Uveitis
Uveitis is inflammation inside the eye that can cause pain, redness, and vision problems. While it affects millions of people worldwide each year, early diagnosis and treatment can prevent serious complications, including permanent vision loss.
Table of contents
- What is Uveitis?
- The Uvea and Eye Anatomy
- Types of Uveitis
- Signs and Symptoms
- Causes and Risk Factors
- How Doctors Diagnose Uveitis
- Treatment Options
- Possible Complications
- Living With Uveitis
What is Uveitis?
Uveitis is a form of inflammation (swelling) that occurs inside the eye. Inflammation is the body’s way of responding to tissue damage, germs, or toxins. In uveitis, this inflammation affects the middle layer of the eye, but it often affects other parts of the eye as well.[1][3]
There isn’t much room inside the eyeball for tissue swelling, so even small amounts of swelling can change the eye’s shape. Since your eye shape is critical to how you see, even tiny changes from swelling can disrupt your vision.[1]
Uveitis is fairly common. Worldwide, there are about 4 million new cases each year. In the United States, estimates range from 80,000 to 168,000 cases annually.[1]
The condition is more common in adults, and the chances of having it increase with age. It’s most common in people ages 20 to 60. Children make up only 2% to 20% of cases.[1][3]
The Uvea and Eye Anatomy
- Iris
- Ciliary body
- Choroid
- Retina
- Vitreous
- Sclera
The uvea is the middle layer of the eye, located between the white outer layer (called the sclera) and the light-sensitive inner layer at the back of the eye (called the retina). The uvea has three main parts.[2][3]
The iris is the colored part of the eye that you can see when you look in a mirror. It sits at the front of the eye and controls how much light enters through the pupil.[2]
The ciliary body is a structure located behind the iris. It helps the eye’s lens focus on objects at different distances.[2][3]
The choroid is a layer of blood vessels between the retina and the sclera. It provides nutrients and oxygen to the retina, which is responsible for sending visual information to your brain.[2][3]
The inside of the back of the eye is filled with a gel-like substance called the vitreous, which helps maintain the eye’s shape.[2]
Types of Uveitis
Doctors classify uveitis based on which part of the eye is affected. There are four main types.[1][3]
Anterior uveitis affects the front part of the eye, specifically the iris and ciliary body. It is the most common type and is usually less serious than other forms. It primarily affects young or middle-aged people.[1][3]
Intermediate uveitis affects the middle portion of the eye, particularly the ciliary body and the vitreous. This type often occurs in young adults who have other health conditions such as multiple sclerosis or sarcoidosis.[1]
Posterior uveitis affects the back part of the eye, including the retina and choroid. This is the rarest type.[1][3]
Panuveitis occurs when inflammation affects all parts of the uvea, from the front to the back of the eye.[1][3]
Signs and Symptoms
The symptoms of uveitis can appear suddenly and get worse quickly. In some cases, they develop gradually. Symptoms may affect one eye or both eyes.[2][3]
The symptoms vary depending on which area of the eye is inflamed. Anterior uveitis typically causes symptoms that are visible to you or others around you.[1]
Common symptoms of anterior uveitis include eye pain, redness or irritation of the eye, blurred vision, and sensitivity to light (called photophobia). You may also notice a swollen outer layer of the eye, changes in pupil shape (from a circle to an irregular shape), or white liquid accumulating at the bottom of the front of the eye.[1]
Intermediate and posterior uveitis usually cause symptoms that are harder for you or others to see. Instead, these symptoms are more likely to affect what you see and how well you see it.[1]
Symptoms of intermediate and posterior uveitis include blurry vision, an increase in floaters (small dark spots or squiggly lines that float across your vision), or floaters that are easier to notice. You may also experience gaps or missing sections in your field of vision or decreased vision overall.[1][3]
Sometimes, especially in children and young adults, there are no symptoms at all, and uveitis is discovered during a routine eye exam.[2]
Causes and Risk Factors
Uveitis can happen for many different reasons. Between 50% and 70% of cases are idiopathic, meaning doctors cannot identify a specific cause.[1][5]
Sometimes uveitis occurs when your immune system (the body’s defense system against illness) is fighting an eye infection. However, it can also happen when your immune system mistakenly attacks healthy tissue in your eyes.[3]
Several types of infections can cause uveitis. Viruses that may trigger the condition include herpes simplex virus, varicella-zoster virus (which causes chickenpox and shingles), and cytomegalovirus. Rubella, which is vaccine-preventable, can also cause uveitis.[1][3]
Bacteria that cause syphilis and tuberculosis can lead to uveitis. Fungi, including Candida species and mold species like Aspergillus, may also cause the condition. Parasites can trigger uveitis as well, including parasites that people can get from pets like cats.[1]
Uveitis is sometimes linked to autoimmune diseases, which occur when the immune system attacks the body’s own tissues. These conditions include AIDS, ankylosing spondylitis, Behcet’s disease, lupus, multiple sclerosis, psoriasis, rheumatoid arthritis, sarcoidosis, ulcerative colitis, and Vogt-Koyanagi-Harada disease.[3]
Other possible causes include eye injury, eye surgery, certain medications, inflammatory disorders, and cancers that can affect the eye, such as lymphoma.[3][4]
Anyone can develop uveitis, but you’re at higher risk if you smoke cigarettes.[3]
How Doctors Diagnose Uveitis
Eye doctors can check for uveitis during a comprehensive eye examination. The exam is simple and painless.[3][6]
The examination typically includes checking your vision and how your pupils respond to light. Your doctor will perform tonometry, which measures the pressure inside your eye. Numbing eye drops may be used for this test.[6]
A slit-lamp examination is necessary to identify tiny inflammatory cells in the front of the eye. A slit lamp is a microscope that magnifies and lights up the front of your eye with an intense line of light.[6]
Your doctor will also perform ophthalmoscopy (also called funduscopy), which involves widening your pupil with eye drops and shining a bright light into the eye to examine the back of the eye.[6]
Additional tests your doctor may recommend include color photography of the inside of the eye, optical coherence tomography (OCT) imaging to map the retina and choroid and reveal swelling, or special dye tests called fluorescein angiography or indocyanine green angiography that photograph swollen blood vessels inside the eyes.[6]
Your doctor will ask about your medical history and may recommend blood tests, imaging tests such as radiography, CT scans, or MRI scans, or analysis of fluid from the eye. These tests help determine if you have an infection or another disease that could be causing uveitis.[3][6]
Sometimes it’s difficult to find a specific cause for uveitis. Even if a specific cause cannot be identified, uveitis can still be treated successfully.[6]
Treatment Options
Treatment for uveitis depends on the type and cause of the inflammation. The main goal is to reduce inflammation, ease symptoms, and prevent vision loss.[3]
Steroids (medications that reduce inflammation) are the most common treatment. Your eye doctor may prescribe steroid eye drops, pills, or injections into the eye. These medicines can reduce inflammation in your eye, ease symptoms, and prevent vision loss.[3]
Traditional treatment often involves using systemic steroids (taken by mouth or through an injection), either alone or with other anti-inflammatory medications. However, this approach can have serious side effects, including increased blood pressure, diabetes, and osteoporosis.[11]
To reduce side effects from systemic steroids, doctors have explored local delivery methods. Steroid implants that are placed inside the eye can deliver medication over time. Newer-generation implants, such as the dexamethasone intravitreal implant and the fluocinolone acetonide implant, use lower doses and are associated with fewer side effects.[11]
For severe uveitis, doctors may prescribe immunosuppressive agents (medications that calm down the immune system). Common first-line agents include methotrexate and mycophenolate mofetil, which are affordable and generally well-tolerated.[11]
Biologics, such as adalimumab, are often used when conventional immunosuppressants don’t work well enough. These medications can extend the time before the condition worsens, improve vision, and reduce inflammation.[11]
If uveitis is caused by an infection, your doctor will treat the underlying infection with appropriate medications.[3]
It’s important to follow your treatment plan exactly as prescribed. Use any prescribed eye drops or ointments as your doctor instructed. Keep the eyedropper or bottle tip clean, and don’t touch it to your eyelashes or any other surface.[14]
Possible Complications
Uveitis can be serious and may lead to permanent vision loss if not treated promptly. In severe cases, it can cause blindness. In fact, uveitis is the third leading cause of blindness in the United States.[1]
Without treatment, uveitis may cause several complications. These include macular edema (swelling in the central part of the retina), glaucoma (increased pressure in the eye), cataracts (clouding of the eye’s lens), optic nerve damage, retinal detachment, and permanent vision loss.[4]
Sometimes uveitis goes away quickly, but it can come back. In some cases, it becomes a chronic (long-term) condition that requires ongoing management.[3]
Living With Uveitis
If you have symptoms of uveitis, see your eye doctor right away. Early diagnosis and treatment are crucial to prevent complications and save your vision.[3]
Follow-up care is an important part of your treatment and safety. Make sure to attend all appointments and call your doctor if you’re having problems.[14]
While recovering, wear sunglasses if light hurts your eyes. Avoid wearing contact lenses and eye makeup until your eyes have healed. Don’t drive if you have blurred vision.[14]
Call your doctor immediately if you have signs of an eye infection, such as pus or thick discharge from the eye, redness or swelling around the eye, or fever. Also contact your doctor if you experience new or worse eye pain, vision changes, or if it feels like something is in your eye.[14]
Living with vision problems caused by uveitis can be challenging. If you have low vision, simple changes at home can help. Remove items on the floor that could be walking hazards, space out furniture to allow room to move around, and label kitchen items with large print. Look for devices with large buttons and numbers, and consider using audiobooks for entertainment. Many computers have accessibility features designed for people with vision problems.[15]
For general eye health, maintain a healthy lifestyle. Eat foods that support eye health, such as those containing vitamin C (papayas, red bell peppers, kiwi, strawberries, oranges) or antioxidants like lutein and beta-carotene (carrots, sweet potatoes, squash, spinach, kale, broccoli). When using a computer, follow the 20/20/20 rule: take a 20-second break every 20 minutes and focus on something at least 20 feet away. Wear protective eyewear when doing work that could affect your eyes, and wear sunglasses outside.[4]
Most importantly, communicate with your eye doctor every step of the way, especially since uveitis symptoms may worsen over time. With proper treatment and care, many people with uveitis can maintain good vision and quality of life.[4]
