Uveitis is 10 times more common in MS patients than in the general population. The frequency of uveitis in patients with MS is reported to be as high as 30%, and the onset of uveitis may precede the diagnosis of MS in up to 25% of patients and by 5–10 years. MS usually affects white women 20–50 years of age, and intermediate uveitis is the most common manifestation of MS-associated uveitis. Up to 95% of cases are bilateral. Up to 15% of patients with pars planitis may eventually develop MS. Intermediate uveitis appears to be of milder severity in MS than in idiopathic cases. Macular edema is less common. Most patients develop mild vitritis with periphlebitis. Periphlebitis in MS is not clearly related to optic neuritis, systemic exacerbations, or disease severity.
The immunopathogenesis of MS is not well understood but appears to involve humoral, cellular, and immunogenetic components directed against myelin. HLA-DR15 appears to be associated with the combination of MS and uveitis. Immunocytologic studies have shown some cross-reactivity between myelin-associated glycoprotein and Müller cells.
Treatment of MS with interferon may have a beneficial effect on intermediate uveitis and associated macular edema. More recently, daclizumab, an interleukin-2 receptor blocking antibody, was approved for the treatment of MS and may be helpful in controlling uveitis. Fingolimod therapy for MS, on the other hand, can lead to macular edema. As biologic therapies for uveitis become more common, it is particularly important to consider the possibility of MS in any patient who presents with intermediate uveitis or pars planitis, as TNF inhibitors have been associated with exacerbations of MS.
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Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.