patients to receive faster treatment. Additionally, educating medical professionals about appropriate medical diagnosis and being a well-rounded clinician is also crucial in patient care, as well as improving uptake of health-seeking services.