Overview

Uveitis
Uveitis

Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It can cause eye pain and changes to your vision.

Most cases get better with treatment – usually steroid medicine. But sometimes uveitis can lead to further eye problems such as glaucoma and cataracts.

The sooner uveitis is treated, the more successful treatment is likely to be.

Symptoms of uveitis

Symptoms of uveitis include:

  • eye pain – usually a dull ache in or around your eye, which may be worse when focusing
  • eye redness
  • sensitivity to light (photophobia)
  • blurred or cloudy vision
  • small shapes moving across your field of vision (floaters)
  • loss of the ability to see objects at the side of your field of vision (peripheral vision)

The symptoms can develop suddenly or gradually over a few days. One or both eyes may be affected by uveitis.

When to get medical advice

Contact a GP as soon as possible if you have persistent eye pain or an unusual change in your vision, particularly if you've had previous episodes of uveitis.

The GP may refer you to an eye specialist (ophthalmologist) who will examine your eye in more detail.

The specialist may suggest further tests if uveitis is diagnosed, including eye scans, X-rays and blood tests. It's important to establish the cause of uveitis because it will help determine what treatment is needed.

Treating uveitis

Steroid medicine is the main treatment for uveitis. It can help reduce inflammation inside your eye.

Different types of steroid medicines are recommended, depending on the type of uveitis. For example:

  • eyedrops are often used for uveitis that affects the front of the eye
  • injections, tablets and capsules are usually used to treat uveitis that affects the middle and back of the eye

Additional treatment may also be needed. This might be eyedrops to relieve pain or in some cases, surgery.

What causes uveitis?

Many cases of uveitis are linked to a problem with the immune system (the body's defence against illness and infection). For unknown reasons, the immune system can become overactive in the eye.

Less often, uveitis can be caused by an infection or an eye injury, and it can also happen after eye surgery.

In some cases, a cause cannot be identified.

Types of uveitis

There are different types of uveitis, depending on which part of the eye is affected:

  • uveitis at the front of the eye (anterior uveitis or iritis) – this can cause redness and pain and tends to start quickly. This is the most common type of uveitis, accounting for about 3 in 4 cases
  • uveitis in the middle of the eye (intermediate uveitis) – this can cause floaters and blurred vision
  • uveitis at the back of the eye (posterior uveitis) – this can cause vision problems

Uveitis can sometimes affect both the front and the back of the eye. This is known as panuveitis.

Uveitis can also be described according to how long it lasts. For example:

  • acute uveitis – uveitis that develops quickly and improves within 3 months
  • recurrent uveitis – where there are repeated episodes of inflammation separated by gaps of several months
  • chronic uveitis – where the inflammation lasts longer and returns within 3 months of stopping treatment

How common is uveitis?

Uveitis is rare, affecting around 2 to 5 people in every 10,000 in the UK each year. It's most common in people aged 20 to 59, but it can also sometimes affect children.

Complications of uveitis

Uveitis can sometimes lead to further problems, particularly if it is not treated quickly and properly.

You're more likely to develop complications if:

  • you're over 60
  • you have long-term (chronic) uveitis
  • you have less common types of uveitis that affect the middle or back of the eye (intermediate or posterior uveitis)

Some of the more common complications of uveitis include:

  • glaucoma – where the optic nerve, which connects your eye to your brain, becomes damaged; it can lead to loss of vision if not found and treated early
  • cataracts – where changes in the lens of the eye cause it to become less transparent, resulting in cloudy or misty vision
  • cystoid macular oedema – swelling of the retina (the thin, light-sensitive layer of tissue at the back of the eye); it can affect some people with long-term or posterior uveitis
  • detached retina – when the retina begins to pull away from the blood vessels that supply it with oxygen and nutrients
  • posterior synechiae – inflammation that causes the iris to stick to the lens of the eye; it's more likely to happen if uveitis is not treated quickly

Who can get it

Uveitis occurs when the eye becomes inflamed (red and swollen).

Inflammation is the body's response to illness or infection.

Most cases of uveitis are linked to a problem with the immune system (the body's defence against infection and illness).

Rarely, uveitis may occur without the eye becoming red or swollen.

Immune system problems

Uveitis often occurs in people who have an underlying autoimmune condition (where the immune system mistakenly attacks healthy tissue).

Autoimmune conditions known to cause uveitis include:

  • ankylosing spondylitis – a condition where the spine and other areas of the body become inflamed
  • reactive arthritis – a condition that causes inflammation in various areas of the body
  • conditions that cause bowel inflammation – such as Crohn's disease and ulcerative colitis
  • psoriasis – a skin condition
  • psoriatic arthritis – a type of arthritis that develops in some people with psoriasis
  • multiple sclerosis – a condition mainly affecting the nerves
  • Behçet's disease – a rare condition that causes mouth ulcers and genital ulcers
  • sarcoidosis – a rare inflammatory condition that affects the lungs, skin and eyes
  • juvenile idiopathic arthritis – a type of arthritis that affects children

Infection

Uveitis can also be caused by an infection, such as:

  • toxoplasmosis – an infection caused by a parasite
  • herpes simplex virus – the virus responsible for cold sores
  • varicella-zoster virus – the virus that causes chickenpox and shingles
  • cytomegalovirus – a common infection that doesn't usually cause any noticeable symptoms, but can cause sight-threatening uveitis in people with a lowered immune system
  • tuberculosis 
  • HIV and syphilis are rare causes

Other causes

Uveitis can also be caused by:

  • trauma or injury to the eyes, or eye surgery
  • some types of cancers, such as lymphoma, although this is a very rare cause of uveitis

Sometimes, a specific cause of uveitis can't be identified. 

Gene HLA-B27

Although uveitis isn't passed down through families, a gene known as HLA-B27 has been linked to an increased risk of developing anterior uveitis (uveitis at the front of the eye).

About half of all people with anterior uveitis have the HLA-B27 gene. The gene has been found in people with certain autoimmune conditions, including ankylosing spondylitis, ulcerative colitis, psoriatic arthritis, Crohn's disease and reactive arthritis.

Treatment

Treatment for uveitis depends on what's causing it and which area of the eye is affected.

Medication is the main treatment, but in rare cases, surgery may be recommended to treat particularly severe uveitis.

Steroid medication

Most cases of uveitis can be treated with steroid medication.  A medicine called prednisolone is usually used.

Steroids work by disrupting the normal function of the immune system so it no longer releases the chemicals that cause inflammation.

Steroid medicines come in different forms, and the type used will often depend on the areas of your eye affected by uveitis.

Steroid eyedrops

Steroid eyedrops are usually the first treatment used for uveitis that affects the front of the eye (anterior uveitis) and isn't caused by an infection.

Depending on your symptoms, the recommended dose can range from having to use eyedrops every hour to once every two days.

You may have temporary blurred vision after using the drops. Don't drive or operate machinery until your vision returns to normal. 

In some people, steroid eyedrops can increase pressure in the eye. The ophthalmologist will check for this and advise you if this happens.

Don't stop using your eyedrops until your GP or ophthalmologist tells you it's safe to do so, even if your symptoms disappear. Stopping treatment too soon could lead to your symptoms returning. The frequency of drops will usually be slowly reduced over a number of weeks.

Steroid injections

If the middle or back of your eye is affected (intermediate or posterior uveitis), or corticosteroid eyedrops haven't worked, you may need corticosteroid injections.

Local anaesthetic eyedrops are used to numb your eye so you won't feel any pain or discomfort.

You'll usually only require one injection while your symptoms are at their worst.

Steroid injections rarely cause significant side effects, but in some people they can make the pressure in the eye increase. The ophthalmologist will check for this and advise you if this happens.

Steroids tablets or capsules

Steroids tablets or capsules are the strongest form of steroids. They're usually used if steroid eyedrops and injections haven't worked or are unsuitable, or for uveitis affecting the back of the eye.

Steroids tablets can cause a wide range of side effects, so will only be recommended if it's thought there's a risk of permanent damage to your vision.

How long you'll have to take oral steroids for depends on how well you respond to treatment and whether you have an underlying autoimmune condition.

Some people only need a three- to six-week course, while others need to have a course lasting months or possibly years.

Short-term side effects of corticosteroids tablets or capsules can include weight gain, increased appetite, insomnia and mood changes – such as feeling irritable or anxious.

In the long term they can cause osteoporosis, thinning of the skin, and an increased risk of infection.

To minimise any side effects, you'll be prescribed the lowest possible dose to control your symptoms.

Read more about the side effects of steroids.

Don't stop taking corticosteroids until your doctor says it's safe to do so. Suddenly stopping your medication can cause unpleasant withdrawal effects.

When your GP or ophthalmologist thinks you can stop the treatment, they'll advise you about how to gradually reduce the amount of steroids you're taking.

Mydriatic eyedrops

If you have uveitis that affects the front of your eye (anterior uveitis), you may be given mydriatic (or dilating) eyedrops in addition to steroid medication.

These drops enlarge (dilate) your pupils and relieve pain by relaxing the muscles in your eye. They can also reduce your risk of developing glaucoma, which affects vision.

However, mydriatic eyedrops can cause some temporary blurring of your vision and problems focusing your eyes.

Treating infection

If an underlying infection is causing your uveitis, the infection may also need to be treated.

Viruses can be treated with antiviral medication, bacterial infections can be treated with antibiotics, and fungal infections can be treated with antifungal medication.

Immunosuppressants

Immunosuppressant may be recommended if you're among the few people who don't respond to the treatments described above.

Immunosuppressants work by controlling the immune system and disrupting the process of inflammation.

If steroid treatment is causing significant side effects, immunosuppressants can also be used to allow your dose of steroids to be reduced.

Possible side effects of immunosuppressants include:

Taking immunosuppressants will make you more vulnerable to infection, so you should try to avoid close contact with anyone who has a known infection.

Report any symptoms of a potential infection, such as a high temperature, cough, or inflammation in other parts of your body, to your GP. You should also have the annual flu jab.

Immunosuppressants can also affect the functioning of some organs and systems, such as the lungs, liver, kidneys and bone marrow. Blood tests are needed at regular intervals to check these systems remain healthy.

A small number of people with uveitis can benefit from treatment with immunosuppressants known as biologics.

Surgery

Rarely, an operation called a vitrectomy may be needed to treat uveitis. It's usually only recommended if you have repeated or severe uveitis, or if the condition is caused by certain infections.

A vitrectomy involves gently sucking out the vitreous humour (the jelly-like substance that fills the inside of the eye). It can be carried out using either general anaesthetic or local anaesthetic.

During the operation, the fluid inside your eye will be temporarily replaced with either a bubble of air or gas (or a mixture of the two), or a liquid substitute. Eventually, the vitreous humour will naturally replace itself. 

Like all operations, a vitrectomy carries a risk of complications. These include needing further surgery and an increased risk of developing cataracts.

Symptom relief

The following measures may help relieve your symptoms:

  • wearing dark glasses if your eye becomes sensitive to light
  • placing a warm flannel over your eye to soothe it
  • taking painkillers, such as ibuprofen, to relieve pain  


The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 03/11/2021 15:00:34