Uveitis: Causes, Symptoms, and Treatment

What is Uveitis?

Uveitis (pronounced you-vee-EYE-tis) is an inflammatory condition that affects the uvea, the middle layer of tissue in the wall of the eye. The uvea consists of the iris (the colored part of the eye), the ciliary body (which helps the eye focus), and the choroid (a layer of blood vessels that nourishes the retina). Uveitis can cause eye redness, pain, and vision problems. If left untreated, it can lead to permanent vision loss.

Uveitis can occur at any age and affects both men and women. It is responsible for about 10% of blindness cases in the United States, according to the National Eye Institute (NEI).

Common Causes

Uveitis can be caused by a variety of factors, including infections, autoimmune disorders, and injuries. In many cases, the exact cause remains unknown. Here are some common causes:

• Autoimmune Disorders: Conditions where the immune system attacks healthy tissue, such as rheumatoid arthritis, lupus, or ankylosing spondylitis.
• Infections: Viral infections like herpes simplex, herpes zoster (shingles), or cytomegalovirus (CMV). Bacterial infections like tuberculosis, syphilis, or Lyme disease. Fungal infections such as histoplasmosis.
• Inflammatory Disorders: Diseases like sarcoidosis or inflammatory bowel disease (IBD) can lead to uveitis.
• Eye Injuries or Surgeries: Trauma to the eye or previous eye surgeries can trigger inflammation.
• Cancer: Rarely, uveitis can be associated with cancers like lymphoma.
• Medications: Certain drugs, such as rifabutin (used to treat tuberculosis) or bisphosphonates (used for osteoporosis), can cause uveitis as a side effect.
• Idiopathic Uveitis: In many cases, the cause of uveitis cannot be determined (idiopathic).
• Juvenile Idiopathic Arthritis (JIA): A common cause of uveitis in children.
• Behçet’s Disease: A rare condition that causes inflammation in blood vessels throughout the body, including the eyes.
• Vogt-Koyanagi-Harada (VKH) Syndrome: A rare disorder that affects pigmented tissues, including the eyes, skin, and inner ear.

Sources: Mayo Clinic, American Academy of Ophthalmology (AAO), National Eye Institute (NEI)

Associated Symptoms

The symptoms of uveitis can develop suddenly and worsen quickly. They may affect one or both eyes and can include:

• Eye redness
• Eye pain, ranging from a dull ache to intense discomfort
• Light sensitivity (photophobia)
• Blurred or decreased vision
• Dark, floating spots in your vision (floaters)
• Headaches
• A small or irregularly shaped pupil
• White or cloudy areas in the normally clear front surface of the eye (cornea)

Symptoms can vary depending on the type of uveitis:

• Anterior Uveitis: Affects the front of the eye (iris and ciliary body). Symptoms include redness, pain, and light sensitivity.
• Intermediate Uveitis: Affects the middle part of the eye (vitrous). Symptoms include floaters and blurred vision.
• Posterior Uveitis: Affects the back of the eye (choroid and retina). Symptoms include vision loss and floaters.
• Panuveitis: Affects all layers of the uvea. Symptoms can include a combination of the above.

Source: Cleveland Clinic, American Academy of Ophthalmology (AAO)

When to See a Doctor

Uveitis is a serious condition that requires prompt medical attention. You should see a doctor if you experience any of the following:

• Sudden eye pain or redness
• Changes in vision, such as blurriness or floaters
• Increased sensitivity to light
• Symptoms that worsen or do not improve within a few days

Early diagnosis and treatment are crucial to preventing complications like glaucoma, cataracts, or permanent vision loss.

Diagnosis

Diagnosing uveitis typically involves a comprehensive eye examination and may include additional tests to determine the underlying cause. Here’s what to expect:

Eye Examination

• Visual Acuity Test: Measures how well you can see at various distances.
• Slit-Lamp Examination: Uses a microscope to examine the front and back of the eye for signs of inflammation.
• Ophthalmoscopy: Allows the doctor to see the retina and other structures at the back of the eye.
• Tonometry: Measures the pressure inside the eye to check for glaucoma.

Additional Tests

If an underlying condition is suspected, your doctor may recommend:

• Blood Tests: To check for infections or autoimmune disorders.
• Imaging Tests: Such as X-rays, CT scans, or MRIs to look for signs of inflammation or disease in other parts of the body.
• Skin Tests: Such as a tuberculosis skin test or a test for sarcoidosis.
• Eye Fluid Analysis: In rare cases, a small sample of fluid from the eye may be taken for laboratory testing.

Source: Mayo Clinic, National Eye Institute (NEI)

Treatment Options

The primary goal of uveitis treatment is to reduce inflammation, relieve pain, prevent tissue damage, and restore vision. Treatment depends on the type and severity of uveitis, as well as the underlying cause.

Medical Treatments

• Corticosteroids: These anti-inflammatory medications are the mainstay of uveitis treatment. They can be administered as eye drops, pills, injections around or into the eye, or intravenous (IV) infusions.
• Immunosuppressants: For severe or chronic uveitis, medications like methotrexate, azathioprine, or mycophenolate may be used to suppress the immune system.
• Biologic Therapies: Drugs like adalimumab (Humira) or infliximab (Remicade) may be used for uveitis associated with autoimmune conditions.
• Antibiotics or Antivirals: If an infection is the cause, specific medications will be prescribed to treat the underlying infection.
• Eye Drops to Dilate the Pupil: These can help reduce pain and prevent complications like glaucoma.

Home and Lifestyle Treatments

• Wear Sunglasses: To reduce light sensitivity.
• Rest Your Eyes: Avoid activities that strain your eyes, such as reading or using screens for extended periods.
• Use Artificial Tears: To relieve dryness and discomfort.
• Manage Underlying Conditions: If uveitis is linked to an autoimmune disorder, work with your healthcare provider to manage that condition effectively.

Source: American Academy of Ophthalmology (AAO), Mayo Clinic

Prevention Tips

While not all cases of uveitis can be prevented, you can take steps to reduce your risk:

• Protect Your Eyes: Wear safety goggles during activities that could cause eye injuries.
• Practice Good Hygiene: Wash your hands regularly to prevent infections that could lead to uveitis.
• Manage Chronic Conditions: If you have an autoimmune disorder, work with your doctor to keep it under control.
• Get Vaccinated: Stay up-to-date on vaccinations to prevent infections like herpes zoster (shingles), which can cause uveitis.
• Regular Eye Exams: Especially if you have a history of uveitis or are at higher risk due to other health conditions.

Source: Centers for Disease Control and Prevention (CDC), National Eye Institute (NEI)

Emergency Warning Signs

Seek immediate medical attention if you experience any of the following symptoms, as they may indicate a severe or sight-threatening condition:

• Sudden, severe eye pain
• Sudden loss of vision or significant vision changes
• Severe light sensitivity that makes it difficult to open your eyes
• Eye redness accompanied by severe headache, nausea, or vomiting (could indicate glaucoma)
• Signs of infection, such as pus or discharge from the eye, fever, or chills

These symptoms require urgent evaluation by an eye specialist (ophthalmologist) to prevent permanent damage.

Source: American Academy of Ophthalmology (AAO), Mayo Clinic