The reason this disease is hard to treat is that it is variable and may involve many tissues and systems. Steroids act quickly but have many side effects (weight gain, bone problems, infection risk), and immunosuppressants and biological agents also have infection and other risks. Usually it is a stepwise treatment: local first, if […]
这病难治的原因在于它多变，可能牵扯到很多组织和系统。激素见效快但副作用不少（体重、骨质、感染风险），免疫抑制剂和生物制剂也有感染等风险。通常是阶梯式治疗：先局部，效果不够再上系统药，最后考虑生物制剂或手术。过程像调一个复杂的机器，要几个月甚至更久才能找到最合适的组合。我换过几种药，那段时间像在试错，但也让我学会了耐心和信任医生的判断。
The treatment goals are two: first, to quickly suppress active inflammation—especially when intraocular inflammatory cell count reaches 1+ or higher, it should be controlled in time to prevent further damage; second, to modulate the immune system through immunosuppressants to reduce long-term relapse and tissue destruction risk. Common practices are to first use topical glucocorticoid
治疗目标有两个：一是尽快抑制活性炎症——尤其当眼内炎症细胞计数达到1+或更高时，要及时控制以防进一步损伤；二是通过免疫抑制剂调节免疫系统，降低长期复发和组织破坏的风险。常见做法是先用局部糖皮质激素滴眼和散瞳剂，必要时短期或长期使用全身糖皮质激素；当炎症需要长期控制或激素副作用不可接受时，会使用免疫抑制剂（如甲氨蝶呤）或对难治病例考虑生物制剂（如Humira/阿达木单抗）。若出现严重并发症（如白内障、青光眼或视网膜脱离），还可能需要手术处理。治疗是个长期且个体化的过程，药物选择、剂量和时机会根据病因、炎症活动度和并发症状况由医生与患者共同调整。我的眼科医生就是按这个目的一点点找出了合适的方案。
If not controlled in time, complications such as glaucoma, cataract, retinal detachment, etc. may occur. Statistically about 30% may develop glaucoma, 40% will develop cataracts, and once retinal detachment occurs vision will drop rapidly or even lead to blindness. These complications often require surgery or more complex treatments, so early control of inflammation can
不及时控制的话会出现青光眼、白内障、视网膜脱离等并发症。统计上大约30%可能发展成青光眼，40%会出现白内障，视网膜脱离一旦发生视力会急速下降甚至失明。这些并发症往往需要手术或更复杂的治疗，所以早期控制炎症真的能防很多事。我见过人因为拖延反复手术，那种痛和无奈会记得很久，这让我每次复查都很认真。
To confirm the diagnosis, the medical history, signs and tests usually need to be combined. Doctors will use a slit lamp to look at eye details, measure intraocular pressure, do blood tests (like antinuclear antibodies, HLA typing), and if necessary do imaging or other specialty consultations. The goal is to neither miss nor misdiagnose; after
确诊通常要把病史、体征和检查结合起来，医生会用裂隙灯看眼睛细节、测眼压、做血检（像抗核抗体、HLA分型），必要时还要做影像学或其他专科会诊。目的是既不漏诊也不误诊，找出病因后治疗才能更有方向。记住，诊断是个全面的过程，不是随便下结论。
The range of symptoms is very large, from having no obvious discomfort at all to having very obvious symptoms. Common manifestations include eye pain, red eyes, photophobia, tearing, blurred vision, seeing floating dark spots (floaters), or flashes. Anterior uveitis typically presents with pain in the front of the eye, congestion and photophobia, while posterior uveitis
症状范围很大，从完全没有明显不适到症状特别明显都可能。常见的表现有眼痛、红眼、畏光、流泪、视物模糊、看到漂浮黑影（飞蚊症）或闪光感。前段炎（前葡萄膜炎）通常以眼前部的疼痛、充血和畏光为主，后段炎（后葡萄膜炎）更多表现为视力下降、视物变形或玻璃体浑浊、漂浮物增多。若同时出现关节痛、发热或皮疹等全身症状，医生会考虑系统性疾病。儿童尤其容易没有明显症状或被忽视，所以往往通过视力筛查或眼底检查被发现。需要注意的是，有时免疫学筛查也可能没有明显异常，但这并不排除已有器质性眼底损伤或葡萄膜炎的可能。 我自己的经历是：从小完全没有眼痛或眼红等任何症状，只是在幼儿园的视力筛查时被发现视力下降。隔了几个月才去做裂隙灯和眼底检查，结果显示眼底已经有器质性损伤；免疫筛查也没有明显异常。这个经历让我深刻体会到——孩子可能没有痛感也能有严重病变，定期视力筛查和必要的眼底检查非常重要。