Uveitis is a term that covers several related inflammatory conditions that mainly affect the uvea, the part of the eye containing the iris, ciliary body, and choroid; however, uveitis can affect other parts of the eye too. (Learn More) There are several types of uveitis. It may clear up in weeks or months, or it can become chronic conditions. (Learn More)

There is not one underlying cause of uveitis. Instead, several autoimmune conditions, diseases, damage to the eye, eye infections, or cancer can trigger inflammation in the eye, along with the rest of the body, which may lead to uveitis among other symptoms. (Learn More)

It is important to get prompt diagnosis and treatment for uveitis to prevent the condition from progressing to other problems like cataracts, glaucoma, or vision loss. (Learn More) There are several medical treatments for uveitis, which focus on reducing inflammation and pain. It is rare that you would need surgery to treat uveitis, but there are surgical options along with prescription medications that can treat this eye condition. (Learn More)

Healthy eye vs. Uveitis

What Is Uveitis?

 

Uveitis is the term for a group of inflammatory eye diseases affecting the uvea, or the middle collection of organs in the eye. While many forms of uveitis have no specific underlying cause, inflammation can be triggered by infections, injury, the development of a different disease, or diseases that impact the immune system. Often, acute uveitis will clear up with treatment in a few weeks; however, chronic uveitis can lead to severe vision loss. In fact, in the developed world, uveitis is the fifth leading cause of blindness in adults.

Uveitis is not limited to the uvea, although it may begin there, and it becomes most apparent in these areas of the eye. The uvea encompasses these parts of the eye:

  • Iris: This is the part of the eye with eye color. This area also secretes nutrients that keep the eye healthy and controls pupil size to manage how much light enters the back of the eye.
  • Ciliary body: This is located between the iris and the choroid. It controls the shape of the lens and manages nutrients that keep the lens healthy.
  • Choroid: This is a thin network of blood vessels resembling a sponge, bringing nutrients to the retina in the back of the eye.

If uveitis spreads, it can affect the lens, retina, vitreous humor, and even the optic nerve. Sometimes, it can damage the cornea and sclera too.

Adults between 20 and 60 years old are the most likely to develop uveitis, but the condition has been found in children and older adults as well. The inflammatory condition may develop in one or both eyes. In the United States, about 200 out of every 10,000 people receive a new diagnosis of uveitis annually. Uveitis that recurs or does not go away is the riskiest form of this condition. It causes about 20 percent of legal blindness in the U.S.

Types of Uveitis

 

While uveitis mainly affects the uvea, it can start or spread to other areas of the eye, eventually leading to blindness. There are several types of uveitis. The most often diagnosed versions include:

  • Anterior uveitis: Also called iritis, this type of inflammation in the eye impacts the front parts of the uvea, especially the iris and the ciliary body. This is the most common form of uveitis in young and middle-aged adults. This condition is most often characterized by pain, light sensitivity, and blurry vision.
  • Intermediate uveitis: Sometimes also called cyclitis, this form of the condition affects the vitreous humor, which is the clear gel-like structure in the center of the eye. It is also common in young adults. The most common symptoms of this type of uveitis include floaters and blurry vision.
  • Posterior uveitis: Also called choroiditis or retinitis, this is the least common form of uveitis, and it primarily affects the back of the eye. Symptoms most common to posterior uveitis include decreased or lost vision along with floaters.
  • Panuveitis: Also called diffuse uveitis, this form of inflammation harms the eye as a whole, not just the uvea.
  • Drug-induced uveitis: Some prescription medications may cause inflammation, which increases the risk of uveitis. Topical formulas, periocular or intraocular injections, and medications that affect the whole body may trigger an inflammation response. If you have prescription medications and are concerned about this side effect, ask your doctor about the risk.

Aside from the areas of the eye that are inflamed, uveitis is also classified based on duration.

  • Acute uveitis: This is short-term uveitis, which may last a few weeks or even a few months, but eventually clears up. While it may clear up on its own, it is best to be diagnosed by an eye doctor and get treatment to help acute uveitis clear up without damaging internal structures in the eye.
  • Chronic uveitis: This lasts for several months to years, and it may recur frequently or never truly clear up.

Causes and Symptoms of Uveitis

woman experiencing eye burn

The primary cause of uveitis is inflammation in the eye, and it leads to various symptoms.

  • Blurry vision
  • Floaters, or dark spots floating in the vision
  • Eye pain
  • Redness in the eye
  • Photophobia, or sensitivity to light
  • Flashing lights in the vision
  • Tearing or watering eyes
  • Narrowing of the pupils to manage light

Inflammation has several potential causes. It is usually the body’s response to infections, tissue damage, toxins, or irritants. Swelling, redness, and warmth destroy the tissues targeted by white blood cells, and for the most part, the body’s response is important and effective. However, some conditions associated with the immune response can be harmful, and uveitis is an unfortunate side effect.

Some triggers of uveitis include:

  • Impact on the eye, leading to bruising.
  • Injury or surgery on the eye, including cosmetic surgeries like LASIK.
  • Infections in the eye or other parts of the body.
  • Tumors in the eye or other parts of the body.
  • Autoimmune diseases.
  • Viruses, parasites, or other infections that impact the immune system.
  • Environmental toxins.

Various diseases have been associated with an increased risk of uveitis.

  • AIDS
  • Tuberculosis
  • Crohn’s disease and other gastrointestinal conditions
  • Herpes zoster (shingles) or herpes simplex infection
  • Histoplasmosis
  • Lyme disease
  • Syphilis
  • Psoriasis
  • Sarcoidosis
  • Toxoplasmosis
  • Ulcerative colitis
  • Rheumatoid arthritis
  • West Nile virus
  • Multiple sclerosis

Some types of cancer trigger inflammation in the body, which may lead to uveitis. Cancer in the eye can also cause uveitis as a side effect.

You may also be more genetically at risk of uveitis than others. This means you may struggle with recurring uveitis, and you require frequent vision checkups and treatment as a result.

The Risks if Uveitis Remains Untreated

 

Uveitis has caused blindness in thousands of people in the U.S. While the condition is more serious when left untreated, chronic uveitis may also progress into blindness after several years. Risks of uveitis include:

  • Glaucoma from high fluid pressure in the eye.
  • Cataracts in one eye or both eyes.
  • Macular edema.
  • Scar tissue throughout the eye.
  • Damage to the optic nerve.
  • Retinal detachment.
  • Permanent vision loss.

Diagnosis and Treatment of Uveitis

Ophthalmologist doctor with the snellen chart

To receive a uveitis diagnosis, an optometrist or ophthalmologist will need to examine your eyes. You may also need to give a medical history, including any existing medical conditions and medications. If you have uveitis, it could indicate an underlying condition, so following a comprehensive eye exam with a visit to your general practitioner is wise.

An eye exam will include thorough examination of your eyes, along with:

  • A visual acuity test, which may include the Snellen eye chart.
  • A fundoscopic exam, in which the pupil is dilated, and a light is shone through with an ophthalmoscope, so your optometrist can examine the middle and back of your eye.
  • Ocular pressure test involving a tonometer or a tonopen, which will touch the surface of your eye after you receive numbing drops and measure the internal pressure of your eye.
  • A slit lamp exam, which uses a dye called fluorescein so the blood vessels throughout your eye can be seen more easily.

Your optometrist or ophthalmologist will try to avoid more invasive tests, but you may also need further medical exams or tests like:

  • Blood tests.
  • Fluid analysis from a sample of the vitreous humor.
  • Angiography to examine the retinal blood flow.
  • Photographic tests examining the thickness of retinal tissue to determine the presence or absence of fluid underneath the retina.

Based on the symptoms you experience, knowledge of any underlying conditions, and the results of tests, you may receive a uveitis diagnosis. If you have uveitis, your eye doctor will provide approaches to treatment that are primarily designed to reduce or eliminate inflammation. They also focus on alleviating pain, preventing tissue damage, and restoring as much lost vision as possible. The specific treatment you are prescribed will depend on what type of uveitis you have.

For example, anterior uveitis is treated with eye drops that dilate the pupil and prevent muscle spasms in the iris and ciliary body (called cycloplegics). You may also receive separate eye drops that contain a steroid like prednisone, which reduces inflammation, or you may receive a combined eye drop.

Intermediate, posterior, and panuveitis treatments may start with steroid eye drops, but they may also include injections in the eye, oral medications, or time-release capsules that are surgically implanted in the eye to manage chronic inflammation. If you are diagnosed with an autoimmune disease, you may take separate immunosuppressants that can alleviate some of your uveitis symptoms.

In some milder cases, you may take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen to reduce inflammation and pain, or you may take these over-the-counter medicines in combination with other prescription treatments.

In more intense or chronic, recurrent cases, you may undergo surgery. Damage to the physical structures of the eye, including chronic diseases like cataracts or glaucoma triggered by uveitis, may require surgical procedures to restore vision.  Another form of surgery you may need is a vitrectomy, which removes some of the vitreous gel from the middle of your eye, relieving pressure and removing some inflamed or infected tissue. Your ophthalmologist will let you know if or when this treatment is needed.

References

 

Facts About Uveitis. (August 2011). National Eye Institute (NEI), National Institutes of Health (NIH).

Uveitis: A Guide to Your Condition and Its Treatment. (December 2016). AbbVie.

Uveitis: Overview. (June 5, 2018). Mayo Clinic.

What Is Uveitis? (August 22, 2018). American Academy of Ophthalmology (AAO).

Drug-Induced Uveitis. (March 13, 2013). Journal of Ophthalmic Inflammation and Infection.

Uveitis Causes. (August 22, 2018). American Academy of Ophthalmology (AAO).

Uveitis: What You Need to Know. (March 7, 2017). Medical News Today.

Uveitis: Diagnosis. (June 5, 2018). Mayo Clinic.