Uveitis (patient information)
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What is uveitis?
Uveitis specifically refers to inflammation of the uvea, the middle layer of the eye. The uvea consists of the iris, ciliary body, and choroid, and it provides most of the blood supply to the retina. In common usage, it may refer to any inflammatory process involving the interior of the eye.
Uveitis may be classified anatomically into the following forms, depending on which part of the eye is primarily affected by the inflammation:
- Anterior uveitis involves inflammation in the front part of the eye. It is the most common form of uveitis, and it is often called iritis because it is usually only effects the iris.
- Posterior uveitis affects the back part of the uvea and involves primarily the choroid, a layer of blood vessels and connective tissue in the middle part of the eye. This type of uveitis is called choroiditis. If the retina is also involved it is called chorioretinitis.
- Intermediate uveitis (also known as pars planitis) affects the narrow area between the iris and the choroid.
- Pan-uveitis is the inflammation of all the layers of the uvea.
What are the symptoms of uveitis?
Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include:
- Blurred vision
- Dark, floating spots in the vision
- Eye pain
- Redness of the eye
- Sensitivity to light (photophobia)
What are the causes of uveitis?
Uveitis can be caused by autoimmune disorders such as rheumatoid arthritis or ankylosing spondylitis, infection, or exposure to toxins. However, in many cases the cause is unknown.
Anterior uveitis may be associated with autoimmune diseases, but most cases occur in healthy people. The disorder may affect only one eye. It is most common in young and middle-aged people.
Posterior uveitis may develop in people who have an autoimmune disease or who have had a systemic (body-wide) infection.
Intermediate uveitis usually occurs in young men and is generally not associated with any other disease. However, some evidence suggests it may be linked to Crohn's disease and possibly multiple sclerosis.
Uveitis can be associated with any of the following:
- AIDS
- Ankylosing spondylitis
- Behcet syndrome
- CMV retinitis
- Herpes zoster infection
- Histoplasmosis
- Injury
- Kawasaki disease
- Psoriasis
- Reactive arthritis
- Rheumatoid arthritis
- Sarcoidosis
- Syphilis
- Toxoplasmosis
- Tuberculosis
- Ulcerative colitis
Who is at risk for uveitis?
How to know you have uveitis?
A complete medical history and eye examination should be performed. Laboratory tests may be done to rule out infection or an autoimmune disorder.
Persons over age 25 with pars planitis should have an MRI of their brain and spine to rule out multiple sclerosis.
When to seek urgent medical care
Call for an appointment with your health care provider if you have symptoms of uveitis (e.g. eye pain or reduced vision). Uveitis requires an urgent referral and thorough examination by an optometrist or ophthalmologist along with urgent treatment to control the inflammation.
Treatment options
Generally speaking, uveitis is typically treated with glucocorticoid steroids, either as topical eye drops (prednisolone acetate) or oral therapy with corticosteroids. In addition to corticosteroids, topical cycloplegics, such as atropine or homatropine, may be used. In some cases an injection of PSTTA can also be given to reduce the swelling of the eye. [1].
If the uveitis is caused by a body-wide infection, treatment may involve antibiotics and powerful anti-inflammatory medicines called corticosteroids.
Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatment with Infliximab or other anti-TNFs' infusions may prove helpful.
More specifically, the treatment regimen differs among the various forms of uveitis:
- Iritis is usually mild. Treatment may involve dark glasses, eye drops that dilate the pupil to relieve pain, and steroid eye drops or ointment
- Pars planitis is often treated with steroid eye drops. Other medicines, including steroids taken by mouth, may be prescribed to help suppress the immune system.
- Choroiditis treatment depends on the underlying cause. Additional specialists in infectious disease or autoimmunity may be needed for such diseases as syphilis, tuberculosis, AIDS, sarcoidosis, or Behcet's syndrome.
Diseases with similar symptoms
Where to find medical care for uveitis
Directions to Hospitals Treating uveitis
Prevention of uveitis
Treatment of an underlying disorder may help to prevent uveitis in persons with a body-wide (systemic) infection or disease.
What to expect (Outlook/Prognosis)
Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States.[2]
However, with proper treatment, most attacks of anterior uveitis go away in a few days to weeks. However, relapses are common.
Inflammation related to posterior uveitis may last from months to years and may cause permanent vision damage, even with treatment.
Possible complications of uveitis include:
- Cataracts
- Fluid within the retina
- Glaucoma
- Retinal detachment
- Vision loss