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Uveal Inflammation (Uveitis)

What is Uveal inflammation?

Uveal inflammation, more commonly called uveitis, is an inflammation of the uvea—the middle layer of the eye that includes the iris, ciliary body, and choroid. The uvea supplies blood to the retina and controls the amount of light that enters the eye. When any part of this structure becomes inflamed, patients may experience pain, light sensitivity, blurred vision, and, if left untreated, permanent vision loss.

Uveitis can be acute (sudden onset, lasting days to weeks) or chronic (persisting for months or recurring). It is classified anatomically:

• Anterior uveitis: inflammation of the iris (irititis) and/or ciliary body (iridocyclitis). This is the most common form.
• Intermediate uveitis: involves the vitreous body and the peripheral retina.
• Posterior uveitis: affects the choroid and retina.
• Pan‑uveitis: inflammation throughout all layers of the uvea.

Uveitis is not a disease itself but a sign that an underlying systemic condition, infection, or ocular problem is present. Prompt recognition and treatment are essential to preserve vision.

Common Causes

Uveitis may be idiopathic (no identifiable cause) in up to 30% of cases, but most episodes have an underlying trigger. The most frequent causes are:

• Autoimmune / inflammatory diseases – e.g., ankylosing spondylitis, sarcoidosis, Behçet’s disease, juvenile idiopathic arthritis (JIA), and inflammatory bowel disease.
• Infections – such as herpes simplex virus (HSV), varicella‑zoster virus (VZV), cytomegalovirus (CMV), toxoplasmosis, tuberculosis, syphilis, and Lyme disease.
• Systemic inflammatory disorders – including rheumatoid arthritis, systemic lupus erythematosus (SLE), and Wegener’s granulomatosis (now called granulomatosis with polyangiitis).
• Trauma or ocular surgery – postoperative inflammation after cataract extraction, vitreoretinal surgery, or penetrating eye injury.
• Masquerade syndromes – intra‑ocular tumors (e.g., lymphoma, melanoma) that mimic inflammation.
• Medication‑induced inflammation – certain drugs like bisphosphonates, cidofovir, or systemic antibiotics can trigger uveitis.
• HLA‑B27 positivity – a genetic marker linked to acute anterior uveitis, especially in people with ankylosing spondylitis.
• Idiopathic – no identifiable cause after thorough evaluation; these cases still require treatment to control inflammation.

Associated Symptoms

Because the uvea sits behind the iris and in front of the retina, inflammation often produces a characteristic cluster of ocular complaints:

• Redness of the eye (especially around the cornea)
• Eye pain, worsening with bright light (photophobia)
• Blurred or decreased vision
• Floaters (tiny specks that drift across the visual field)
• Flashing lights or “photopsia”
• Small or irregularly shaped pupil (due to muscle spasm)
• Eye tearing or discharge
• Headache, particularly around the temple area
• Systemic signs when related to a broader disease (fever, joint pain, skin rash)

Symptoms may be unilateral (one eye) or bilateral, and the pattern often helps clinicians narrow the cause.

When to See a Doctor

Uveitis can progress rapidly, and delayed treatment increases the risk of cataract, glaucoma, macular scarring, or permanent vision loss. Seek eye‑care promptly if you notice:

• Sudden eye redness accompanied by pain or light sensitivity.
• Blurred vision that does not improve within a day.
• Floaters or flashes, especially if they appear after trauma.
• Persistent tearing or discharge with redness.
• Any eye symptom that recurs after a period of normal vision.

Even if symptoms resolve quickly, a professional exam is essential because inflammation may be ongoing beneath the surface.

Diagnosis

Diagnosing uveitis involves a combination of detailed history, comprehensive eye examination, and targeted laboratory testing.

Ophthalmic Evaluation

• Visual acuity test – measures how clearly you see.
• Slit‑lamp examination – a microscope with a bright light that lets the doctor view the anterior segment and detect cells/flare in the anterior chamber.
• Fundoscopy (indirect ophthalmoscopy) – evaluates the retina, choroid, and vitreous for signs of posterior inflammation.
• Intra‑ocular pressure (IOP) measurement – inflammation can raise or lower eye pressure.
• Fluorescein or indocyanine green angiography – imaging that highlights blood‑vessel leakage in the retina/choroid.
• Optical coherence tomography (OCT) – cross‑sectional imaging of the retina to identify swelling or scarring.

Systemic Work‑up

Because many systemic illnesses cause uveitis, doctors often order blood tests and imaging:

• Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) or C‑reactive protein (CRP) – markers of inflammation.
• HLA‑B27 typing – useful when ankylosing spondylitis is suspected.
• Serologic tests for infections: syphilis (RPR/VDRL), tuberculosis (Quantiferon‑TB or PPD), toxoplasmosis (IgG/IgM), Lyme disease, viral PCR panels.
• Autoimmune panels: ANA, rheumatoid factor, anti‑CCP, anti‑neutrophil cytoplasmic antibodies (ANCA).
• Chest X‑ray or CT scan – to look for sarcoidosis or tuberculosis.

In rare cases where a masquerade syndrome is suspected, an intra‑ocular biopsy may be required.

Treatment Options

The primary goals are to suppress inflammation, relieve symptoms, prevent complications, and treat any underlying systemic disease.

Medication‑Based Treatments

• Topical corticosteroids (e.g., prednisolone acetate 1% drops) – first‑line for mild anterior uveitis.
• Cycloplegic agents (e.g., atropine, cyclopentolate) – relieve ciliary spasm, reduce pain, and prevent posterior synechiae (iris sticking).
• Oral corticosteroids (prednisone) – used for intermediate, posterior, or severe anterior uveitis, typically for a short course with a taper.
• Immunosuppressive agents – methotrexate, azathioprine, mycophenolate mofetil, or cyclosporine for chronic or steroid‑dependent cases.
• Biologic therapies – anti‑TNF agents (adalimumab, infliximab) or interleukin inhibitors for uveitis associated with Behçet’s disease, JIA, or sarcoidosis.
• Antimicrobial therapy – targeted antibiotics, antivirals, or anti‑parasitics when an infectious cause is identified (e.g., azithromycin for toxoplasmosis, acyclovir for HSV).
• Non‑steroidal anti‑inflammatory drugs (NSAIDs) – oral or topical NSAIDs can provide adjunctive pain relief.

Procedural and Supportive Measures

• Periocular steroid injections (e.g., triamcinolone) for posterior uveitis not responding to topical drops.
• Intravitreal steroid implants (Ozurdex, Iluvien) or anti‑VEGF agents for chronic macular edema.
• Laser therapy – peripheral retinal photocoagulation may be required if neovascularization develops.
• Glaucoma management – pressure‑lowering eye drops or surgery if steroid‑induced glaucoma occurs.
• Regular monitoring –