When any part of the uvea becomes inflamed, it can affect vision, cause pain, and, if not treated promptly, lead to serious complications. Uveitis can affect one or both eyes and can occur as a single episode or recur over time.
At Pure Sight Eye Surgeons, Dr Alison Chiu and her colleagues diagnose and manage uveitis, working to identify the underlying cause and prevent complications that could threaten your vision.
Types of Uveitis
Uveitis is classified by the part of the uvea that’s affected:
- Anterior uveitis (iritis) — inflammation of the iris, at the front of the eye. This is the most common form and typically causes eye pain, redness, and sensitivity to light. It often responds well to treatment and has a good prognosis when managed promptly.
- Intermediate uveitis — inflammation of the ciliary body and the vitreous (the gel that fills the eye). It can cause floaters and blurred vision.
- Posterior uveitis — inflammation at the back of the eye, affecting the choroid and potentially the retina. This is less common but can cause more significant vision loss.
- Panuveitis — inflammation affecting all layers of the uvea. This is the most serious form and requires careful management.
Causes
Uveitis can have many different causes, and in some cases the exact trigger isn’t identified. Known causes and associations include:
- Autoimmune and inflammatory conditions — conditions such as ankylosing spondylitis, rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), psoriatic arthritis, and sarcoidosis are commonly associated with uveitis
- Genetic factors — certain genetic markers, particularly HLA-B27, are strongly associated with anterior uveitis
- Infections — bacterial, viral, and fungal infections can trigger uveitis. These include herpes simplex virus, varicella-zoster virus (shingles), toxoplasmosis, tuberculosis, and syphilis
- Eye injury or surgery — trauma to the eye can cause inflammation
- Idiopathic — in many cases, no specific cause is found despite thorough investigation
When uveitis is suspected to be linked to a systemic condition, your ophthalmologist may work with other specialists, such as a rheumatologist or immunologist, to investigate and manage the underlying cause.
Symptoms
Symptoms of uveitis can develop suddenly or gradually, depending on the type. They may include:
- Eye pain, which may be dull or aching
- Redness of the eye
- Sensitivity to light (photophobia)
- Blurred vision
- Floaters (dark spots or shapes drifting across your vision)
- A small or irregularly shaped pupil
Not all types of uveitis cause pain. Posterior uveitis, for example, may present mainly as blurred vision and floaters without significant redness or pain. If you experience any sudden change in your vision, redness, or eye pain, you should seek prompt assessment.
Diagnosis
Dr Chiu and her clinical team will perform a detailed assessment and examination using a slit lamp microscope, which allows close inspection of the front and back of the eye. She’ll look for signs of inflammation, including cells and protein in the fluid inside the eye, changes to the iris, and any effects on the retina or optic nerve.
Additional tests may include:
- Optical coherence tomography (OCT) — to assess the retina and detect fluid or swelling
- Fluorescein angiography — to evaluate the retinal blood vessels if posterior uveitis is suspected
- Blood tests — to check for autoimmune markers (such as HLA-B27), inflammatory markers, and infectious causes
- Imaging — chest X-ray or other scans may be requested if conditions like sarcoidosis or tuberculosis are being investigated
Treatment
The treatment for uveitis depends on the type, severity, and underlying cause. The primary goals are to reduce inflammation, relieve pain, prevent complications, and preserve vision.
Corticosteroid eye drops
For most cases of anterior uveitis, corticosteroid eye drops are the first-line treatment. These are prescribed on a specific tapering schedule, and it’s important to follow the schedule closely. Stopping drops too soon can cause a recurrence. Pupil-dilating drops may also be prescribed to relieve pain and prevent the iris from sticking to the lens (posterior synechiae).
Oral or injectable corticosteroids
For more severe uveitis, particularly intermediate and posterior types, oral corticosteroids or injections around or into the eye may be needed to control inflammation.
Immunosuppressive therapy
If uveitis is chronic or recurrent, or if it’s associated with a systemic autoimmune condition, longer-term immunosuppressive medication may be required. This is typically managed in collaboration with a rheumatologist or immunologist.
Treating the underlying cause
If an infection is identified as the cause, specific antimicrobial treatment will be prescribed alongside anti-inflammatory therapy. Managing any associated systemic condition is also essential for preventing recurrence.
Complications
If uveitis is not treated promptly or adequately, it can lead to serious complications, including:
- Increased eye pressure (uveitic glaucoma)
- Cataract formation
- Macular oedema (swelling of the central retina)
- Retinal detachment
- Permanent vision loss
Early diagnosis and treatment are essential to reduce the risk of these complications. If you have a known autoimmune condition, regular eye examinations can help detect uveitis early, even before symptoms become obvious.
Frequently Asked Questions
Is uveitis serious?
It can be. While many cases of anterior uveitis respond well to treatment and resolve without lasting damage, untreated or poorly controlled uveitis can cause permanent vision loss. Posterior uveitis and panuveitis tend to be more serious. Prompt assessment and treatment give the best chance of preserving vision.
Can uveitis come back?
Yes, uveitis can recur, particularly if it’s associated with an autoimmune condition or a genetic predisposition such as HLA-B27. Some people experience a single episode, while others have repeated flare-ups that require ongoing management.
Is uveitis contagious?
No. Although some cases of uveitis are caused by infections, the uveitis itself is not contagious. You can’t catch it from someone else or pass it on.