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.
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
Symptoms could include:
- Red eyes
- Eye pain (dull ache around the eye, this can get worse when trying to focus)
- Sensitivity to light (photophobia)
- Blurry or cloudy vision
- The appearance of small shapes in your field of vision (floaters)
Uveitis can affect one or both eyes, with symptoms either coming on suddenly or developing gradually over time.
If you experience any of these symptoms, or if you ever have any concerns about your eyes, you should get them checked by your optometrist.
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.
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.
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. 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.1
Early studies are showing promise, but more work is needed before OCT scans can become the standard testing method for uveitis.2
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.
If they think you have uveitis, they’ll refer you on to an eye specialist to confirm the diagnosis and get you started with treatment as soon as possible.
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 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?
- How common is uveitis?
- Uveitis is a relatively rare condition. In the UK it affects approximately two to five people in every 10,000.3
- Can you go blind from uveitis?
- Is uveitis contagious?
- Do autoimmune diseases cause uveitis?
- Regatieri CV, Alwassia A, Zhang JY, Vora R, Duker JS. Use of optical coherence tomography in the diagnosis and management of uveitis. Int Ophthalmol Clin. 2012;52(4):33–43. [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131430/ [Accessed 16 November 2019].
- Montesano, G., Way, C., Ometto, G., Ibrahim, H., Jones, P., Carmichael, R., Liu, X., Aslam, T., Keane, P., Crabb, D. and Denniston, A. (2018). Optimizing OCT acquisition parameters for assessments of vitreous haze for application in uveitis. Scientific Reports, 8(1).
- Moorfields Eye Hospital (no date). Uveitis. Available at: https://www.moorfields.nhs.uk/condition/uveitis#:~:text=It's%20estimated%20that%20two%20to,cases%20get%20better%20with%20treatment [accessed May 2021]