All about uveitis
Uveitis refers to a collection of inflammatory eye conditions. Uveitis is most commonly cause by autoimmune disease, but it can also occur due to infection or injury.
What is uveitis?
Uveitis is a group of inflammatory eye conditions. The term “uveitis” technically refers to inflammation of the uveal tract (Wikipedia), which is a layer of the eye that includes the iris, ciliary body, and choroid.
In practice, the term “uveitis” is used by specialists to refer to a range of conditions that affect more than just the uveal tract. Other parts of the eye can be involved such as the sclera, retina, optic nerve, and lens — all of these would end up being managed by a uveitis specialist like me.
Anyone can get uveitis, although the typical age of onset in adults is 20–50 years old, which is younger than the other conditions I see such as cataracts and macular degeneration. I also specialise in treating children with uveitis, including running the uveitis clinic at the Women’s & Children’s Hospital.
What causes uveitis?
There are four main causes of uveitis:
Autoimmune or auto-inflammatory disease: This is when the body’s immune system incorrectly attacks its own health tissues. Autoimmune uveitis can be related to a specific autoimmune condition (e.g. inflammatory bowel disease, inflammatory arthritis, etc.), or considered “idiopathic” where no other inflammatory condition is found. Autoimmune disease is the most common kind of uveitis, and idiopathic is the most common autoimmune uveitis.
Infections: Viruses such as cold sore virus (herpes simplex) and chickenpox/shingles virus (varicella zoster) are the most common causes of infectious uveitis. Other uncommon causes include toxoplasmosis, tuberculosis, and syphilis. Note that infective conjunctivitis, the kind of eye conditions most people are familiar with, is not considered uveitis.
Trauma: Eye injuries involving blunt force can cause uveitis, while full-thickness cuts to the eye can introduce severe internal eye infections. Very severe injuries to one eye can, uncommonly, trigger an autoimmune reaction in both eyes called sympathetic ophthalmia.
Medication/surgery: Glaucoma eye drops are the most common ocular medication to cause uveitis. Non-eye medications include osteoporosis treatment, cancer immunotherapy, and some anti-infectives. Uveitis after surgery can be due to prolonged post-operative swelling, exacerbation of an underlying autoimmune disease, or a mild chronic infection.
Sometimes other eye conditions may look like uveitis but actually be something else. An important example of this is intraocular lymphoma, which is rare but always considered in older patients and those with specific risk factors.
What are the symptoms?
Uveitis and ocular inflammation can present in several ways. Symptoms include:
Eye pain
Light sensitivity
Redness
Blurred/cloudy vision
Floaters/spots in the vision
The most common types of uveitis present with pain, light sensitivity, and redness. Less common forms of uveitis involving mainly the back of the eye are more likely to present without pain.
How is uveitis treated?
Because uveitis is a range of conditions, there are a range of treatments depending on your specific problem. In general the type of treatment is determined by:
The specific disease: Autoimmune uveitis is treated with medications that decrease the immune system’s activity and dampen inflammation. Infections are managed by treating the infection with antivirals, antibiotics, etc, and using anti-inflammatory medications to settle down inflammation.
What is affected: Eye drops might be all that is needed for mild to moderate uveitis affecting only the front of the eye. Eye drops are not effective for severe disease or uveitis involving the middle or back of the eye – in these cases tablets, local injections, and systemic injections may be needed. If a person with uveitis has inflammation in other parts of their body, generally it’s best to treat the whole body with a tablet or injection.
How long the disease will last: Most commonly uveitis comes in episodes, using treatments that are designed to last only until the episode recovers. Long-term treatments (usually tablets or systemic injections) are used when the disease is chronic and long-term, or when episodes are so frequent that repeated short-term treatments are considered risky
When should I see a uveitis specialist?
Uveitis is relatively uncommon, but any ophthalmologist should be able to manage simple uveitis such as occasional episodes of iritis that respond to eye drops. I’d recommend seeing a uveitis specialist for uveitis that:
Isn’t responding to eye drops
Continues for more than 3 months
Involves the back of the eye and affects vision
Requires long-term immunosuppressive treatment
Uveitis in children
Ophthalmologists with experience in retinal conditions may also specialise in uveitis — if you want to know if your eye specialist is an expert in uveitis just ask them.
If you have uveitis and would like a review or second opinion, contact me to make an appointment.