Uveitis

Uveitis affects people in different ways depending on which part of the uvea and eye is affected (front, middle or back). The symptoms of uveitis may include pain, sensitivity to bright lights and poor vision. However, some symptoms can be less obvious, making uveitis more difficult to diagnose initially. Some people may not notice any symptoms and so uveitis can be undetected for several weeks or months.

Most cases of uveitis get better with treatment. Some types of uveitis are more difficult to treat because they are long-term and have sight-threatening inflammation which can also involve other tissues close by, causing more permanent changes to your sight.

This page contains a summary of our information on uveitis. To read our full information, download our factsheet:

Uveitis is described in different ways depending on which part of your uvea is affected:

• Anterior uveitis – inflammation of the iris or ciliary body.
• Intermediate uveitis – inflammation of the ciliary body and front part of the choroid, seen in the vitreous gel.
• Posterior uveitis – inflammation of the choroid and/or retina, retinal blood vessels or optic nerve head.
• Panuveitis – inflammation of all parts of the uvea.

Uveitis may also be described depending on how long it lasts:

• Acute: when your uveitis starts suddenly but improves within three months.
• Recurrent: when the inflammation flares up and settles down over months and years. Anterior uveitis is usually recurrent with acute episodes.
• Chronic: when the inflammation is longer lasting and comes back within three months of stopping treatment. Intermediate and posterior types of uveitis are usually chronic.

There are several known causes for uveitis but sometimes the cause is unknown (idiopathic). Possible causes include:

• autoimmune and inflammatory conditions
• infections
• injury.

Anterior uveitis, sometimes called iritis, is when the iris or ciliary body at the front of your eye is inflamed. Anterior uveitis is the most common type of uveitis.

What are the symptoms of anterior uveitis?

In adults, the symptoms of anterior uveitis usually start over hours or days and often affect one eye at a time. It typically causes eye pain, eye redness and sensitivity to light (photophobia). Your eye can feel achy, and the eyeball may be tender. Your vision may be slightly blurred as well.

In children, anterior uveitis may start without any obvious symptoms, and may not be noticed by the child or their parents for a long time. This is chronic anterior uveitis.

What is the treatment for anterior uveitis?

For most people with acute anterior uveitis a course of eye drops is all the treatment needed to clear up the inflammation. In people with chronic anterior uveitis, they may need long-term medication including immunosuppressants.

Steroid eye drops

Corticosteroid eye drops, often referred to as just steroids, are used to reduce the inflammation at the front of the eye.

Depending on the level of inflammation in your eye, the dose can range from using the steroid eye drops every hour to using them just once a day. As the inflammation gets better, the dose will be reduced slowly by your ophthalmologist. It’s important not to stop using your steroid eye drops until your ophthalmologist tells you that it is safe to do so, even if your symptoms disappear. Stopping your treatment too soon can cause the inflammation to return.

Cycloplegic or mydriatic eye drops

Cycloplegic or mydriatic eye drops may be given for anterior uveitis in addition to steroid medication, but this is not always the case.

Cycloplegic drops relieve your eye pain by paralysing the muscles of your iris and ciliary body as it is the movement of these inflamed muscles that cause the pain.

What happens in the long term with anterior uveitis?

An episode of acute anterior uveitis which has been treated promptly does not usually cause any long-term changes to your sight. This is because it responds quickly to treatment initially so only a short course of eye drops is needed, and most people recover within a few weeks.

Some people will only have a single episode of anterior uveitis. However, it can recur or become chronic in which case, it may cause more problems over time.

Intermediate uveitis is when the area behind your ciliary body is inflamed, with most of the inflammation being seen in the vitreous gel, the clear jelly-like substance that fills most of your eye. Intermediate uveitis is most commonly seen in young adults.

Posterior uveitis can cause inflammation of:

• the choroid (choroiditis)
• retina (retinitis)
• the retinal blood vessels (vasculitis) and affect
• the optic nerve head, where the nerve fibres leave your eye to the brain

There are many types of posterior uveitis including birdshot chorioretinopathy and punctate inner choroidopathy (PIC). Posterior uveitis is the least common form of uveitis.

What are the symptoms of intermediate and posterior uveitis?

Intermediate uveitis can cause dense floaters (black dots, shapes and wispy lines that move across your vision) as a result of inflammatory cells in the vitreous gel. It usually affects both of your eyes. Your vision may gradually become increasingly blurry and occasionally, you may be sensitive to light.

Posterior uveitis causes blurry, distorted vision or patchiness or gaps in your vision. It can also cause problems with colour vision and/or seeing in the dark at night (nyctalopia).

Intermediate or posterior uveitis do not usually cause any eye pain or redness.

What are the treatments for intermediate and posterior uveitis?

Treatment for uveitis can differ from person to person quite considerably and will also consider the cause of your uveitis.

Corticosteroid medication

Apart from certain types of uveitis caused by infection, the key to treating uveitis is to use medications that reduce inflammation and control the immune system. Corticosteroids - often referred to as ‘steroids’ for short - work by reducing the activity of your immune system so that it no longer releases the chemicals which cause inflammation.

Corticosteroid injections or implants

Injections are used for intermediate or posterior uveitis to deliver the steroid to the parts of the eye that are inflamed. Injections can be given around the eye or into the eye. Steroids can be injected into the eye either as a liquid or as a small implant to treat non-infectious uveitis. Injections and implants are often used if only one eye requires treatment but can be given to both eyes.

Corticosteroid oral medicine

Oral (tablet) corticosteroids are another way of treating intermediate or posterior uveitis. They may also be used to treat an underlying inflammatory condition elsewhere in your body.

Immunosuppressants

Immunosuppressants can help reduce inflammation by suppressing some of the activity of your immune system. They are important for people who need long-term medication to control their uveitis, since it would not be safe to take high-dose steroids long-term.

Uveitis caused by infection

If your uveitis is caused by an infection, the infection will need to be treated with antiviral or antibiotic medication, although steroid treatment may be used to help control excessive inflammation.

Surgery

In rare cases, surgery may be needed to treat uveitis. However, this is usually only used if you have repeated or severe uveitis that affects the back of your eye.

An operation called a vitrectomy to remove the vitreous (jelly that fills the eye) may be used.

Anti-TNF drugs

Anti-TNF medication may be given to people where treatments with corticosteroids or immunosuppressants have not worked or if they are causing health problems, and the uveitis is causing worsening of vision.

What happens in the long term with intermediate and posterior uveitis?

The way in which your sight may be affected in the long term by intermediate uveitis, posterior uveitis or panuveitis may be due to the direct effects of the uveitis or its complications.

Uveitis affecting the back of your eye tends to heal more slowly so treatment may continue for a longer period. How your sight will be affected in the short and long term varies so much among individuals. The length of time it takes for your eye(s) to respond to treatment and how long a flare-up lasts also varies from person to person.

If you have chronic or recurrent uveitis you will usually be under the long-term care of an ophthalmologist and will have regular check-ups in the outpatient clinic.

Uveitis needs to be treated promptly to try to reduce the risk of further problems that might affect your sight. Good control of inflammation can be achieved in most people, and this reduces the risk of developing complications. The treatments that are used for uveitis can have side effects, and may need monitoring, but controlling the uveitis properly with treatments will give a better outcome for your sight than under-treating and allowing the uveitis to continue.

Some of the complications of uveitis include:

• raised eye pressure
• macula oedema
• cataract
• floaters
• new blood vessel growth (neovascularisation)
• retinal detachment.

It’s completely natural to be upset when you have been diagnosed with uveitis and it’s normal to find yourself worrying about the future and how you will manage with a change in your vision. We’re here to support you every step of the way, and to answer any questions you may have – just get in touch with our Sight Loss Advice Service.

Can I get help to see things better?

If your uveitis has caused reduced vision, then there is much that can be done to help you make the most of your remaining vision and adapt to any changes.

You should ask your ophthalmologist, optometrist or GP about low vision aids and having a low vision assessment. During this assessment you’ll be able to discuss the use of magnifiers and aids to see things more clearly.

Local social services should also be able to offer you information on staying safe in your home and getting out and about safely. They should also be able to offer you some practical mobility training to give you more confidence when you are out.

Our Sight Loss Advice Service can also give you practical guidance on living with sight loss, and our Online Shop has products that can make everyday tasks easier.

Other useful contacts

• Uveitis Information Group have detailed information about uveitis on their website.
• Olivia’s Vision can provide information, advice and support to anyone affected by uveitis, including uveitis in childhood. They can also help you connect with others in the same position.
• Birdshot Uveitis Society is a charity providing support and information for people with a type of uveitis called Birdshot chorioretinopathy.