Introduction

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 medication. But sometimes uveitis can lead to further eye problems such as glaucoma and cataracts (see below). The sooner uveitis is treated, the more successful treatment is likely to be. This page covers:

Symptoms of uveitis

Symptoms of uveitis include:

  • eye pain – usually a dull ache in or around your eye, which may be worse on focusing
  • eye redness 
  • sensitivity to light (photophobia)
  • blurred or cloudy vision 
  • small shapes moving across your field of vision (floaters)
  • loss of peripheral vision (the ability to see objects at the side of your field of 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 your 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 sooner uveitis is treated, the more successful treatment is likely to be.

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

They 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 the specific treatment needed.

Treating uveitis

Steroid medication (corticosteroids) is the main treatment for uveitis. It can help reduce inflammation inside your eye.

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

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

Additional treatment may also be needed. This might be eyedrops to relieve pain, a type of medicine known as an immunosuppressant or, in some cases, surgery.

Read more about treating uveitis.

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 occur after eye surgery.

In some cases a cause can't be identified.

Read more about the causes of uveitis.

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) – it can cause redness and pain and tends to come on quickly
  • uveitis in the middle of the eye (intermediate uveitis) – it can cause floaters and blurred vision
  • uveitis at the back of the eye (posterior uveitis) – it can cause vision problems

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

Uveitis at the front of the eye is the most common type of uveitis, accounting for about three out of four cases.

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

  • acute uveitis – uveitis that develops quickly and improves within three 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 three months of stopping treatment

How common is uveitis?

Uveitis is rare, affecting around two to five 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 isn't 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 detected and treated early on
  • 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 occur if uveitis isn't treated quickly 

Information about you

If you have uveitis, your clinical team may ask you for permission to pass information on to the Congenital Anomaly Register and Information Service CARIS.

CARIS helps scientists identify more effective ways of treating and preventing rare conditions, such as ichthyosis. You can opt out of the register at any time.

Find out more about the CARIS register.

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Causes

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:

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.

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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 (corticosteroids). A medicine called prednisolone is usually used.

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

Corticosteroids are available in a number of forms, and the type used will often depend on the areas of your eye affected by uveitis.

Corticosteroid eyedrops

Corticosteroid 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.

Corticosteroid 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.

Corticosteroid 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.

Corticosteroids tablets or capsules

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

Corticosteroids 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 (see complications of uveitis for more information).

How long you'll have to take oral corticosteroids 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 corticosteroids.

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 corticosteroids 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  
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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 21/03/2017 09:15:40