Eye Inflammation and Uveitis: Symptoms & Treatment

What is uveitis?

Eye inflammation of the uvea, known as uveitis, is the name for the group of conditions that cause inflammation of the uveal tract of the eye. The uvea is made up of the iris, the ciliary body and the choroid. (The first two are in the front part of the eye and the third in the back.)

Page contents

1. What is uveitis?
2. What causes uveitis?
3. What are the symptoms of uveitis?
4. How is uveitis treated?
5. When is eye inflammation an emergency?
6. How is eye inflammation diagnosed?
7. Types of uveitis by location
8. Acute, chronic or recurrent?
9. Uveitis and systemic diseases
10. Infectious causes
11. Red eye: uveitis, conjunctivitis or glaucoma?
12. Laboratory tests
13. Treatment in detail
14. Complications prevented by proper monitoring
15. Uveitis in children
16. Episcleritis and scleritis
17. Living with chronic or recurrent uveitis
18. What happens at the examination in the clinic
19. Why sticking to treatment is so important
20. Daily life during an episode
21. Myths about uveitis
22. Outlook: what the diagnosis means for your vision
23. How often you need a check-up
24. Frequently Asked Questions about Eye Inflammation and Uveitis

Inflammation of the iris and ciliary body is usually referred to as anterior uveitis or iritis.

Posterior uveitis is inflammation of the choroid, and the retina and its blood vessels are usually affected as well.

What causes uveitis?

In most cases, the cause of the inflammation remains unknown. A disorder of the immune system is usually responsible, while in some cases it may be due to an infection.

The inflammation may be limited to the eye or be linked to a condition somewhere else in the body. This may be something the patient already knows about, or something found during the tests we carry out once uveitis has been diagnosed.

What are the symptoms of uveitis?

Anterior uveitis can cause:

• Pain
• Sensitivity to light
• Blurred vision
• These symptoms can appear suddenly or get gradually worse over days or weeks.

Posterior uveitis can cause:

• Dark spots (floaters), caused by clusters of inflammatory cells in the vitreous
• Reduced vision

How is uveitis treated?

• Anterior uveitis is usually treated with eye drops.
• For posterior uveitis, eye drops are not enough, and systemic treatment (in tablet form) or an injection around or into the eye (periocular or intraocular injection) is usually needed.

When is eye inflammation an emergency?

A red eye with a little itching or burning is usually not urgent. However, some signs point to inflammation inside the eye or in the cornea and need an examination the same day:

• pain inside the eye, not just discomfort on the surface,
• severe photophobia, meaning difficulty looking even in normal light,
• blurred or reduced vision,
• redness concentrated around the iris,
• a white spot on the cornea, especially in contact lens wearers,
• a red eye with headache, nausea and blurred vision, which may mean acute glaucoma,
• redness and pain in the first few days after surgery or an intravitreal injection,
• a new episode in a patient with known uveitis.

In these cases, do not start eye drops on your own, especially steroid or antibiotic drops, as they may mask the picture or make an infection worse. Prompt treatment of uveitis limits complications such as cataract, raised intraocular pressure and macular oedema.

How is eye inflammation diagnosed?

Diagnosis starts with a detailed medical history, because many types of eye inflammation are linked to conditions affecting the rest of the body, such as ankylosing spondylitis, inflammatory bowel disease, sarcoidosis or certain infections.

The eye examination includes:

• slit lamp examination, looking for inflammatory cells and haziness inside the eye,
• measurement of the intraocular pressure,
• dilated fundoscopy, looking for inflammation in the vitreous, retina or optic nerve,
• optical coherence tomography (OCT), to detect macular oedema,
• fluorescein angiography, when inflammation of the retinal blood vessels is suspected.

Depending on the findings, blood tests, X-rays or other imaging may be requested to check for systemic diseases and infections. When a systemic disease is suspected, investigation and treatment are carried out together with a rheumatologist or internal medicine specialist, so that the cause of the inflammation is treated as well.

Types of uveitis by location

Uveitis is not a single condition but a group of inflammations with different causes, symptoms and treatments. The first way to classify it is by the part of the eye that is inflamed.

Anterior uveitis (iridocyclitis)

This is the most common form. The inflammation is located in the iris and ciliary body, at the front of the eye. It usually comes on suddenly, with redness around the iris, pain, severe sensitivity to light and blurred vision. It responds well when treatment starts early.

Intermediate uveitis

The inflammation is mainly in the vitreous. It is not painful and the eye does not usually turn red. The patient notices floaters and slight blurring. It is more common in young adults and is sometimes linked to multiple sclerosis or sarcoidosis.

Posterior uveitis

This affects the choroid and the retina. It can seriously threaten vision, especially when it is close to the macula or the optic nerve. It is often caused by infections, such as toxoplasmosis.

Panuveitis

The inflammation spreads to all parts of the uvea. This is the most serious form and needs intensive treatment and close monitoring.

Acute, chronic or recurrent?

The second way to classify uveitis is by duration. Acute uveitis starts suddenly and settles with treatment within a few weeks. Recurrent uveitis comes back again and again, with periods of remission between episodes. Chronic uveitis lasts more than three months or returns as soon as treatment is reduced. This distinction determines whether eye drops are enough or whether long-term treatment acting on the whole body is needed.

Uveitis and systemic diseases

In many patients, eye inflammation is the first sign of a disease affecting the whole body. That is why the ophthalmologist will ask about lower back pain, joint pain, rashes, mouth ulcers or bowel problems. The conditions most often linked to uveitis are:

• Ankylosing spondylitis and other spondyloarthropathies, often in people who are HLA-B27 positive. They typically cause recurrent anterior uveitis, alternating between one eye and the other.
• Sarcoidosis, which can affect any part of the eye.
• Behçet’s disease, with mouth and genital ulcers and severe posterior inflammation.
• Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis.
• Juvenile idiopathic arthritis in children.
• Multiple sclerosis, mainly with intermediate uveitis.

Infectious causes

Some types of uveitis are caused by microorganisms. The most common are herpes, which causes anterior inflammation often with raised eye pressure, and toxoplasmosis, which is the most common cause of posterior uveitis. Less often, syphilis, tuberculosis and, in people with a weakened immune system, cytomegalovirus are responsible. Identifying an infectious cause is crucial, because treatment with steroids alone can make the infection worse. In these cases a specific antimicrobial or antiviral medicine is needed.

Red eye: uveitis, conjunctivitis or glaucoma?

A red eye is one of the most common reasons for seeing an ophthalmologist, and its causes vary greatly in seriousness. Some clues help you tell when it is something more than simple conjunctivitis:

• Conjunctivitis: Redness over the whole white of the eye, discharge, eyelids stuck together in the morning, a gritty feeling. Vision stays good and any pain is mild.
• Anterior uveitis: Redness mainly around the iris, deep pain, severe photophobia, blurred vision, with little or no discharge. The pupil may be smaller than in the other eye.
• Acute angle-closure glaucoma: Very severe pain, headache, nausea or vomiting, blurred vision with bright haloes around lights. This is an emergency.

Whenever a red eye comes with pain, photophobia or reduced vision, it needs to be examined the same day. Eye drops “for redness” or antibiotic drops do not treat uveitis and delay the correct diagnosis.

Laboratory tests

After the eye examination, the doctor decides whether tests are needed to find the cause. For a first, mild episode of anterior uveitis with no other symptoms, testing may be limited. For recurrences, inflammation in both eyes or posterior inflammation, targeted blood tests, a chest X-ray or other imaging are requested, depending on what is suspected. There is no “full package” for everyone: tests are chosen based on how the eye looks and the patient’s history.

In the eye itself, optical coherence tomography (OCT) detects macular oedema, while angiography shows inflammation in the retinal blood vessels.

Treatment in detail

Steroid and cycloplegic eye drops

In anterior uveitis, the mainstay of treatment is steroid eye drops, used very frequently during the day at first and then gradually tapered. Stopping suddenly can cause a relapse, so the tapering schedule is followed carefully. Cycloplegic drops dilate the pupil, relieve pain and stop the iris from sticking to the lens.

Injections around or into the eye

When the inflammation is further back or there is macular oedema, steroids can be given by injection around the eye or as a slow-release implant inside the eye, through intravitreal injections.

Treatment for the whole body

Severe, bilateral or chronic forms need oral steroids and, for long-term control, immunomodulatory or biologic medicines. These allow the inflammation to be controlled without the side effects of long-term steroids. This treatment is organised in close cooperation with a rheumatologist.

Complications prevented by proper monitoring

• Glaucoma: Both the inflammation and steroids can raise the eye pressure. That is why the pressure is measured at every visit. Read more about glaucoma.
• Cataract: This develops more often and earlier in people with chronic uveitis. Cataract surgery can be done safely once the inflammation has been quiet for at least three months.
• Cystoid macular oedema: The most common cause of permanent loss of vision in uveitis.
• Posterior synechiae: The iris sticks to the lens and the pupil takes on an irregular shape.

Uveitis in children

In children with juvenile idiopathic arthritis, uveitis can be completely “silent”: the eye is not red or painful and the child does not complain. Without checks, the inflammation can cause cataract or glaucoma before it is noticed. That is why children with arthritis need regular screening with a slit lamp, often every 3 months, regardless of symptoms. Read more about paediatric ophthalmology.

Episcleritis and scleritis

Eye inflammation also includes episcleritis and scleritis, where the outer layers of the eye become inflamed. Episcleritis causes localised redness with mild discomfort and is usually harmless. Scleritis, on the other hand, causes severe, deep pain that wakes the patient at night and is often linked to rheumatic diseases. It needs prompt diagnosis and systemic treatment.

Living with chronic or recurrent uveitis

People who have relapses quickly learn to recognise the first signs: slight sensitivity to light or a little redness around the iris. Contacting your ophthalmologist early at this stage makes the episode milder and shorter. Keep a simple diary of episodes and treatment, follow the eye drop tapering schedule and do not stop your medicines on your own.

What happens at the examination in the clinic

Uveitis is diagnosed mainly with the slit lamp, a microscope with a thin beam of light. In the fluid of the front chamber of the eye, the ophthalmologist looks for floating inflammatory cells, like dust in a sunbeam, and haziness of the fluid caused by proteins. Their number is graded, so that at each follow-up visit we can see precisely whether the inflammation is settling.

Next, the intraocular pressure is measured and, after the pupil has been dilated, the vitreous and the back of the eye are examined. Fundoscopy is essential even when the symptoms suggest anterior inflammation, because sometimes there is also inflammation at the back of the eye, which completely changes the treatment. Expect your vision to be blurred for a few hours afterwards, so do not drive.

Why sticking to treatment is so important

Uveitis often “calms down” within a few days and the patient feels well. The temptation to stop the drops is strong, but the inflammation inside the eye may continue without symptoms. Stopping too early is the most common cause of relapse and a chronic course.

On the other hand, steroid eye drops should not be used for a long time without check-ups, as they can raise the eye pressure or speed up cataract development. For this reason, any change in dose is made only after an examination. Never use steroid drops you were given for a previous episode without being seen by a doctor, because if the cause is herpetic or bacterial, steroids on their own can do harm.

Daily life during an episode

• Light: Sunglasses relieve photophobia, even indoors in bright lighting.
• Contact lenses: Stop wearing them until the inflammation has fully settled.
• Driving: Avoid driving while your vision is blurred or your pupil is dilated from cycloplegic drops.
• Work: Most people carry on working, with screen breaks and reduced brightness.
• General health: If you are on immunomodulatory treatment, tell every doctor who looks after you and discuss your vaccinations.

Myths about uveitis

• “It is contagious.” No. Even the infectious forms are not passed on through contact, as conjunctivitis is.
• “Now that it has gone, I do not need a check-up.” Complications, such as raised pressure, can develop without symptoms. A follow-up visit is essential.
• “It is all down to stress.” Stress may be linked to relapses in some people, but uveitis always has an underlying cause that needs to be investigated.

Outlook: what the diagnosis means for your vision

Most patients with anterior uveitis keep very good vision, as long as treatment starts quickly and is completed properly. In posterior and chronic forms, the outlook depends on the cause, whether the macula is affected, and how well the inflammation is controlled in the long term. Modern biologic medicines have significantly changed the course of the disease for many patients who in the past were at risk of losing their sight.

The most important thing you can do is attend your follow-up visits, follow your treatment schedule, and get in touch straight away as soon as you notice the first signs of a new flare-up. Close cooperation between the ophthalmologist, the rheumatologist and the patient is what keeps vision safe.

How often you need a check-up

During an acute episode, visits are frequent at first, often every few days, and become less frequent as treatment is reduced. Once the inflammation has settled, a check-up a few weeks after stopping the drops confirms that there is no remaining activity. In chronic forms, the schedule is set according to the treatment and the risk of complications.

People taking immunomodulatory or biologic medicines also need regular blood tests, coordinated with the rheumatologist. At every visit to the clinic we record your vision, eye pressure and the degree of inflammation, so your progress over time is clear.

If you have a red eye with pain, sensitivity to light or blurred vision, call 210 677 0007 for an examination the same day.

Frequently Asked Questions about Eye Inflammation and Uveitis

Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO