Uveitis

What is Uveitis?

People with uveitis develop red, swollen, inflamed eyes, together with eye pain. Certain conditions increase the risk of uveitis, but the disease often occurs for no known reason. Treatments can restore lost vision and prevent further loss, although some types of uveitis can return after treatment, and untreated uveitis can lead to blindness. Uveitis is inflammation of the uvea of the eye — a general term for a group of diseases that cause red eyes, eye pain and inflammation. The uvea is the middle layer of the eye, lying between the outer white layer (the sclera) and the inner layer (the retina).
These diseases usually affect the uvea, but they can also involve other parts of the eye. Without treatment, uveitis can cause permanent blindness or loss of vision.

Does uveitis affect both eyes?

Uveitis can develop in one eye or in both. It can affect:

• Retina: The innermost layer of the eye, which senses colour and light and sends images to the brain
• Uvea: The middle layer of the eye, comprising the iris (the coloured part of the eye), the choroid (the membrane containing most of the eye’s blood vessels) and the ciliary body (which connects the iris and the choroid and supplies nutrients to the eye)
• Sclera: The white outer part of the eye

How common is uveitis?

It is estimated that two to five in every 10,000 people in the UK develop uveitis each year. Men and women are equally affected.

Who might get uveitis?

Uveitis affects people of all ages, including children. Women, and people between the ages of 20 and 60, are at slightly higher risk.

What are the types of uveitis?

Uveitis is usually classified according to where in the eye the inflammation occurs:

• Anterior: The most common type, anterior uveitis causes inflammation at the front of the eye. Symptoms can appear suddenly and, if mild, occasionally settle on their own. Some people have chronic, recurrent inflammation that subsides with treatment and then returns. You may be more prone to anterior uveitis if you have:
  • Arthritis, including ankylosing spondylitis
  • Autoimmune diseases, such as sarcoidosis or juvenile idiopathic arthritis
  • Gastrointestinal disorders, such as inflammatory bowel disease
  • A previous herpes virus infection (cold sores or genital herpes) or chickenpox virus infection
• Intermediate: Young adults are more prone to intermediate uveitis, which causes inflammation in the middle of the eye. Also called iridocyclitis or vitritis, it often affects the vitreous, the fluid-filled space inside the eye. Symptoms can improve and subside, then return and worsen. About one in three people with intermediate uveitis also have:
  • Multiple sclerosis
  • Sarcoidosis
• Posterior: The least common form, posterior uveitis affects the inner part of the eye and is often also the most severe. It can involve the retina, the optic nerve and the choroid — the layer that contains the blood vessels supplying the retina. It is sometimes called choroiditis or chorioretinitis. Associated causes include:
  • Birdshot chorioretinopathy
  • Viral causes such as herpes virus or chickenpox virus
  • Systemic Lupus Erythematosus
  • Sarcoidosis
  • Syphilis
  • Tuberculosis
• Panuveitis: Rarely, uveitis affects all three layers of the eye. This form is more severe and carries a higher risk of permanent vision loss. Potential causes include:
  • Bacterial or fungal retinitis
  • Viral retinitis
  • Toxoplasmosis
  • Systemic Lupus Erythematosus
  • Sarcoidosis
  • Syphilis
  • Tuberculosis

What causes uveitis?

It is estimated that one in three cases of uveitis has no known cause. People who smoke are more prone to the condition. Eye inflammation can also be caused by:

• Eye injury
• Eye surgery
• Infections such as herpes virus, chickenpox virus, tuberculosis and syphilis
• Inflammatory diseases such as lupus, inflammatory bowel disease and rheumatoid arthritis

What are the symptoms of uveitis?

Symptoms of uveitis may appear gradually or suddenly:

• Blurred vision
• Dark, floating shapes in your field of vision (eye floaters)
• Eye pain or pressure
• Light sensitivity
• Red eyes
• Loss of vision

How is uveitis diagnosed?

During an eye examination, your ophthalmologist will look inside your eye. A typical examination usually includes:

• A visual acuity test (reading an eye chart) to check for vision loss
• An eye pressure test (tonometry) to measure intraocular pressure
• A slit-lamp examination of the inside of the eye

What tests may be requested?

During an eye examination, your ophthalmologist will look inside your eye. A typical examination usually includes:

• A visual acuity test (reading an eye chart) to check for vision loss
• An eye pressure test (tonometry) to measure intraocular pressure
• A slit-lamp examination of the inside of the eye

The ophthalmologist may also order other tests, such as:

• Blood tests to exclude infections or underlying autoimmune diseases
• Imaging of your chest or brain to look for systemic inflammatory causes
• Fluorescein angiography to image the blood vessels at the back of the eye
• Gonioscopy to examine the front of the eye, where fluid drains
• Optical coherence tomography (OCT) to take detailed images of the back of the eye, including the retina
• Optical coherence tomography with angiography (OCTA) to produce three-dimensional images of blood flow through the eye
• A visual field test to check for optic nerve damage that may affect your peripheral vision

How is uveitis treated?

Untreated uveitis can lead to blindness, so it is important to see your ophthalmologist immediately if you have redness, inflammation or pain in the eyes. In many cases, treatment helps restore lost vision; it can also prevent further tissue damage and ease inflammation and pain. If an underlying health condition has contributed to the uveitis, treating that condition should also relieve the eye inflammation.

Some forms of uveitis take a long time to subside, and some return after treatment. Depending on the type of disease, treatments include:

• Antibiotics, antivirals or antifungals: These medicines treat uveitis caused by an infection.
• Eye drops: Dilating (enlarging) the pupil with eye drops can reduce pain and swelling. Drops can also prevent the iris and lens from sticking together, a complication that can occur with anterior uveitis. Your ophthalmologist may also prescribe drops to reduce raised eye pressure (ocular hypertension).
• Steroidal anti-inflammatories: Medications containing corticosteroids (steroids) relieve eye inflammation. They come in many forms: drops, ointments, oral tablets, injections inside or around the eye, intravenous (IV) infusions, or a capsule that your doctor surgically implants in the eye.
• Immunosuppressants: These medications calm the immune system’s response to autoimmune disease or body-wide inflammation. Your doctor may prescribe them if uveitis affects both eyes, does not respond to steroids or threatens your vision. They can be taken orally as a tablet, by injection or through an intravenous infusion.

What are the side effects or risks of treatment of uveitis?

Some immunosuppressants may increase the risk of cancer. Long-term use of steroids can lead to:

• Cataracts or glaucoma (raised eye pressure)
• Cushing’s syndrome (an excess of cortisone)
• Diabetes
• Heart disease
• Osteoporosis
• Peptic (stomach) ulcers
• Weight gain, fluid retention and oedema

What are the complications of uveitis?

It is estimated that one in five people with uveitis will develop raised pressure in the eye (ocular hypertension), which can lead to glaucoma and irreversible loss of vision. People with uveitis are also at risk of other eye problems, such as:

• Posterior synechiae
• Glaucoma
• Cataracts
• Cystoid macular oedema
• Retinal detachment
• Damage to the retina leading to vision loss

What is the prognosis for those suffering from uveitis?

Most people who receive prompt treatment for uveitis have few, if any, long-term vision problems. Treatment can halt the progression of the disease and restore lost vision. Severe forms may require long-term treatment, and serious disease is more likely to cause vision loss or even blindness. If you have conditions that put you at risk of uveitis, regular eye examinations are essential.

When should I call my ophthalmologist?

You should call your doctor if you experience:

• Eye floaters or flashes
• Eye pain, redness or swelling
• Eye pressure
• Sensitivity to light
• Loss of vision