Uveitis

What is Uveitis;

Those suffering from uveitis develop red, swollen, inflamed eyes. They also have 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 vision loss. Some types of uveitis can come back after treatment. Untreated uveitis can lead to blindness. Uveitis is inflammation of the uvea of the eye, it is a general term used to describe a group of diseases that cause red eyes, eye pain and inflammation. The uvea is the middle layer of the eye. It is located between the outer, white, layer of the eye called the sclera and the inner layer called the retina.
These diseases usually affect the uvea. They can also affect other parts of the eye. If not treated, uveitis can cause permanent blindness or loss of vision.

Does uveitis affect both eyes?

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

Retina: The innermost layer of the eye senses colors and light and sends images to the brain
Uvea: The middle layer of the eye includes the iris (colored part of the eye), the choroid (membrane with the most blood vessels of the eye) and the ciliary body (connects the iris and the choroid and provides nutrients to the eye)
Sclera: The white outer part of the eye

How common is uveitis?

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

Who might get uveitis?

Uveitis affects people of all ages, even children. Women and people between the ages of 20 and 60 have a slightly higher risk.

What are the types of uveitis?

Uveitis is usually classified based on where eye inflammation occurs:

Anterior: The most common type, anterior uveitis causes inflammation in the front of the eye. Symptoms can appear suddenly and can occasionally subside on their own if they are mild. Some people have chronic, recurrent eye inflammation that subsides with the treatment and then comes back; 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
- Previous herpes virus infections (cold sores or genital herpes) or chicken pox virus
Intermediate: Young adults are more prone to intermediate uveitis. This condition causes inflammation in the middle of the eye. It is also called iridocyclitis or vitritis, it often affects the vitreous, the wet-filled space inside the eye. Symptoms can improve, subside, and then come back and worsen; about one in three people with intermediate uveitis also have:
- Multiple sclerosis
- Sarcoidosis
Posterior: The least common form, the posterior uveitis affects the inner part of the eye. it is often also the most severe. It can affect the retina, optic nerve and the choroid. The choroid contains blood vessels that supply blood to the retina. It’s sometimes called choroiditis or chorioretinitis.
- Birdshot chorioretinopathy
- Viral etiologies such as herpes virus or chicken pox virus
- Systemic Lupus Erythematosus
- Sarcoidosis
- Syphilis
- Tuberculosis
Panuveitis: Rarely, uveitis affects all three layers of the eye. This type is more severe and increases the chances 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 have no known cause. People who smoke are more prone to uveitis. Eye inflammation can also be caused by:

Eye injury
Eye surgery
Infections, such as herpes virus, chicken pox virus, tuberculosis, 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?

Your ophthalmologist will look inside your eye during an eye examination. A typical eye examination usually includes:

Visual acuity test (reading of ocular diagrams) for vision loss testing
Eye pressure test (tonometry) to measure intraocular pressure
Examination with a slit lamp of the inside of the eye

What tests may be requested?

Your ophthalmologist will look inside your eye during an eye examination. A typical eye examination usually includes:

Visual acuity test (reading of ocular diagrams) for vision loss testing
Eye pressure test (tonometry) to measure intraocular pressure
Examination with a slit lamp 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 get images of blood vessels in the back of the eye
Gonioscopy to examine the front of the eye where liquid 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
Visual field test to check for damage to the optic nerve that may affect your peripheral vision

How is uveitis treated?

Untreated uveitis can lead to blindness. It is important to see your ophthalmologist immediately if you have redness, inflammation or pain in the eyes. In many instances, treatments help restore lost vision. They can also prevent more damage to tissues and ease inflammation and pain. If a health condition contributed to uveitis, treatment of this disease should also relieve eye inflammation.

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

Antibiotics, antivirals or antifungals: These drugs treat uveitis caused by an infection.
Eye drops: Dilation (enlargement) of the pupil with eye drops can reduce pain and swelling. Eye drops can also prevent the iris and lens from sticking together, a complication that can occur with anterior uveitis. Your ophthalmologist may also prescribe eye drops to reduce eye pressure (ocular hypertension).
Steroidal anti-inflammatories: Medications containing corticosteroids (steroids) relieve eye inflammation. These drugs are present in many forms: drops, ointments, oral pills, injections inside or around the eye, intravenous (IV) infusions or a capsule that your doctor surgically implants into the eye.
Immunosuppressants: These medications calm the immune system’s response to autoimmune disease or inflammation throughout the system. Your doctor may prescribe these medications if uveitis affects both eyes, does not respond to steroids or threatens your vision. You can take the drug orally as a pill, as an injection or through an intravenous infusion into a vein.

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 (high ocular pressure)
Cushing’s syndrome (excessive 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 high pressure in the eye (ocular hypertension). This condition can lead to glaucoma and irreversible loss of vision. People with uveitis are also at risk for other eye problems, such as:

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

What is the prognosis for those suffering from uveitis?

Most people who receive promt treatment for uveitis have little, if any, long-term vision problems. Treatments can stop the progression of the disease and restore lost vision. Severe forms may need long-term treatment. Serious illness is more likely to cause vision loss or even blindness. If you have conditions that put you at risk for uveitis, regular eye examinations are necessary.

When should I call my ophthalmologist?

You should call your doctor if you experience: