Uveitis is inflammation inside your eye. When your immune system fights an infection, it can trigger inflammation. Sometimes uveitis means your immune system is fighting an eye infection — but it can also happen when your immune system attacks healthy tissue in your eyes. Uveitis can cause symptoms like pain, redness, and vision loss.
Evaluation and diagnosis of uveitis
Your doctor will conduct a complete medical history and eye exam to determine what type of uveitis you have and if there are any other underlying conditions. The exam may involve a variety of tests, such as blood work, X-rays, or scans.
Your doctor will also thoroughly examine your eyes. This usually involves placing drops in your eye to make your pupils wider, or dilate them. This allows the doctor to see into your eye more easily. You may also have a fluorescein angiogram. During a fluorescein angiogram, a special dye and camera are used to look at blood flow in the retina and choroid. These are two layers in the back of the eye. Because the drops affect your eyesight for a short period of time, you will not be able to drive or read for a couple of hours after your appointment.
Types of uveitis
- Anterior (sometimes called iritis or iridocyclitis) - Uveitis in the front part of the eye. Anterior uveitis can be subdivided into acute disease and chronic disease. Acute lasts a few weeks, whereas chronic lasts more than three months.
- Posterior - Uveitis in the back of the eye. Posterior uveitis is usually chronic and can last a long time.
- Panuveitis - Uveitis in the front and back of the eye.
It is important to know which type of uveitis you have, as this determines the investigations and treatment you need, as well as the complications associated with the condition.
Treatment options for uveitis
Prompt treatment is necessary to minimize vision loss. Eye drops, especially steroids and pupil dilators, are medications used to reduce inflammation and pain. For deeper inflammation, oral medication or injections may be necessary. Complications such as glaucoma, cataracts or new blood vessel formation (neovascularization) also may need treatment in the course of the disease. If complications are advanced, conventional or laser surgery may be necessary.
Anterior uveitis usually can be controlled by frequent eye drops. Posterior uveitis is often more difficult to treat.
What to expect
The part of your eye affected by uveitis will determine the duration of the condition. With proper treatment, anterior uveitis can clear up in a matter of days to weeks. Posterior uveitis, on the other hand, may last several months or years and could permanently alter your vision.
If your uveitis responds poorly to corticosteroids, steroids used to treat inflammation, or becomes severe enough to threaten your vision, you may need a different kind of medication. Other medications include immunosuppressive or cytotoxic agents. Both suppress the immune system to calm inflammation. Vitrectomy—surgery to remove the jelly-like material in your eye (vitreous)—may sometimes be necessary for diagnosis and treatment of uveitis.
Uveitis can recur, so it's important to see your doctor if your symptoms reappear after successful treatment.
Frequently asked questions
How did I get uveitis?
The cause is unknown for most people. There is an association with some infections (such as toxoplasmosis) and certain diseases (sarcoidosis and Behcet's disease) in some patients. Some patients have an increased likelihood due to the genes they carry (HLA-B27 and HLA-A29). But in many patients, a cause cannot be identified. Uveitis is classified as an autoimmune disease, meaning the body reacts against itself. The trigger for this is unknown, but it might be an infection in susceptible individuals. Treating for infection is unlikely to help, though, as the immune system is already activated and causes the damage.
Can uveitis be cured?
No. Treatment only suppresses the harmful inflammation until your body's healing process stops the disease process. The treatment needs to be continued until the inflammation resolves. It is not possible to determine how long the disease will last in any patient.
Will I go blind?
Most patients treated for acute uveitis do not lose their vision. The main causes of vision loss in patients with chronic uveitis are cataracts, glaucoma or damage to the back of the eye from pressure inside the eye, and macular edema of the retina. The two most important factors in preventing vision loss are controlling inflammation and ensuring that intraocular pressure is not elevated.