Retina On Line

By Moorfields Eye Hospital

What is uveitis?

It is an inflammation of the uveal tract, which includes the iris (coloured part of the eye), the ciliary body and the
choroid. The first two structures are found towards the front of the eye, and the last one is found under the retina at the back of the eye. Inflammation involving the iris and ciliary body is referred to as “Anterior uveitis”, very frequently called Iritis. “Posterior uveitis” involves inflammation to the choroid, but also tends to involve the retina and retinal vessels.

                         The primary parts of the eye affected by uveitis 

What causes uveitis? 

In a large number of cases, the cause is unknown. An imbalance of your immune system is usually responsible for
the inflammation, and in a few cases an infection is the trigger. The inflammation may be confined to the eye or
may represent a manifestation of a disease elsewhere in your body, which may or may not be apparent at the time
you experience uveitis. 

Can stress cause uveitis?

There is no evidence to support this theory, but many patients do report “flare-ups” of the condition during times of stress in their lives.

What are the signs and symptoms?

Anterior uveitis may show itself with symptoms of pain, light sensitivity and blurring of vision, but in some cases the
symptoms may be minimal. These may occur suddenly or develop gradually over days or even in some cases a week
or so. Posterior uveitis will cause “floaters” (debris in the vitreous body, the gel inside the eye), or reduction in vision, depending on where in the back of the eye the problem occurs. Sometimes the front and the back of the eye can get inflamed at the same time and the symptoms will be combined.

What tests are necessary?

Depending on the case, investigations will be organised in an attempt to discover an associated disease, or exclude an infection. The doctor will make a decision about ordering tests after you are examined.
The tests may be a blood test, chest X-ray, scans of your eye, or photographs of your retina after the injection of
a special dye in a vein in your arm. You will receive full explanation about each test after these have been selected.

What is the treatment for uveitis?

Anterior uveitis is usually treated with eye drops; most frequently steroid drops in combination with dilating drops
(to enlarge the pupil). They are necessary to reduce the inflammation, reduce the pain and prevent complications
such as “posterior synechiae” (adhesions between the iris and the crystalline lens resulting in an odd-shaped pupil).
Steroid drops are used quite frequently in the early stages, with a slowly reducing dose to prevent a recurrence. It is
important to follow the instructions properly.
In posterior uveitis, eye drops will not solve the problem, which is deeper inside the eye, and other forms of treatment will be used. If your problem is affecting only one eye or is more severe in one eye you may be offered an injection of a steroid around your eye. This is minimally painful (you will receive proper local anaesthesia) and has the advantage of giving you a localised treatment, avoiding side effects to the rest of the body. If the injection fails (no more than 3 attempts at regular intervals) or the disease involves both eyes equally, you will be offered oral treatment with steroids or other drugs, which will help control your immune system. If another disease is discovered in your body, your GP will be informed and you will be referred to see a specialist in that condition. Specific antibiotics will be prescribed if an infection is found to be the reason for your uveitis.                                                                                       

Always follow the instructions for the use of drops and tablets. All these drugs have potential side effects and you will be given full explanations about the drugs you are prescribed. You will be closely monitored by regular blood tests and your GP will be kept informed at all times. Some steroid drops need to be shaken vigorously before each application to guarantee good dispersion of the drug inside the bottle, to make them effective.
                                                                                                 

Please note that steroid drops or tablets should not be stopped abruptly. Sudden discontinuation can lead
to severe rebound inflammation, or have more serious consequences to your general health.

Possible complications of uveitis

In the majority of cases where inflammation is only in the front of the eye, permanent damage to the vision is unlikely.
The most likely complication is that the condition can recur. As you are now aware, prompt attention by an eye specialist is important if you think this has happened, for example, if your symptoms recur. Other possible complications, which may cause problems with vision, are:

•Cataract (clouding of the lens behind the pupil)

•Glaucoma (raised pressure inside the eye leading to the damage to the nerves at the back of the eye)

•Macular oedema (water logging of the most sensitive area of the retina used for central vision occurs).

In posterior uveitis the complications may be more severe with a higher risk of visual loss, especially if you do not
adhere to treatment or miss appointments. Macular oedema is an important potential cause of visual loss, and cataract and glaucoma may also occur. Other possible complications include clouding of the  gel inside the eye, closure of blood vessels and retinal detachment.

Home care tips for uveitis

Some people find the use of hot compresses to be very soothing in anterior uveitis. To do this, hold a clean flannel
soaked in comfortable hot water against the (closed) eyelid for about 5 minutes. You will need to reheat the flannel in
hot water as necessary as it cools. Never share a flannel with others. If you are sensitive to light, dark glasses will help. Anti-inflammatory type painkillers are useful, e.g. aspirin and Nurofen® – always read the instructions for the medication carefully.

Is there anything else I can do to help myself?

•Comply with the instructions from your doctor by correctly taking the drugs prescribed

•Return for follow-up checks as scheduled

•Return to the hospital promptly if you notice a recurrence of your symptoms, or any further deterioration in vision or
other symptoms such as pain or redness

•Use sunglasses during an attack to reduce light sensitivity

Practical matters

Remember to ask your doctor for a sick certificate complying with your employer’s requirements, to ensure you
receive sick pay for any time off work. You may also wish to speak to our Medical Social Worker regarding sickness
benefits particularly if you are self-employed. You may wish to see your Occupational Health Nurse if your employer has one, who may be able to provide additional advice and support in the work environment.