Uveitis

What is uveitis?

Uveitis is inflammation inside your eye, affecting the uvea, the middle layer between the white of your eye and the retina at the back. It can affect one or both eyes, and needs prompt treatment to help protect your sight.

What are the symptoms of uveitis?

Symptoms of uveitis can include:

• eye pain, which may feel worse when reading
• red or watery eyes
• blurred or reduced vision
• sensitivity to light
• floaters (dark spots or flashes of light drifting across your vision).

Symptoms can appear suddenly, over hours or days, or build up more gradually over weeks or months. Uveitis affecting the front of the eye tends to be more painful, while uveitis further back often causes little or no pain, just blurred vision or floaters. Sometimes there are no symptoms at all.

What are the causes of uveitis and who is at risk?

The exact cause of uveitis often isn't known; this is the case in around half to seven in ten people with the condition. When a cause is identified, it's usually one of the following:

• an autoimmune or inflammatory condition, such as multiple sclerosis, ankylosing spondylitis, sarcoidosis, or inflammatory bowel disease
• an infection, including the herpes simplex virus, the virus that causes shingles, toxoplasmosis, tuberculosis, or syphilis
• an injury to the eye, including from eye surgery
• rarely, certain medicines, or a growth in the eye.

Uveitis is a rare condition overall. It can affect anyone at any age, but it's most common in adults in their 20s to 60s, and is somewhat more common in women. Smoking also appears to increase your risk.

Are there different types of uveitis?

Yes, uveitis is grouped into four types, depending on which part of the eye is affected:

• Anterior uveitis (also called iritis) affects the front of the eye, around the iris. This is the most common type.
• Intermediate uveitis (sometimes called cyclitis) affects the middle of the eye, around the ciliary body and the gel-like vitreous.
• Posterior uveitis (also called choroiditis) affects the back of the eye, including the choroid and retina.
• Panuveitis, or diffuse uveitis, is when inflammation affects all parts of the uvea at once.

Intermediate uveitis, posterior uveitis and panuveitis are more likely than anterior uveitis to become recurrent or long-term, and this ongoing inflammation carries a higher risk of lasting damage to your sight, particularly to the retina and optic nerve.

How is uveitis diagnosed?

If a GP suspects uveitis, they'll refer you to an eye specialist (ophthalmologist), usually to be seen within 24 hours so treatment can start quickly.

The ophthalmologist will examine your eyes closely, often using a slit lamp (a special microscope) to look for inflammation, and may use eye drops to widen your pupils for a better view of the back of your eye. They may also check the pressure inside your eye and take detailed images of your retina.

If a cause isn't obvious, you may be offered blood tests or scans, such as a chest X-ray, to check for underlying conditions like an autoimmune disease or infection.

How is uveitis treated?

Treatment aims to reduce the inflammation, ease your symptoms, and prevent damage to your sight. What's used depends on which part of your eye is affected, the cause, and how severe your uveitis is.

Non-surgical treatment for uveitis

Steroid medicines are usually the first treatment. They can be given as eye drops, tablets, or an injection around or into the eye, depending on which part of the eye needs treating. Eye drops alone aren't effective for uveitis at the back of the eye, so an injection is often used instead to get the medicine where it's needed.

You may also be given drops to widen your pupil, which helps ease pain and stops the iris sticking to nearby parts of the eye. If an infection is the underlying cause, you'll be given antibiotics or antiviral medicine alongside anti-inflammatory treatment.

If your uveitis is severe or keeps coming back, your specialist may suggest medicines that dampen down your immune system (immunosuppressants), or newer treatments that target specific proteins involved in inflammation (biologics, including TNF inhibitors). Laser treatment or a brief freezing treatment (cryotherapy) to part of the eye are other options for difficult cases.

Surgical treatment for uveitis

Surgery isn't usually needed for uveitis itself, but it may be used in severe cases, or to treat complications such as cataracts, glaucoma or a detached retina. One option is a vitrectomy, where the gel-like substance inside your eye is removed and replaced with a gas bubble, air bubble, or a special solution while your eye heals.

When should I see a doctor?

Get an urgent GP appointment or contact NHS 111 if you have:

• pain in your eye or eyes
• sensitivity to light
• changes in your vision, such as flashing or blurring
• very red eyes, in one eye or both.

Go to A&E or call 999 straight away if you suddenly lose your vision.