Uveitis

Uveitis affects people in different ways and 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 soat all. This means uveitis can sometimes go be undetected for several weeks or months.

The symptoms of uveitis may include:

• Pain
• Redness
• Sensitivity to light
• Blurriness
• Floaters
• Reduced vision

When inflammation is treated promptly, the eye can usually recover well, but if it lasts too long or becomes too strong, it may lead to lasting t changes to the eye tissues and affect your vision permanently, which is why monitoring and treatment are important.

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:

Around two to five in every 10,000 people are affected by uveitis in the UK every year. Uveitis affects people of any age, but most commonly between the ages of 20 and 59 years. Uveitis in children and young people is less common than in adults. Uveitis in children commonly affects the front (anterior) of the uvea. Adults and children are more likely to get uveitis if they have certain autoimmune conditions (see below), or other long-term health conditions.

Uveitis is named based on which part of your uvea is affected:

• Anterior uveitis – inflammation of the iris or ciliary body.
• Intermediate uveitis – inflammation of the vitreous.
• Posterior uveitis – inflammation of the choroid and/or retina.
• Panuveitis – inflammation of all parts of the eye, meaning the iris, ciliary body, vitreous, retina and choroid.

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

• Acute: when the inflammation starts suddenly but improves within three months.
• Recurrent: when the inflammation flares up and settles down over months and years. Adult anterior uveitis can be recurrent with acute episodes.
• Chronic: when the inflammation is longer lasting and comes back within three months of stopping treatment.

Sometimes uveitis has a known cause, but other times no underlying cause can be found and the uveitis is labelled ‘idiopathic’.

The most common causes of uveitis include:

• Autoimmune and inflammatory conditions
• Infections

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

What are the symptoms of anterior uveitis?

Acute anterior uveitis typically has a sudden onset and is usually symptomatic. Symptoms generally develop over hours to days and may affect one eye or both eyes. The symptoms are:

• eye pain
• eye redness
• sensitivity to light (photophobia).
• slightly blurred vision

However, anterior uveitis can also present as a more silently progressive, chronic condition, with symptoms developing gradually over days to weeks. Chronic anterior uveitis often has few symptoms at first, so diagnosis is often delayed.

What is the treatment for anterior uveitis?

Treatment for anterior uveitis is usually with eye drops and is given quickly to reduce inflammation and pain.

Corticosteroid eye drops

Corticosteroid eye drops, often referred to as steroids, are used to reduce the inflammation in anterior uveitis.

Depending on how bad the inflammation in your eye is, steroid eye drops may be prescribed as often as every hour. 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 along with steroid medication to treat anterior uveitis, but this is not always the case.

Cycloplegic drops relieve your eye pain by paralysing the muscles of your iris and ciliary body. It is the movement of these inflamed muscles that cause the pain, so limiting the movement helps to reduce this pain.

Treating infection

If your anterior uveitis is caused by an infection, treatment will also focus on the underlying cause and may include antiviral, antibiotic, or antiparasitic medications, depending on the type of infection.

What happens in the long term with anterior uveitis?

For most people with acute anterior uveitis a course of eye drops is all the treatment needed to clear up the inflammation.

If acute anterior uveitis is treated quickly, it doesn’t cause long-term problems with your vision. This is because it responds well to early treatment, and most people get better within a few weeks.

Some people will only have a single episode of anterior uveitis. However, it can recur or become chronic, especially in children. In these cases, the uveitis may cause more problems over time.

Intermediate uveitis is when the inflammation is mainly in the clear gel (vitreous) that fills most of your eye. It can happen in children, young adults and adults.

What are the symptoms of intermediate uveitis?

Intermediate uveitis can cause thick floaters (black dots, shapes and wispy lines) that move across your vision. This happens because tiny, inflamed cells are floating in the vitreous gel. It can affect one eye or both of your eyes. When it affects both eyes, it is not always at the same time or to the same degree. Your vision may gradually become more blurry and occasionally, you may be sensitive to light.

Intermediate uveitis does not usually cause any eye pain or redness. It is often chronic, meaning that it can last for a long time - sometimes months or even years. The severity can change over time; the inflammation may flare up suddenly or develop more slowly.

Posterior uveitis can cause inflammation of:

• the choroid (choroiditis)
• the retina (retinitis)
• the retinal blood vessels (vasculitis)

There are many types of posterior uveitis. These may be caused by infections or by non-infectious inflammatory conditions, and they can occur either as a condition affecting only the eye or as part of a condition that affects other parts of the body.

What are the symptoms of posterior uveitis?

The symptoms of posterior uveitis can develop gradually or suddenly and may affect one or both eyes. Common symptoms include blurred or reduced vision, floaters, flashes of light, distortion of vision, and reduced colour vision. Unlike anterior uveitis, posterior uveitis is less likely to cause a painful red eye or sensitivity to light. If left untreated, it can lead to permanent vision loss, so prompt assessment by an ophthalmologist is important.

Posterior uveitis is often chronic, meaning that it can last for a long time - sometimes months or even years. The severity can change over time. It can affect both eyes, but not always at the same time or to the same degree, or one eye only.

What are the treatments for intermediate and posterior uveitis?

Treatment for uveitis can vary a lot from person to person and depends on what is causing the uveitis.

Corticosteroid medication

Apart from certain types of uveitis caused by infection, treatment usually focuses on reducing inflammation and controlling the immune system. Corticosteroids - often referred to as ‘steroids’ for short are commonly used. They work by slowing down the activity of your immune system, which stops it from releasing the chemicals that cause inflammation.

Corticosteroid injections or implants

Steroid injections are used for intermediate or posterior uveitis to target the inflamed areas of the eye. They can be given either around the eye or into the eye. When injected into the eye, steroids may be given as a liquid or as a small implant for non-infectious uveitis. Injections and implants are commonly used when only one eye needs treatment, but can be used in both eyes if necessary.

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 slowing down some of the activity of your immune system. They are important for people who need long-term long-term treatment for uveitis, because it isn’t safe to take high-dose steroids l for a long time. If your uveitis is linked to another condition in your body (a systemic condition), this medicine helps treat that condition as well as your eyes.

Anti-infective medication

If your uveitis is caused by an infection, the infection will need to be treated with antiviral, antibiotic, antifungal, or antiparasitic medications. Steroids may also be used to help control excessive inflammation.

Anti-TNF drugs

Anti-TNF medication may be used if corticosteroids or conventional immunosuppressants have not worked, or if they are causing health problems, and the uveitis is affecting your vision.

Panuveitis is inflammation of all parts of the uvea of the eye, which includes the iris, ciliary body, and choroid. The condition can also affect the lens, retina, optic nerve, and vitreous, causing reduced vision or sight loss.

What are the symptoms of panuveitis?

The symptoms of panuveitis are like those of the other types of uveitis. You may notice blurred or reduced vision, light sensitivity, eye pain or redness, or floaters in your vision. Sometimes, panuveitis can come on suddenly; other times it can be less obvious, developing slowly and lasting a long time. Examination by an ophthalmologist is necessary to get an accurate diagnosis.

What is the treatment for panuveitis?

The treatment for panuveitis varies depending on its cause and severity. The standard treatment is oral steroid with steroid eye drops. Both are started at a high dose and then gradually reduced. A gradual reduction in steroid medication is vital to prevent the panuveitis from immediately flaring up again.

If the underlying cause of the panuveitis is an autoimmune condition, then immunosuppressants or anti-TNF drugs that alter the immune system response are used to help prevent new episodes of panuveitis from occurring. If an infection is the cause of panuveitis, antiviral, antibiotic, antifungal, or antiparasitic medications are usually used, in many cases alongside the steroids to help control excessive inflammation.

Uveitis needs to be treated quickly promptly to try to reduce the risk of further eye problems that might affect your sight. Good control of inflammation can be achieved in most people, which lowers and this reduces the risk chance of developing complications. TheAlthough treatments that are used for uveitis can have side effects, and may need monitoring, but controlling the uveitis properly with treatments will gives a much better outcome for your sight than under-treating not treating it enough and allowing the uveitis to letting the inflammation 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 retinochoroiditis (or Birdshot chorioretinopathy).