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Uveitis

Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract

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What is uveitis?

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Uveitis is a term that covers a variety clinic phenotype of eye conditions of intraocular inflammation conditions. There are different terms that people refer to uveitis, as iritis and chorioretinitis, however, each of them has different meanings.

Uveitis is more common in people aged 20 to 59, but may happen in any age.

It's estimated that two to five in every 10,000 people is affected by uveitis in the UK every year. Despite being an uncommon eye condition, uveitis is an important cause of visual impairment in this country.

Most cases get better with treatment. However, uveitis may lead to further eye problems such glaucoma and cataract.

The sooner uveitis is treated, the more successful the treatment is likely to be. This is why it is very important to confirm a diagnosis of uveitis as soon as possible if you develop symptoms that could be related to the condition.

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How uveitis affects vision and what causes it

Symptoms of uveitis include:

• eye pain – usually a dull ache in or around your eye, which may be worse when focusing the vision.

• eye redness.

• light sensitivity (photophobia).

• blurred or cloudy vision.

• small shapes that move across your visual field (floaters).

• loss of the ability to see objects at the side of your field of vision.

The symptoms can develop suddenly or gradually and one or both eyes may be affected by the condition. In some cases, however, the symptoms may be minimal and not noticed.

The inflammation may be limited to the eyes or it could be related to a condition somewhere else in your body. 

The causes may vary and they can be primarily inflammatory, infective, malignant or injury to the eye. However, in about 40% of patients it remains undetermined, even after appropriate clinical assessment and investigation.

Types of uveitis

There are different types of classifications for this condition, but the most common are related to which part of the eye is affected and the duration of symptoms:

• Anterior Uveitis – this is inflammation of the iris (iritis) or inflammation of the iris and the ciliary body (iridocyclitis), and is the most common type of uveitis, accounting for the majority of the cases:

  • > acute anterior uveitis – the commonest form of acute uveitis, accounting for one in four of all intraocular inflammation.

  • > chronic anterior uveitis – defined as persisting for more than three months.

• Intermediate uveitis – this affects the area around and behind the ciliary body, also known as an inflammation that is centered on the pars plana and peripheral retina.

• Posterior uveitis – this affects the area at the back of the eye, the choroid and the retina. It is also known as chorioretinits.

• Panuveitis – this happens when the inflammation affects front and back of the eye.  

How can I be diagnosed with uveitis?

The diagnosis of uveitis is predominantely clinical, subject to meticulous history taking and examination. It is vital that a comprenhensive ocular and systemic history is taken by the doctor. In order to help that, you may keep a logbook about some previous events that may be related to your condition. You can also keep the letters and the documents you have if you have already been seen by your GP or another specialist and bring them to your appointment.

Which investigations will I need?

Depending on the presentation, symptoms, severity of the condition, we may need to do further tests to confirm or exclude some eye and/or systemic conditions.

The most common tests are eye scans and/or photographs, blood tests and chest x-ray. After examining your eyes, your eye doctor will be able to explain to you which tests you will need to have done.

Treatments for uveitis

The treatment for the condition depends on the cause of the inflammation. It is important to understand why the inflammation is happening so we can deliver the specific treatment, for example, antibiotics in cases of infections, although finding its cause may not always be possible.

The main treatment of uveitis is a medication called corticosteroid, also known as steroid,  which can reduce inflammation inside the eye.

Several different types of steroid medication may be used, depending on the type of uveitis you have. Eye drops are often used for uveitis affecting the front of the eye, whereas injections, tablets and capsules are more often used to treat uveitis affecting the middle and back of the eye.

Some cases may require other treatments, including eye drops to relieve the pain or dilate the pupil; another type of medication, called an immunosuppressant; and rarely surgery.

All these drugs have possible side effects and your doctor will explain them to you. We may need to proceed with frequent assessments including blood tests in order to monitor your general health.

Please, note that steroid should not be stopped suddenly because you may develop serious ‘rebound inflammation’ or you may have severe consequences in your health. Always seek for advice from your doctor if you have any question about your medication.

Which complications can I experience?

Although most cases of uveitis, especially in the front part of the eye, respond quickly to treatment and cause no further consequences there is still a risk of complications, which is related to the area of the eye is affected.

The risk of complication is higher in people who have intermediate or posterior uveitis, or who have repeated episodes of uveitis.

Complications of uveitis include permanent deterioration in vision, glaucoma, cataract, retinal damage and macular swelling, among others.

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