ROBENIOL, HESTER MARIE S.

APRIL 14, 2018

VMUF JUNIOR INTERN

UVEITIS

Uveitis is inflammation of the uveal tract. The uveal tract is

the name given to the part of eye that is made up of:

 The iris: the part of the eye that gives it colour.

 The ciliary body: a small ring-like muscle that sits
behind the iris.
 The choroid: the layer of tissue between the retina
and the sclera, containing blood vessels and a
pigment that absorbs excess light.

Parts of the eye next to the uveal tract can also be affected.
These include:

 The retina: the light-sensitive layer lining the interior of the eye.
 The optic nerve: the nerve responsible for vision.
 The vitreous humour: the jelly-like material that fills the chamber behind the lens.

The sclera: the white outer layer of the eyeball.

DIFFERENT TYPES OF UVEITIS

Uveitis is classified according to the part of the uveal tract that the inflammation affects:

 Anterior uveitis is when the inflammation affects the anterior part of the uveal tract at the
front of the eye. This can include the iris (iritis) or the iris and the ciliary body (iridocyclitis). It
is the most common type of uveitis.
 Intermediate uveitis is when the inflammation affects the middle part of the uveal tract or
eye, mainly the vitreous humour. It can also affect the underlying retina.
 Posterior uveitis is when the inflammation affects the back of the eye. It can affect the
choroid, the head of the optic nerve, and the retina (or any combination of these structures).
It includes chorioretinitis, retinitis and neuroretinitis.
 Panuveitis is when the inflammation affects the whole of the uveal tract.

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ROBENIOL, HESTER MARIE S. APRIL 14, 2018
VMUF JUNIOR INTERN

Uveitis can also be:

 Acute: the uveitis is of sudden onset and tends not to last very long (less than three months but
usually around six weeks).
 Chronic: which means it is persistent. The uveitis lasts for more than three months and also
relapses (comes back) within three months of stopping treatment.
 Recurrent: the disease can flare up (relapse) and, at other times, it settles down.

The reason why some people develop chronic uveitis is not known. However, it is not thought to be due
to inadequate treatment.

CAUSES

There are many different causes of uveitis and uveitis is associated with a number of other diseases.
However, in up to half of cases, no specific cause for uveitis is found. This is known as idiopathic uveitis.
The known causes and associations of uveitis include the following:

Autoimmune and inflammatory diseases

Our immune system normally makes antibodies (small proteins) to attack bacteria, viruses, and other
'germs'. In people with autoimmune diseases, their immune system makes antibodies against the tissues
of their body causing damage and inflammation. It is not clear why this happens. Some people have a
tendency to develop autoimmune diseases. In such people, something might trigger the immune system
to attack the body's own tissues. The 'trigger' is not known.

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ROBENIOL, HESTER MARIE S. APRIL 14, 2018
VMUF JUNIOR INTERN

Autoimmune diseases that are associated with uveitis include Behçet's syndrome and rheumatoid
arthritis. (See leaflet called 'Rheumatoid Arthritis' for further information about this disease. Behçet's
syndrome is a condition that causes recurrent mouth ulcers. It can also affect other parts of the body
including heart, lungs, gut, joints and nervous system.) It is also thought that 'idiopathic' uveitis may
actually have an autoimmune basis.People with some other inflammatory diseases are also more prone
to uveitis

Infection
Various types of bacterial, fungal and viral infections can cause inflammation of the eye and uveitis.
Infections include herpes simplex, herpes zoster, toxoplasmosis, cytomegalovirus, syphilis, gonorrhoea,
tuberculosis and Lyme disease. Infections are a rare cause of uveitis.

Injury to the eye

Uveitis can occur after injury to the eye.

SYMPTOMS OF UVEITIS

The symptoms can vary depending on which type of uveitis.

Anterior uveitis

This usually affects one eye. The common symptoms are eye pain (usually felt as a dull ache in and
around the eye), redness of eye, and photophobia. May develop blurred vision or even some visual loss
(usually temporary). May develop headaches and notice that the iris (the part of the eye that gives it
colour) is a slightly different colour. Eye may become watery. The symptoms tend to develop over a few
hours or days.

Intermediate uveitis

This usually causes painless blurred vision. It is unusual to experience photophobia and redness of eye.
May notice floaters and these are a common symptom. Floaters are dark shapes seen, especially when
looking at a brightly illuminated background such as a blue sky. Both eyes are usually affected in
intermediate uveitis.

Posterior uveitis

This commonly causes painless blurred vision. In some people, it can also cause severe visual loss. May
notice floaters, as described above. May also develop scotomata. Scotomata are small areas of less

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VMUF JUNIOR INTERN

sensitive, or absent, vision in visual field. These areas are surrounded by normal sight. It is usual for only
one of the eyes to be affected in posterior uveitis and symptoms tend to take longer to develop.

TREATMENT

Treatment for uveitis aims to help relieve pain and discomfort in the eye(s), treat any underlying cause (if
possible), and to reduce the inflammation. This may prevent permanent loss of vision or other
complications. Treatment usually includes the following:

Treatment to relieve pain and discomfort

 Cycloplegic eye drops: these are special eye drops that can be used to relieve pain by causing the
pupil to dilate (widen). The drops cause pupil to dilate by relaxing the muscle in the ciliary body.
As a result, pain reduces and the inflamed iris is able to rest and recover. Examples include
atropine and cyclopentolate eye drops. However, they can have some side-effects. They can
make pupil appear large, can cause temporary blurred vision and also difficulty with focusing.
When the effect of the drops wears off, these side-effects will disappear. The drops need to be
used as frequently as every hour when uveitis is first diagnosed. If the drops are not used, the
inflammation in the iris may cause it to become 'stuck' to the lens causing permanent scarring.
 Dark glasses: if symptoms include photophobia (sensitivity to bright light), wearing dark glasses
may be helpful.
 Painkillers: painkillers, such as paracetamol, taken by mouth may also help.

Steroid eye drops are used to reduce the inflammation in uveitis. They are usually the main treatment.
Although steroid eye drops usually work well, in some cases side-effects occur, which are sometimes
serious. Possible side-effects that sometimes occur include ulcers on the cornea of the eye which can be
very painful and affect the vision. If steroid eye drops are used for long periods of time, they can lead to
cataracts or glaucoma.

In severe uveitis, steroids are sometimes given by injection into or around eye. They can also be given by
mouth. Again, these can have side-effects if used in the long-term. The main side-effects from steroids
taken by mouth occur when they are used for more than a few weeks. These include thinning of the
bones (osteoporosis), thinning of the skin, weight gain, muscle wasting and an increased risk of serious
infection.

If steroid treatment is needed in the longer term to treat uveitis, a second drug known as an
immunosuppressive drug may be used. This can help to reduce the amount of steroids needed and/or
help to control the uveitis if steroids are not working.

Treatment of underlying conditions and causes

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ROBENIOL, HESTER MARIE S. APRIL 14, 2018
VMUF JUNIOR INTERN

Any underlying cause of uveitis also needs to be treated (if possible). This means treating any underlying
infection, inflammatory disease or autoimmune disease.

Occasionally, surgery is needed to treat uveitis (usually chronic uveitis). For example, if someone has
persistent floaters that are affecting their ability to see, the vitreous humour in the eye can be removed.
Floaters tend to develop because of inflammation causing damage to the vitreous humour. Surgery may
also be used to treat the complication of cataracts that can occur.

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