Uveitis (characterized by eye pain, severe light sensitivity, and vision changes) is estimated to be responsible for approximately 10% of blindness in the United States. Uveitis requires an urgent and thorough examination by an ophthalmologist, along with urgent treatment to control the inflammation.
Inflammation in any of the parts of the uveal tract is called uveitis. The uvea tract (marked in red below) is the middle layer of the eye. It consists of the iris, the ciliary body, and the choroid, which covers the eye like a tunic or coat.
Uveitis is an inflammatory response inside the eye. Inflammation is a complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. It is a protective response involving immune cells, blood vessels, and molecular mediators.
A myriad of conditions can lead to the development of uveitis, including systemic diseases and syndromes confined to the eye. Causes of uveitis can be infectious or noninfectious, traumatic, drug-induced, or malignant. Doctors do not always know what causes uveitis. In many cases, the cause is unknown. You are more likely to get uveitis if you have or have had:
Uveitis occurs throughout the world. Both women and men of any race, ethnicity, or age may develop uveitis.
Uveitis can affect any part of the eye or its surrounding structures. The symptoms of uveitis, for the most part, depend on the area of the eye that is affected by the inflammation. The most common signs and symptoms of uveitis are:
Eye pain, severe light sensitivity, and any vision changes are considered emergency signs and require immediate attention from an ophthalmologist. Contact your ophthalmologist immediately if you experience any of these symptoms.
The prognosis is generally good for those who receive prompt diagnosis and treatment. Still, serious complications (including cataracts, glaucoma, band keratopathy, retinal edema, and permanent vision loss) may result if left untreated. The type of uveitis, as well as its severity, duration, and responsiveness to treatment or any associated illnesses, all factor into the outlook.
Usually, when eye inflammation is suspected, your urgent duty is to contact your ophthalmologist so that you can receive a thorough eye exam, including:
Uveitis in the front and middle part of the eye (iritis or cyclitis) is commonly more sudden in onset, generally lasting six to eight weeks, and in the early stages can usually be controlled by the frequent use of drops. Often, this type of uveitis cannot be given a specific cause. Uveitis in the back part of the eye (choroiditis) is commonly slower in onset and may last longer, and is often more challenging to treat.
Uveitis must be treated promptly to prevent long-term complications.
Uveitis treatments primarily try to eliminate inflammation, alleviate pain, prevent further tissue damage, and restore any loss of vision. Treatments depend on the type of uveitis a patient displays.
Ophthalmologists often treat uveitis with eyedrop medicine that reduces inflammation (corticosteroids). Corticosteroid eye drops and injections, which are administered around the eye or inside the eye, target the eye exclusively. In contrast, other treatments, such as immunosuppressive agents taken orally, may be used when the disease occurs in both eyes, particularly in the back of both eyes.
Your doctor may also use an eye drop to widen (dilate) the pupil, which helps reduce pain and swelling. Sometimes medicine may need to be given by injection (shots) or taken by mouth. Oftentimes, your ophthalmologist will work with a special kind of doctor called a rheumatologist to help treat you.
You may be prescribed steroidal anti-inflammatory medication that can be administered in various ways, including as eye drops, swallowed as a pill, injected around or into the eye, infused into the bloodstream intravenously, or released into the eye via a surgically implanted capsule. Immunosuppressive agents commonly used include methotrexate, mycophenolate, azathioprine, and cyclosporine.
Anterior uveitis may be treated by:
Intermediate, posterior, and pan-uveitis are often treated with injections around the eye, medications administered orally, or, in some instances, time-release capsules that are surgically implanted inside the eye. Other immunosuppressive agents may be given.
Uveitis is typically categorized into four forms: anterior, intermediate, posterior, and panuveitic.
Intermediate, posterior, and pan-uveitis are the most severe and highly recurrent forms of uveitis. They often cause blindness if left untreated.
Swelling of the uvea near the front of the eye is called anterior uveitis. Frequently termed iritis, anterior uveitis occurs in anywhere from two-thirds to 90% of uveitis cases. It is the most common form of uveitis, predominantly occurring in young and middle-aged people. Many cases occur in healthy people and may only affect one eye, but some are associated with rheumatologic, skin, gastrointestinal, lung, and infectious diseases.
Anterior uveitis typically begins suddenly, and symptoms can persist for up to eight weeks. This condition can occur as a single episode and subside with proper treatment or may take on a recurrent or chronic nature. Acute anterior uveitis may occur in one or both eyes and, in adults, is characterized by eye pain, sensitivity to light, a small pupil, blurred vision, and redness.
Anterior uveitis may be treated by:
Swelling of the uvea in the middle of the eye is called intermediate uveitis. The center of the inflammation often appears in the vitreous. Intermediate uveitis causes blurred vision and floaters. Usually, it is not associated with pain. Symptoms can last for a few weeks to many years. This form may undergo cycles of improvement, then decline.
Intermediate uveitis is commonly seen in young adults. It has been linked to several disorders, including sarcoidosis and multiple sclerosis.
Swelling of the uvea toward the back of the eye is called posterior uveitis. It is often referred to as choroiditis or chorioretinitis and may involve both the retina and the choroid. Posterior uveitis is the least common form of uveitis. Symptoms can develop gradually and last for many years.
Posterior uveitis can produce vision loss. This type of uveitis can only be detected during a comprehensive eye examination. There are many infectious and non-infectious causes of posterior uveitis.
Pan-uveitis is the term used when all three major parts of the eye are affected by inflammation. Behcet’s disease is one of the most well-known forms of pan-uveitis, which significantly damages the retina.
