Everything You Need to Know About Uveitis

Uveitis is an inflammatory condition that affects the uveal tract of the eye. While the condition can resolve rapidly with treatment, it can lead to blindness in patients with certain untreated systemic illness.

Although uveitis mainly occurs in persons between the ages of 20 and 50, it can also occur in children and the elderly. Pediatric uveitis accounts for 5 to 10 percent of all cases (Current Opinion in Ophthalmology, 2013).

What Are The Symptoms of Uveitis I Should Know? 

Uveitis may occur suddenly and rapidly worsen, or it may develop gradually. One or both eyes may be affected. The most common symptoms of uveitis include:

• Decreased visual acuity or “haziness”
• Dull, aching eye pain
• Red eyes
• Light sensitivity

These symptoms primarily occur in people with acute anterior uveitis, the most common type. Chronic anterior uveitis may present without pain or light sensitivity, however. People with intermediate or posterior uveitis are usually pain-free but have blurred vision and see “floaters,” typically in both eyes. People with panuveitis may have symptoms of all types of uveitis.

Uveitis is a rare disease, affecting about 1 percent of the population, and is considered an ophthalmologic emergency because it can permanently damage eyesight. Eye pain is not always a symptom of uveitis.

The possibility of uveitis is one of the reasons you should contact your eye doctor immediately if you notice any change in your vision. Corticosteroids are usually the first-line treatment after an infectious cause has been ruled out. Immunosuppressive agents may be necessary to preserve sight.

What Are The Different Types of Uveitis?

The location of the inflammation in the uveal tract determines what type of uveitis you have:

• Anterior uveitis (iritis) – affects the iris
• Intermediate uveitis (cyclitis) – affects the ciliary body
• Posterior uveitis (choroiditis) – affects the choroid and structures in the back of the eye
• Panuveitis – affects all areas of the uvea

What Causes Uveitis in People?

The cause of uveitis is often unclear, although in some idiopathic cases (cases in which the cause of symptoms cannot be determined), uveitis may be associated with a systemic illness. Uveitis has been linked to numerous conditions, including:

• Autoimmune disorders such as reactive arthritis, rheumatoid arthritis, ankylosing spondylitis, Kawasaki disease, sarcoidosis, and Behçet syndrome
• Cancers that can affect the eye
• Eye injury
• Infectious diseases such as herpes zoster infection, histoplasmosis, toxoplasmosis, syphilis, tuberculosis, cytomegalovirus retinitis, and Lyme disease
• Immune-mediated skin diseases such as psoriasis
• Inflammatory diseases such as ulcerative colitis and Crohn’s disease

You may be at increased risk for uveitis if you have a genetic predisposition for the disease or if you smoke cigarettes. One study found that “A history of smoking is significantly associated with all anatomic subtypes of uveitis and infectious uveitis” (Ophthalmology, 2010).

How is Uveitis Diagnosed Properly?

Uveitis is typically diagnosed by an eye care professional. When you visit your eye care professional, he or she will perform a complete eye examination using a slit lamp and direct and indirect funduscopy.

Your eye care professional will specifically look for white blood cells floating in the aqueous humor (the fluid between the cornea and the iris) and protein expelled from the inflamed iris or ciliary body. These are considered the hallmarks of anterior uveitis.

Your doctor will ask you to provide a detailed health history to determine whether an underlying condition may be causing your symptoms.

Factors that can help determine the cause of your uveitis include: whether your uveitis is acute or chronic (i.e., whether it has been present for a few weeks or a few years); whether the front or back of the eye is affected; and whether the uveitis affects one or both eyes (unilateral uveitis is more commonly acute and can be infectious, whereas bilateral uveitis may indicate a chronic, or systemic condition).

You may need laboratory blood testing if you have systemic symptoms in addition to eye symptoms. Some laboratory testing will also be necessary if your uveitis is bilateral, is recurrent, or persists after treatment.

It can be difficult to find a specific cause for uveitis, and it may be necessary for you to be referred to another specialist for further evaluation and testing.

What Are My Treatment Options For Uveitis?

The purpose of treatment is to alleviate symptoms and reduce inflammation. Your treatment may involve management of an underlying condition, if one is identified as the cause of uveitis. For instance, uveitis caused by an infection can be treated with antibiotics, antiviral agents, or other medications.

The mainstay of treatment is corticosteroid therapy. Your doctor may prescribe the medication as an eye drop, pill, or injection, depending on the type of uveitis you have. For instance, eye drops are often used to treat anterior uveitis, whereas tablets or injections are usually prescribed for posterior uveitis.

Another option for people with posterior, intermediate, or diffuse uveitis may be a surgical implant. A device is implanted in the back of the eye and slowly releases corticosteroid medication for about 30 months.

Studies have shown that implants are as effective as corticosteroid medications in treating chronic, non-infectious uveitis. The implants may be an alternative for systemic corticosteroid treatment, which is known to cause serious adverse effects, such as kidney damage, high blood sugar, high blood pressure, osteoporosis, and glaucoma.

In addition to corticosteroid therapy, you may be given eye drops to reduce pain, and if necessary, eye drops to lower intraocular pressure. If your response to treatment is not as good as expected or symptoms are severe, your doctor may consider treating you with immunosuppressive or cytotoxic agents. These agents can cause adverse effects, however, similar to those of systemic corticosteroid therapy.

You will be monitored carefully throughout the treatment process. It is important to keep your appointments and follow your doctor’s instructions on how to take your medications, in order to prevent complications and adverse effects.

Vitrectomy, a surgery to remove some of the vitreous (jelly-like material) in the eye, may be necessary in patients with complications.

It can also provide helpful information for diagnosis, because a small sample of the vitreous can enable the doctor to identify a virus, bacterium, lymphoma, or other cause of eye inflammation. Whether it can be used in place of other treatments is still a matter of debate.

What is The Overall Prognosis for Uveitis? 

How quickly your eye heals may be determined by the location of the inflammation in your eye. In general, acute anterior uveitis heals more quickly than other types of uveitis and has the best visual prognosis.

Posterior uveitis and panuveitis are typically associated with a worse visual prognosis because they are more difficult to treat and the affected eye takes longer to heal.

Recurrence of uveitis is possible, especially if you have an underlying condition. Persistent inflammation in the eye can result in damage to ocular structures and visual impairment.

The main complications associated with anterior uveitis are cystoid macular edema, cataracts, and glaucoma. These conditions can cause loss of sight.