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Uveal Inflammation (Uveitis)

What is Uveal inflammation (uveitis)?

Uveitis is an inflammation of the uvea – the middle layer of the eye that includes the iris, ciliary body, and choroid. Because the uveal tissue supplies blood to the retina and controls the eye’s focus, inflammation here can quickly affect vision and cause pain, light sensitivity, and redness. Uveitis can be anterior (affecting the iris), intermediate (affecting the vitreous), posterior (affecting the retina/choroid), or panuveitis (inflammation of all three segments). It may occur in one eye (unilateral) or both (bilateral) and can be acute (sudden onset) or chronic (lasting months to years).

Uveitis accounts for about 10–15% of all cases of blindness in the United States and is a leading cause of visual loss worldwide. Early recognition and treatment are essential to prevent permanent damage.

Common Causes

Uveitis is often a manifestation of an underlying systemic condition, infection, or direct ocular injury. The most frequent causes include:

• Autoimmune diseases – e.g., ankylosing spondylitis, rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus.
• Behçet’s disease – a rare vasculitis that frequently causes recurrent anterior uveitis.
Infectious agents (each can affect different parts of the eye):
• Herpes simplex virus (HSV) or varicella‑zoster virus (VZV)
• Toxoplasma gondii (ocular toxoplasmosis)
• Syphilis (Treponema pallidum)
• Tuberculosis (Mycobacterium tuberculosis)
• HIV‑related opportunistic infections (e.g., cytomegalovirus)

• Masquerade syndromes – intra‑ocular lymphoma or leukemia presenting as uveitis.
• Trauma – penetrating eye injury, blunt trauma, or intra‑ocular foreign bodies.
• Post‑operative inflammation – after cataract extraction, vitrectomy, or glaucoma surgery.
• Systemic sarcoidosis – granulomatous disease that often involves the posterior segment.
• HLA‑B27 associated uveitis – linked to ankylosing spondylitis, reactive arthritis, and inflammatory bowel disease.

Associated Symptoms

The clinical picture varies by the anatomical site of inflammation but commonly includes:

• Eye redness (especially around the cornea)
• Pain, especially on eye movement
• Photophobia (light sensitivity)
• Blurred or decreased vision
• Floaters (spots or threads drifting in vision)
• Scotomas (dark spots in the visual field)
• Eye tearing or watery discharge
• Seeing halos around lights
• Feeling of pressure or “fullness” in the eye

Systemic symptoms may accompany ocular inflammation, such as fever, joint pain, skin rashes, or oral/genital ulcers, depending on the underlying disease.

When to See a Doctor

Uveitis can progress rapidly, so prompt evaluation is critical. Seek eye‑care promptly if you notice:

• Sudden onset of eye pain or redness that does not improve within 24 hours.
• New or worsening blurred vision.
• Persistent photophobia or light sensitivity.
• Floaters or dark spots that appear suddenly.
• Any vision loss, even if mild.
• Recent eye injury or surgery followed by inflammation.

If you have a known systemic disease (e.g., ankylosing spondylitis, sarcoidosis) and develop any of the above eye symptoms, contact your rheumatologist or ophthalmologist immediately.

Diagnosis

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

1. Clinical Examination

• Visual acuity test – determines the level of vision loss.
• Slit‑lamp biomicroscopy – magnified view of the anterior segment to detect cells and flare in the anterior chamber.
• Fundus examination (indirect ophthalmoscopy) – evaluates the vitreous, retina, and choroid for infiltrates, exudates, or vasculitis.
• Intra‑ocular pressure (IOP) measurement – inflammation can raise or lower IOP.
• Fluorescein angiography – highlights retinal vascular leakage, especially in posterior uveitis.
• Optical coherence tomography (OCT) – provides cross‑sectional images of retinal layers to detect macular edema.

2. Laboratory & Imaging Tests

Testing is guided by the suspected cause:

• Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C‑reactive protein (CRP) – screen for systemic inflammation.
• HLA‑B27 typing – especially in young adults with acute anterior uveitis.
• Serologic tests for infections: VDRL/RPR (syphilis), Quantiferon‑TB Gold or T‑spot (TB), toxoplasma IgG/IgM, HSV/VZV PCR from aqueous humor.
• Chest X‑ray or CT scan – assess for sarcoidosis or tuberculosis.
• Joint imaging or rheumatologic panels when systemic autoimmune disease is suspected.

3. Aqueous or Vitreous Tap

In cases where infection or masquerade syndrome is suspected, a small sample of fluid can be taken for PCR, culture, cytology, or flow cytometry.

Treatment Options

Treatment aims to control inflammation, preserve vision, and address any underlying systemic disease. Therapy is individualized based on the anatomic location, severity, and cause.

1. Medications

• Corticosteroid eye drops (e.g., prednisolone acetate 1%) – first‑line for mild‑to‑moderate anterior uveitis.
• Oral corticosteroids (prednisone) – used for intermediate/posterior uveitis or when topical therapy is insufficient.
• Periocular or intravitreal steroid injections – deliver high concentrations to the posterior segment (e.g., triamcinolone acetonide).
• Immunomodulatory therapy (IMT) – steroid‑sparing agents for chronic or recurrent disease:
  • Antimetabolites: methotrexate, mycophenolate mofetil, azathioprine.
  • Calcineurin inhibitors: cyclosporine, tacrolimus.
  • Biologic agents: adalimumab (approved for non‑infectious uveitis), infliximab, secukinumab.
• Antimicrobial therapy – directed at the underlying infection (e.g., azithromycin for toxoplasmosis, doxycycline for Lyme disease, antiviral acyclovir for HSV/VZV).
• Non‑steroidal anti‑inflammatory drugs (NSAIDs) – oral or topical NSAIDs can be adjuncts for mild inflammation.

2. Supportive and Home Care

• Artificial tears or lubricating ointments to relieve dryness.
• Cold compresses to reduce discomfort.
• Wearing UV‑blocking sunglasses to minimize photophobia.
• Avoiding smoking, which can worsen inflammatory eye disease.
• Adhering to a medication schedule and never abruptly stopping steroids without physician guidance.

3. Surgical Interventions

Reserved for complications:

• Glaucoma surgery if intra‑ocular pressure remains uncontrolled.
• Pars plana vitrectomy for persistent vitreous inflammation or tractional retinal detachment.
• Cataract extraction when steroid‑induced cataracts impair vision.

Prevention Tips

While not all cases of uveitis are preventable, several strategies can reduce risk or lessen recurrence:

• Control systemic disease: Keep rheumatoid arthritis, ankylosing spondylitis, sarcoidosis, and other inflammatory conditions well managed with the help of your rheumatologist.
• Follow treatment plans: Take prescribed immunosuppressive or antimicrobial medications exactly as directed.
• Regular eye exams: People with known risk factors should have comprehensive ophthalmic evaluations at least annually.
• Protect eyes from trauma: Use protective eyewear during sports, construction work, or any activity with a risk of impact.
• Practice good hygiene: Reduce exposure to infectious agents (e.g., wash hands after handling cat litter to lower toxoplasmosis risk).
• Avoid smoking and limit alcohol: Both can exacerbate systemic inflammation.
• Vaccinations: Stay up‑to‑date on vaccines (e.g., shingles vaccine) to lower the chance of viral ocular reactivation.

Emergency Warning Signs

Key Take‑aways

Uveitis is a potentially sight‑threatening inflammation of the eye's middle layer. Early detection, accurate identification of the underlying cause, and timely treatment are essential to preserve vision. Patients with systemic inflammatory or infectious diseases should be especially vigilant for ocular symptoms, and anyone experiencing sudden eye pain, redness, or visual changes must seek professional evaluation without delay.

References

1. Mayo Clinic. “Uveitis.” https://www.mayoclinic.org. Accessed June 2026.
2. Cleveland Clinic. “Uveitis: Symptoms, Causes, and Treatment.” https://my.clevelandclinic.org. Accessed June 2026.
3. National Eye Institute (NEI). “Uveitis.” https://www.nei.nih.gov. Accessed June 2026.
4. American Academy of Ophthalmology. Preferred Practice Pattern: Uveitis. 2024.
5. World Health Organization. “Global Vision Impairment and Blindness.” 2023.

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