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Uveitis: Causes, Symptoms & Treatment

Uveitis is an inflammation of the uvea, the middle layer of the eye. If left untreated, it can cause serious vision damage. Early diagnosis and treatment are essential.

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Things worth knowing about "Uveitis"

Uveitis is an inflammation of the uvea, the middle layer of the eye. If left untreated, it can cause serious vision damage. Early diagnosis and treatment are essential.

What is Uveitis?

Uveitis refers to inflammation of the uvea, the middle layer of the eye. The uvea consists of three structures: the iris, the ciliary body, and the choroid. Depending on which part is affected, uveitis is classified into different types. It is one of the leading causes of visual impairment and blindness worldwide and can affect people of all ages.

Types of Uveitis

Anterior uveitis (iritis/iridocyclitis): Inflammation in the front of the eye; the most common form.
Intermediate uveitis: Affects the middle section of the eye, particularly the vitreous.
Posterior uveitis (choroiditis/chorioretinitis): Inflammation in the back of the eye, involving the choroid and retina.
Panuveitis: All three sections are simultaneously affected.

Causes

The causes of uveitis are diverse. In many cases, an underlying autoimmune condition is responsible, where the immune system mistakenly attacks the eye tissue. Other possible causes include:

Infections: Viruses (e.g., herpes simplex, cytomegalovirus), bacteria (e.g., tuberculosis, syphilis), parasites (e.g., toxoplasmosis), or fungi.
Systemic diseases: Ankylosing spondylitis, sarcoidosis, rheumatoid arthritis, Crohn's disease, ulcerative colitis.
Trauma: Injuries or surgical procedures involving the eye.
Idiopathic: In a significant proportion of cases, no identifiable cause is found.

Symptoms

Symptoms vary depending on the type and severity of the inflammation. Common complaints include:

Eye pain or a feeling of pressure in the eye
Light sensitivity (photophobia)
Blurred vision or vision loss
Red eye (without discharge)
Floaters or moving shadows in the visual field (mouches volantes)
Changes in intraocular pressure

In posterior uveitis, pain is often absent, and visual disturbances are the primary concern.

Diagnosis

Diagnosis is primarily made by an ophthalmologist (eye specialist). The following examinations are typically used:

Slit-lamp examination: Assessment of the anterior eye segment for signs of inflammation.
Ophthalmoscopy (funduscopy): Examination of the back of the eye.
Tonometry: Measurement of intraocular pressure; abnormal values may indicate complications.
Fluorescein angiography: Imaging of the blood vessels within the eye.
Blood tests and imaging studies: To identify underlying systemic diseases or infectious causes.

Treatment

Treatment depends on the cause, type, and severity of uveitis:

Medical Treatment

Corticosteroids: First-line treatment for reducing inflammation, administered as eye drops, periocular injections, or systemic tablets.
Mydriatics/cycloplegics: Eye drops that dilate the pupil, relieving pain and preventing adhesions (synechiae).
Immunosuppressants: Used in chronic or systemic uveitis, e.g., methotrexate, azathioprine, mycophenolate mofetil.
Biologics: For more severe cases, e.g., TNF-alpha inhibitors (adalimumab).
Antibiotics or antivirals: Used specifically when an infectious cause is identified.

Surgical Treatment

If complications such as cataracts, glaucoma, or retinal detachment develop, surgical intervention may be necessary.

Prognosis and Course

Uveitis can follow an acute, chronic, or recurrent course. With timely treatment, the prognosis is generally favorable. However, if left untreated or diagnosed late, serious complications including permanent vision loss can occur. Regular follow-up appointments with an ophthalmologist are therefore essential.

References

Jabs DA, Nussenblatt RB, Rosenbaum JT - Standardization of Uveitis Nomenclature (SUN) Working Group: Standardization of Uveitis Nomenclature for Reporting Clinical Data. American Journal of Ophthalmology, 2005.
American Academy of Ophthalmology (AAO) - Uveitis: Clinical Guidelines and Overview, www.aao.org.
Rosenbaum JT - Uveitis: An Internist's View. Archives of Internal Medicine, 1989; and updated reviews available on PubMed (pubmed.ncbi.nlm.nih.gov).

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