Uveitis is a relatively rare eye condition, which happens when the middle layer of the eye (called the uvea or uveal tract) becomes inflamed, causing symptoms which can include redness, eye pain, increasing floaters and changes to your vision.
What is inflammatory eye disease?
Inflammatory eye disease includes a range of conditions associated with eye inflammation – the symptoms of which vary. The signs of eye inflammation can come on suddenly and progress quickly. It’s important that you see your optometrist if you are concerned that any part of your eye might be inflamed.
A breakdown of the eye
The human eye is a complex structure with many parts. The main areas that are more likely to become inflamed are:
- Conjunctiva: A connective tissue that covers the surface of the eyeball and underside of the eyelids.
- Cornea: This is a transparent 'window' at the front of the eye. It's responsible for transmitting and focusing light into the eye, the cornea is what helps make your vision sharp and clear.
- Optic nerve: A bundle of more than one million nerve fibres that carry images from the retina (the light-sensitive layer at the back of your eye) to the brain.
- Sclera: The opaque white part of the eye is called the sclera, which protects and supports the eye.
- Uvea: The uvea is the middle layer of tissues in the eye, under the sclera. It consists of three parts: the iris (the coloured part, which controls the diameter of the pupil), the ciliary body (which secretes a nourishing liquid called the aqueous humour), and the choroid (which is a layer of blood vessels between the sclera and retina).
All these parts of the eye play an important role in its functionality, and they can all become inflamed.
Types of uveitis
The uvea is the middle layer of your eye and is made up of three parts: the iris, ciliary body and choroid. Uveitis can affect one or more of these parts at any time, which is why it sometimes has different names depending on which part is affected.
- Anterior uveitis - this is the most common form of uveitis, and the inflammation can affect the iris, (the coloured part of the eye), known as iritis. It can also affect both the iris and the ciliary body (a ring of muscle around the iris), which is known as iridocyclitis.
- Intermediate uveitis - this affects the middle section of the eye, and the inflammation will occur in the outer areas of the retina (at the back of the eye) and the area around and behind the ciliary body (a layer of tissue that provides oxygen and nutrients to the eye’s tissues).
- Posterior uveitis - this is where the inflammation affects the retina and choroid at the back of the eye. This is sometimes referred to as chorioretinitis.
- Panuveitis - this is where the inflammation affects both the front and back of the eye at the same time.
The type of uveitis can also be identified by how long it lasts, and if it comes back after treatment. Usually, each type falls into one of three categories: acute, chronic, or recurrent uveitis:
- Acute uveitis tends to come on quickly and the symptoms can be quite severe, including redness, light sensitivity and pain. Usually, this type improves in three months with treatment.
- Chronic uveitis develops gradually, and symptoms tend to be less dramatic. Symptoms may include eye irritation, redness, and decreased vision
- Recurrent uveitis is a type that goes through cycles of getting better and worse
What are the other symptoms of eye inflammation?
Conjunctivitis (pink eye) – conjunctival inflammation
Pink eye (conjunctivitis) is an inflammation or infection of the transparent membrane (conjunctiva) that lines your eyelid and covers the white part of your eyeball. When small blood vessels in the conjunctiva become inflamed, they're more visible. Pink eye is commonly caused by a bacterial or viral infection or an allergic reaction. Though pink eye can be irritating, it rarely affects your vision.
Keratitis – corneal inflammation
Wearing your contact lenses too long or not following proper hygiene practices can lead to keratitis. It can also happen as a result of infection or minor injury to the cornea. Keratitis can make your eyes red and watery, as well as cause some pain, light sensitivity, a gritty sensation in your eye or blurred vision.
Optic neuritis – optic nerve inflammation
Symptoms of optic neuritis typically include pain and temporary loss of vision in one eye. Some people also see flashing lights or find that colours appear less vivid. It can develop quickly, so if you experience any sudden changes to your eyes, it's important to book an appointment with an optometrist as soon as possible.
Scleritis – scleral inflammation
Scleritis is a serious eye condition which can cause long-term problems to vision if left untreated. Symptoms include pain, redness, excessive tearing, and light sensitivity.
Scleritis has been associated with autoimmune disorders such as rheumatoid arthritis and lupus. This condition can be treated with steroid medications, however, it’s important to seek medical attention quickly. Scleritis can also be detected using a slit lamp.
There are a number of reasons why eye inflammation can occur, including autoimmune disorders, irritation, eye injury and trauma to the eyes. Inflammation can also occur as a result of infection and allergies
Uveitis is strongly linked to problems with the body’s immune system which results in an inflammatory response. Certain autoimmune disorders can cause uveitis by mistakenly attacking the healthy tissue within the eye. These can include disorders like lupus, rheumatoid arthritis and sarcoidosis.
Sometimes uveitis can be caused by injury or trauma to the eye, as well as certain infections and, in some cases, genetics.
When the cause isn’t known, this is known as idiopathic uveitis.
What causes eye inflammation?
The eye is composed of tissues that are similar to joints.As a result, many autoimmune diseases that affect joints also affect the eyes — such as rheumatoid arthritis.
The most common eye-related symptom of rheumatoid arthritis is dryness, although more severe cases can cause inflammation in the white part (sclera) of your eyes, leading to scleritis.
Sjögren's syndrome is a chronic autoimmune disease that attacks the glands responsible for keeping the eyes, mouth and other parts of the body moist and lubricated.
People with Sjögren's syndrome are much more likely to experience dry eyes due to its effect on the lacrimal glands which secrete tears. When diagnosing Sjögren's syndrome, ophthalmologists will look out for signs of severe dry eye syndrome, alongside blocked, inflamed glands.
Multiple sclerosis (MS) is an autoimmune disease that affects the brain, spinal cord and optic nerve. Optic neuritis (inflammation of the optic nerve in the eye) is a common symptom of MS, and is typically one of the first signs of MS, which can be detected by an OCT scan.
Those affected by optic neuritis usually experience symptoms in just one eye. Other eye symptoms associated with MS include nystagmus (rapid, uncontrolled movement of the eyes) and diplopia (double vision).
Reiter’s syndrome (also known as reactive arthritis) is a type of inflammatory arthritis that affects the joints, eyes, and urethra. Eye inflammation is a common symptom of Reiter’s syndrome, which can occur in the form of conjunctivitis and uveitis (inflammation of the middle layer of the eye).
You can find out more about the types of autoimmune disease and how these can cause eye inflammation.
How is uveitis diagnosed?
Due to the nature of the inflammation, uveitis can be difficult to detect and manage. As there are so many types of uveitis, many different parts of the eye can be affected, and there isn’t one common symptom which can definitively determine whether someone has uveitis. The condition varies from person to person.
There are several tests carried out during a routine eye examination to check for signs of uveitis. Your optometrist will often start by asking you to read a test chart through different strength lenses, to see if your visual acuity has changed.
Then, they’ll measure the pressure in your eye using a tonometer and assess the front and back of your eye with a powerful microscope called a slit lamp. Slit lamps are used to observe the health of your cornea, your iris and your lens. The optician will ask you to place your head against a frame and your chin in a rest while they look through a powerful microscope at each eye. It's also used in combination with a high powered handheld lens to provide the optician with a 3D view of the back of the eye.
Both of these procedures are non-invasive and painless. Your optometrist will also use an ophthalmoscope to examine the retina at the back of your eye, your optic nerve and its blood vessels.
If you’re experiencing persistent eye pain or an unusual change in vision, you should contact your optometrist as soon as possible. Your optometrist may refer you to an eye specialist who will examine your eye in greater detail as, in some cases, uveitis needs urgent attention.
Can OCT scans detect uveitis?
Yes and no. It’s important to remember that OCT scans are part of a wider eye exam process that includes other valuable tests. The training Specsavers’ optometrists go through and the equipment they have to hand will enable them to assess your symptoms and see if you have uveitis, or something else.
Research has been, and continues to be, carried out to assess whether optometrists could use OCT scans to more accurately detect and manage uveitis. By providing a clearer image, OCT scans could allow us to detect certain signs and complications of types of uveitis.
Early studies are showing promise, but more work is needed before OCT scans can become the standard testing method for uveitis.
If you have any symptoms of uveitis, you should see your optometrist or GP as soon as possible. They’ll have a good look in your eyes to check for some specific signs of inflammation that could indicate uveitis, as well as testing your vision.
Complications of uveitis
Complications with uveitis are more like to happen in people with intermediate or posterior uveitis, or in people who have repeated cases of uveitis. Complications can include a permanent change in vision, as well as:
- Glaucoma - anterior uveitis can slow down the fluid draining from the eye, which can raise the eye’s pressure (intraocular pressure). Without treatment or monitoring, this increased eye pressure can lead to glaucoma and may cause permanent sight loss.
- Macular oedema - people with posterior or chronic uveitis can develop macular oedema, which is a build-up of fluid at the central part of the retina (called the macula) that can affect your vision.
- Cataracts - inflammation can lead to clouding of the eye’s lens.
- Retinal detachment - in some cases of posterior uveitis, the inflammation in the retina can make it more prone to tearing, resulting in a retinal detachment.
- Posterior synechiae - the inflammation of the iris with uveitis can cause sections of the iris to stick to the eye’s lens, which is behind the iris. This can result in the pupil no longer looking perfectly round. Posterior synechiae are more likely to happen if treatment for uveitis is not started quickly.
Early treatment is the best chance of successful treatment, so you should see your GP or optometrist if you think you have any symptoms of uveitis.
Uveitis is typically managed by an eye specialist who will be able to determine the best treatment plan for you. Treatment plans will usually involve trying to establish the cause of the uveitis and, if a cause is found, treatment and management plans will be organised for the underlying condition.
Most cases of uveitis are treated with a course of steroids over a few weeks which will help to reduce the inflammation. Steroid eye drops may be used for cases of anterior uveitis, while a combination of steroid medication and injections might be better suited for intermediate and posterior uveitis.
In cases of anterior uveitis, you may also be prescribed dilating drops to reduce the inflammation and the likelihood of posterior synechiae developing. These drops relieve the pain but can blur your vision, particularly for close-work tasks.
If the intraocular pressure is found to be high in your eyes you may also be treated with eye drops to lower the pressure.
Noticed a change in your eyesight?
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