Eyes - uveitis

About Uveitis

Uveitis is a medical term describing inflammation within the eyeball. It may involve one or more of the following internal parts of the eye: The iris, the ciliary body, the vitreous gel, the retina, the choroid or the optic nerve.

Iritis is the most common type of uveitis. It is inflammation of the iris, the coloured part of the eye. It is also called anterior uveitis. Uveitis may be caused by infections, autoimmune disorders or side effects of various medications, although in a large percentage of patients no cause is ever found.

Iritis symptoms typically begin suddenly and can include a red eye, eye pain, light sensitivity, blurred vision, pain when moving the eye or when trying to focus on near objects and a small or distorted pupil. Attacks typically only involve one eye at a time. Without correct treatment, iritis can cause permanent vision problems. Young and middle-aged people are most commonly affected.

There is not always a cure for iritis, but treatment of individual episodes can control inflammation and prevent complications. However, iritis may come back.

Anatomical types of uveitis

Uveitis may be classified based on the part of the eye it predominantly involves:

• Anterior uveitis – inflammation of the iris and ciliary body, also commonly known as iritis or iridocyclitis. It is the most common pattern of uveitis.
• Intermediate uveitis or pars planitis – inflammation involving the vitreous gel. Vitreous gel fills the majority of the eye cavity.
• posterior uveitis – inflammation of the choroid, retina or optic nerve. The choroid is the major layer of blood vessels within the eyeball and is commonly involved in inflammation at the back of the eye.
• Pan uveitis – All the above parts of the eye are involved.

Causes of uveitis

Common known causes include:

• Autoimmune disease – such as ankylosing spondylitis or sarcoidosis
• Infections – such as herpes virus infection, syphilis, Toxoplasmosis or bacteria in patients with sepsis
• Isolated ocular autoimmune disorder – the immune system attacks the iris for unknown reasons, even when no other autoimmune disease is present.
• Certain medications, including some glaucoma drops and cancer immunotherapy
• Past eye injury or multiple eye operations
• Immune reaction of the body against tattoo ink

It is important that you have an assessment by a medical specialist (ophthalmologist) who will review your medical history and may preform tests (such as blood tests and x-rays) to find out if there is an underlying cause of your uveitis.

Symptoms of uveitis

Uveitis can involve one or both eyes. Symptoms typically come on suddenly and can include:

• red eye
• eye pain
• eye pain when in bright light
• blurred vision
• small and/or distorted pupil.
• pain when moving the eye
• pain when focusing on near objects (reading text/phone)

Diagnosis of uveitis

Diagnosis of uveitis depends on a thorough eye examination. If uveitis is diagnosed and treated in its early stages, there is often no permanent damage to the eye or vision.

Treatment of uveitis

Uveitis should be treated by a medical eye specialist (ophthalmologist). Treatment typically takes six to ten weeks to treat an episode of anterior uveitis. Treatment of intermediate and posterior uveitis is more complex and can take many months or even years. You need to be closely monitored during treatment to minimise the development of complications.

Treatment may include:

• corticosteroids – The most potent anti inflammatory medications. Most people with uveitis respond to corticosteroid eye drops. Those with posterior uveitis often require local injections of corticosteroids or oral corticosteroids. Some people require additional immunosuppressive medications
• cycloplegic medication – eye drops that dilate the pupil to prevent it sticking to the lens of the eye. These drops reduce the risk of scarring between the pupil and the lens and also help reduce pain
• treatment of an underlying condition – uveitis may be a sign of an undiagnosed disease or infection somewhere else in the body. If so, that disease will need to be treated

Complications of uveitis

Complications associated with uveitis include:

• glaucoma – Uveitis and the corticosteroid treatment for uveitis can both cause the pressure inside the eye to increase to high levels. That may in turn damage the optic nerve and the vision.
• Lens opacity (AKA cataract) – Uveitis and the corticosteroid treatment of uveitis can both cause the natural lens inside the eye to lose its transparency and become opaque. This may be treated relatively easily by replacing the opaque natural lens with a clear artificial lens (cataract surgery)

Where to get help

• Your GP (doctor)
• Ophthalmologist
• Local general hospital or specialist eye hospital