Uveitis

Overview - Uveitis

Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It can cause eye pain and changes to your vision.

Most cases get better with treatment – usually steroid medicine. 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.

Symptoms of uveitis

Symptoms of uveitis include:

  • eye pain – usually a dull ache in or around your eye, which may be worse when focusing
  • eye redness
  • sensitivity to light (photophobia)
  • blurred or cloudy vision
  • small shapes moving across your field of vision (floaters)
  • loss of the ability to see objects at the side of your field of vision (peripheral vision)

The symptoms can develop suddenly or gradually over a few days. One or both eyes may be affected by uveitis.

When to get medical advice

Contact a GP as soon as possible if you have persistent eye pain or an unusual change in your vision, particularly if you've had previous episodes of uveitis.

The GP may refer you to an eye specialist (ophthalmologist) who will examine your eye in more detail.

The specialist may suggest further tests if uveitis is diagnosed, including eye scans, X-rays and blood tests. It's important to establish the cause of uveitis because it will help determine what treatment is needed.

Treating uveitis

Steroid medicine is the main treatment for uveitis. It can help reduce inflammation inside your eye.

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

  • eyedrops are often used for uveitis that affects the front of the eye
  • injections, tablets and capsules are usually used to treat uveitis that affects the middle and back of the eye

Additional treatment may also be needed. This might be eyedrops to relieve pain or in some cases, surgery.

Read more about treating uveitis.

What causes uveitis?

Many cases of uveitis are linked 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 happen after eye surgery.

In some cases, a cause cannot be identified.

Read more about the causes of uveitis.

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) – this can cause redness and pain and tends to start quickly. This is the most common type of uveitis, accounting for about 3 in 4 cases
  • uveitis in the middle of the eye (intermediate uveitis) – this can cause floaters and blurred vision
  • uveitis at the back of the eye (posterior uveitis) – this can cause vision problems

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

Uveitis can also be described according to how long it lasts. For example:

  • acute uveitis – uveitis that develops quickly and improves within 3 months
  • recurrent uveitis – where there are repeated episodes of inflammation separated by gaps of several months
  • chronic uveitis – where the inflammation lasts longer and returns within 3 months of stopping treatment

How common is uveitis?

Uveitis is rare, affecting around 2 to 5 people in every 10,000 in the UK each year. It's most common in people aged 20 to 59, but it can also sometimes affect children.

Complications of uveitis

Uveitis can sometimes lead to further problems, particularly if it is not 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 found and treated early
  • 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 happen if uveitis is not treated quickly

Page last reviewed: 3 January 2020
Next review due: 3 January 2023

Causes - Uveitis

Uveitis happens when the eye becomes red and swollen (inflamed).

Inflammation is the body's response to illness or infection.

Most cases of uveitis are linked to a problem with the immune system (the body's defence against infection and illness).

Rarely, uveitis may happen without the eye becoming red or swollen.

Immune system problems

Uveitis often happens in people who have an autoimmune condition. This is where the immune system mistakenly attacks healthy tissue.

Autoimmune conditions known to cause uveitis include:

Infection

Uveitis can also be caused by an infection, such as:

  • toxoplasmosis – an infection caused by a parasite
  • herpes simplex virus – the virus responsible for cold sores
  • varicella-zoster virus – the virus that causes chickenpox and shingles
  • cytomegalovirus – a common infection that does not usually cause any noticeable symptoms, but can cause sight-threatening uveitis in people with a lowered immune system
  • tuberculosis
  • HIV and syphilis are rare causes

Other causes

Uveitis can also be caused by:

Sometimes, a specific cause of uveitis cannot be identified.

Gene HLA-B27

Although uveitis is not passed down through families, a gene known as HLA-B27 has been linked to an increased risk of developing uveitis at the front of the eye (anterior uveitis).

About half of all people with anterior uveitis have the HLA-B27 gene. The gene has been found in people with certain autoimmune conditions, including ankylosing spondylitis and ulcerative colitis.

Page last reviewed: 3 January 2020
Next review due: 3 January 2023

Treatment - Uveitis

Treatment for uveitis depends on what's causing it and which area of the eye is affected.

Medicine is the main treatment, but in rare cases, surgery may be recommended to treat particularly severe uveitis.

Steroid medicine

Most cases of uveitis can be treated with steroid medicine. A medicine called prednisolone is usually used.

Steroids work by disrupting the normal function of the immune system so it no longer releases the chemicals that cause inflammation.

Steroid medicines come in different forms, and the type used will often depend on the areas of your eye affected by uveitis.

Steroid eyedrops

Steroid eyedrops are usually the first treatment used for uveitis that affects the front of the eye and is not caused by an infection.

Depending on your symptoms, the recommended dose can range from having to use eyedrops every hour to once every 2 days.

You may have temporary blurred vision after using the drops. Do not drive or operate machinery until your vision returns to normal.

In some people, steroid eyedrops can increase pressure in the eye. The eye specialist (ophthalmologist) will check for this and advise you if this happens.

Do not stop using your eyedrops until a GP or ophthalmologist tells you it's safe to do stop, even if your symptoms disappear. Stopping treatment too soon could lead to your symptoms returning. The frequency of drops will usually be slowly reduced over a number of weeks.

Steroid injections

If the middle or back of your eye is affected or steroid eyedrops have not worked, you may need steroid injections.

Local anaesthetic eyedrops are used to numb your eye so you will not feel any pain or discomfort.

You'll usually only require 1 injection while your symptoms are at their worst.

Steroid injections rarely cause significant side effects, but in some people they can make the pressure in the eye increase. The ophthalmologist will check for this and advise you if this happens.

Steroids tablets or capsules

Steroids tablets or capsules are the strongest form of steroids. They're usually used if steroid eyedrops and injections have not worked or are unsuitable, or for uveitis affecting the back of the eye.

Steroids tablets can cause a wide range of side effects, so will only be recommended if it's thought there's a risk of permanent damage to your vision.

How long you'll have to take steroid tablets for depends on how well you respond to treatment and whether you have an underlying autoimmune condition.

Some people only need to take them for 3 to 6 weeks, while others need to take them for months or possibly years.

Short-term side effects of steroids tablets or capsules can include weight gain, increased appetite, insomnia and mood changes such as feeling irritable or anxious.

In the long term they can cause osteoporosis, thinning of the skin, and an increased risk of infection.

To minimise any side effects, you'll be prescribed the lowest possible dose to control your symptoms.

Read more about steroids.

Do not stop taking steroids until a doctor says it's safe to do so. Suddenly stopping your medicine can cause unpleasant withdrawal effects.

When a GP or ophthalmologist thinks you can stop the treatment, they'll advise you about how to gradually reduce the amount of steroids you're taking.

Mydriatic eyedrops

If you have uveitis that affects the front of your eye (anterior uveitis), you may be given mydriatic eyedrops as well as steroid medicine.

These eyedrops enlarge (dilate) your pupils and relieve pain by relaxing the muscles in your eye. They can also reduce your risk of developing glaucoma, which affects vision.

However, mydriatic eyedrops can cause some temporary blurring of your vision and problems focusing your eyes.

Treating infection

If an underlying infection is causing uveitis, the infection may also need to be treated.

Viruses can be treated with antiviral medicine. Bacterial infections can be treated with antibiotics. Fungal infections can be treated with antifungal medicine.

Immunosuppressants

Immunosuppressant may be recommended if you're among the few people who do not respond to the treatments described above.

Immunosuppressants work by controlling the immune system and disrupting the process of inflammation.

If steroid treatment is causing significant side effects, immunosuppressants can also be used to allow your dose of steroids to be reduced.

Possible side effects of immunosuppressants include:

  • skin rash
  • numbness or tingling in different parts of your body
  • loss of appetite
  • nausea and vomiting
  • high blood pressure
  • headaches
  • hair loss
  • breathlessness

Taking immunosuppressants will make you more vulnerable to infection, so you should try to avoid close contact with anyone who has a known infection.

Report any symptoms of a potential infection, such as a high temperature, cough, or inflammation in other parts of your body, to a GP. You should also have the annual flu vaccine.

Immunosuppressants can also affect the functioning of some of your organs and systems in your body, such as your lungs, liver, kidneys and bone marrow. Regular blood tests are needed to check these systems remain healthy.

A small number of people with uveitis can benefit from treatment with immunosuppressants known as biologics.

Surgery

Rarely, an operation called a vitrectomy may be needed to treat uveitis. It's usually only recommended if you have repeated or severe uveitis, or if the condition is caused by certain infections.

A vitrectomy involves gently sucking out the jelly-like substance that fills the inside of the eye (vitreous humour). It can be done using either a general anaesthetic or a local anaesthetic.

During the operation, the fluid inside your eye will be temporarily replaced with either a bubble of air or gas (or a mixture of the 2), or a liquid substitute. Eventually, the vitreous humour will naturally replace itself.

Like all operations, a vitrectomy carries a risk of complications. These include needing further surgery and an increased risk of developing cataracts.

Symptom relief

The following measures may help relieve your symptoms:

  • wearing dark glasses if your eye becomes sensitive to light
  • placing a warm flannel over your eye to soothe it
  • taking painkillers, such as ibuprofen, to relieve pain

Page last reviewed: 3 January 2020
Next review due: 3 January 2023