Uveitis

INFLAMMATORY EYE DISEASE (UVEITIS)

Inflammation in the color part of the eye called the uvea is known as uveitis.  The iris is the front part of the uvea and inflammation affecting only the iris is known as iritis.  Inflammation in the eye can cause eye pain and changes to your vision.

Most cases get better with treatment – usually using steroid medications. But sometimes uveitis can lead to further eye problems such as glaucoma and cataracts.   The sooner uveitis is treated, the more successful treatment is likely to be.

What are the symptoms of uveitis?

Symptoms of uveitis include:

• eye pain – usually a dull ache in or around your eye, which may be worse on focusing

• eye redness

• sensitivity to light (photophobia)

• blurred or cloudy vision

• small shapes moving across your field of vision (floaters)

• loss of peripheral vision (the ability to see objects at the side of your field of vision)

The symptoms can develop suddenly or gradually over a few days. One or both eyes may be affected by uveitis.  Uveitis can happened as a single episode or as multiple recurrent episodes.

When to get medical advice?

The sooner uveitis is treated, the more successful treatment is likely to be.

If you have persistent eye pain or an unusual change in your vision, particularly if you've had previous episodes of uveitis, you should see your eye specialist.

Your eye specialist will perform a full eye examination, which would include special photographs taken of the back of your eye (fundus photography and OCT).  Your eye specialist may suggest further tests if uveitis is diagnosed, including X-rays and blood tests. It's important to establish the cause of uveitis because it will help determine the specific treatment needed. 

How is uveitis treated?

Steroid medication (corticosteroids) is the main treatment for uveitis. It can help reduce inflammation inside your eye.

Different types of steroid medication are recommended depending on the type of uveitis. For example:

• eyedrops are often used for uveitis that affects the front of the eye (anterior)

• injections, tablets and capsules are usually used to treat uveitis that affects the middle and back of the eye (intermediate and posterior)

Additional treatment may also be needed. This might be eyedrops to relieve pain, a type of medicine known as an immunosuppressant or, in some cases, surgery.

It is quite important that infection is excluded as a cause of the inflammation.  If infection is identified then your eye specialist will work with a physician to treat the infection.

What causes uveitis?

Majority of cases of uveitis are related to a problem with the immune system (the body's defence against illness and infection). For unknown reasons, the immune system can become overactive in the eye.  Less often, uveitis can be caused by an infection or an eye injury, and it can also occur after eye surgery.  In some cases a cause can't be identified.

Types of uveitis

There are different types of uveitis, depending on which part of the eye is affected:

• uveitis at the front of the eye (anterior uveitis or iritis) – it can cause redness and pain and tends to come on quickly

• uveitis in the middle of the eye (intermediate uveitis) – it can cause floaters and blurred vision

• uveitis at the back of the eye (posterior uveitis) – it can cause vision problems

Uveitis can sometimes affect both the front and the back of the eye. This is known as panuveitis.

Uveitis at the front of the eye (iritis) is the most common type of uveitis, accounting for about three out of four cases.  Fortunately treatment of this type of uveitis is generally very successful using steroid eye drops. 

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Complications of uveitis

Uveitis can sometimes lead to further problems, particularly if it isn't treated quickly and properly.

You're more likely to develop complications if:

• you're over 60

• you have long-term (chronic) uveitis

• you have less common types of uveitis that affect the middle or back of the eye (intermediate or posterior uveitis)

Some of the more common complications of uveitis include:

• glaucoma – where the optic nerve, which connects your eye to your brain, becomes damaged: it can lead to loss of vision if not detected and treated early on

• cataracts –  where changes in the lens of the eye cause it to become less transparent, resulting in cloudy or misty vision

• cystoid macular oedema – swelling of the retina (the thin, light-sensitive layer of tissue at the back of the eye): it can affect some people with long-term or posterior uveitis

• detached retina – when the retina begins to pull away from the blood vessels that supply it with oxygen and nutrients

• posterior synechiae – inflammation that causes the iris to stick to the lens of the eye: it's more likely to occur if uveitis isn't treated quickly