Uveitis (inflammation of the uvea of the eye)
Uveitis is inflammation of the uvea, the middle layer of the eye that sits between the white of the eye and the retina and supplies it with blood.
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Medicines commonly prescribed for Uveitis (inflammation of the uvea of the eye)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: EYEDROP, 1.5 mg/mlActive substance: dexamethasoneManufacturer: Sifi S.P.A.Prescription requiredDosage form: EYEDROP, 1 mg/mlActive substance: dexamethasoneManufacturer: Brill Pharma S.L.Prescription requiredActive substance: dexamethasoneManufacturer: Abbvie Deutschland Gmbh & Co. KgPrescription required
Uveitis is inflammation of the uvea, the middle layer of the eye that sits between the white of the eye and the retina and supplies it with blood. From the outside it looks like nothing more than a red eye, and for the first few days most people reach for whatever drops are left in the cupboard. In fact this is one of the few eye conditions where the clock matters: inflammation inside the eye does not settle by itself, and its consequences — raised pressure, cataract, swelling of the central retina — build up quietly and take sight away for good. Treated promptly, it almost always comes under control. So the whole point of this page fits into one sentence: pain in the eye together with real sensitivity to light and blurring vision means seeing an eye specialist the same day, not trying some drops and waiting.
What it feels like from day one
Usually one eye is affected, sometimes both. The picture is fairly recognisable:
- a deep, aching pain inside the eye that gets worse when you read or focus on something close, and worse again in bright light;
- redness in a ring around the iris, strongest right at the edge of the coloured part, rather than spread across the white or gathered in the corners;
- photophobia — an ordinary room light is painful and you instinctively look for the shade;
- misty vision, as if you were looking through a film, which does not clear however much you blink;
- floating dots, threads or flakes drifting across your sight, sometimes flashes at the edge;
- watering without any discharge or pus; the pupil may become smaller than usual and lose its round shape.
The pace varies. When the front of the eye is inflamed, it declares itself within hours or a day or two: this is the commonest and the most obvious form. When the back of the eye is inflamed, it creeps up over weeks and may cause neither pain nor redness, only slowly dimming vision and floaters. In children with juvenile arthritis, uveitis often causes no symptoms at all and is picked up only at a routine eye check — which is exactly why those checks are arranged.
How it differs from conjunctivitis
This is the most useful distinction on the page, because this is precisely where a week gets lost. In conjunctivitis the redness is spread over the whole white of the eye and is strongest towards the corners, there is grittiness and itching, there is discharge — the lashes stick together overnight — and vision does not drop: it clouds behind the tear film and clears when you blink. Bright light is unpleasant but bearable.
Uveitis is different on every count: the pain is genuine and deep rather than a sting; the redness forms a ring around the iris; light hurts; vision falls and blinking does not restore it; there is no pus. Keep one rule in mind: pain plus light sensitivity plus vision that is dropping means an eye specialist the same day, whatever the final diagnosis turns out to be.
And it will not always be uveitis. The same picture comes from an acute attack of glaucoma — pain, coloured haloes around lights, an eye that feels hard, nausea — and from inflammation of the cornea, particularly in contact lens wearers. You cannot tell them apart by looking: they are separated by a slit lamp examination and a pressure reading, which is one more reason not to start dropping medicines into the eye yourself.
Why waiting is the wrong move
Inflamed tissues inside the eye stick to one another. The iris adheres to the lens, the pupil loses its shape, the outflow of fluid inside the eye is obstructed and the pressure climbs — that is secondary glaucoma, and it damages the optic nerve permanently. Prolonged inflammation and long courses of steroids speed up clouding of the lens, in other words cataract. And the commonest reason for lasting loss of vision in uveitis is macular oedema, fluid collecting in the central part of the retina: what people notice is that straight lines start to wave and letters drop out of a line of print.
All of this progresses painlessly, while the eye feels as though it is settling. Put plainly: untreated and half-treated uveitis remains one of the causes of irreversible sight loss in people of working age, and a lost week here genuinely costs vision.
See an eye specialist the same day if you get:
- pain in the eye with redness around the iris;
- sudden inability to tolerate light;
- misting or loss of vision;
- a sudden shower of new floaters, or flashes;
- any of these in someone who has had uveitis before.
Do not wait until morning if there is sudden loss of vision, a dark curtain across one side, severe pain with nausea and vomiting, an injury to the eye, or an inflamed eye in someone whose immune system is suppressed or who has recently had shingles on the face. An ambulance (the single European number is 112) is needed for a penetrating eye injury or sudden total blindness; in every other situation the call to make is not to the emergency services but to find an eye specialist who can see you today.
What lies behind uveitis
In roughly half of people no cause is ever found, and that is a normal result rather than a failure of investigation. In the rest, something else sits behind the inflamed eye, and the list of suspects is fairly consistent:
- the spondyloarthritides — ankylosing spondylitis, reactive arthritis and psoriatic arthritis; these keep company with anterior uveitis more often than anything else;
- inflammatory bowel disease — Crohn's disease and ulcerative colitis;
- sarcoidosis, Behçet's disease and multiple sclerosis;
- juvenile idiopathic arthritis in children, the situation where the eye neither hurts nor reddens;
- infections — herpes simplex and herpes zoster viruses, toxoplasmosis, tuberculosis, syphilis, Lyme disease and cytomegalovirus in people with severe immune suppression;
- injury to the eye and previous eye surgery;
- rarely a tumour inside the eye or a lymphoma, both of which can imitate stubborn inflammation; they are considered when treatment inexplicably fails to work.
The link runs in both directions. In some people the inflamed eye is the first visible sign of a condition affecting the whole body, and it is the eye specialist who refers to the rheumatologist rather than the other way round. That is why repeated episodes prompt investigation beyond the eye itself.
How the diagnosis is made
The key part of the appointment is the slit lamp examination: in the beam of light the doctor can see cells floating in the front chamber of the eye, and that is what confirms inflammation. The pupil is then dilated with drops so the vitreous and retina can be checked; after those drops everything is blurred and light is uncomfortable for several hours, so it is best not to drive that day. Eye pressure is always measured, and if swelling of the central retina is suspected an image of the retina is taken.
After a first mild episode, nothing further is usually needed. If episodes recur, if both eyes are involved, if the inflammation is at the back of the eye or the picture is unusual, then the cause is looked for: blood tests including inflammatory markers, HLA-B27, a chest X-ray, tests for syphilis and tuberculosis and, where there is reason, for Lyme disease and toxoplasmosis. The questions matter as much as the tests: the doctor will ask about morning stiffness and low back pain, bowel habit, skin rashes, mouth ulcers, joint pain, recent travel and past infections. This is not box-ticking — the treatment depends directly on what is found.
Treatment, and why only an eye specialist should prescribe the drops
The mainstay of treatment for anterior uveitis is steroid eye drops, given frequently at first and then on a reducing schedule, together with drops that dilate the pupil, which relieve the spasm — and with it that pain on reading — and stop the iris sticking to the lens. It works quickly and it works well, but there are three warnings that this section exists for.
- Using someone else's drops is the most dangerous thing you can do to an inflamed eye. If what lies behind the redness is a herpetic, bacterial or fungal problem in the cornea, steroids take away the pain while giving the infection a free hand. These stories end in a corneal ulcer and a corneal graft.
- Steroids themselves raise eye pressure and hasten cataract, so pressure is checked during the course, and the drops are neither stopped abruptly nor continued on your own initiative: both lead to a fresh flare.
- If the cause is an infection, antiviral, antimicrobial or antiparasitic treatment is started first or alongside — steroids without it make the illness worse.
For posterior and severe uveitis, steroids are added as tablets or as an injection beside or into the eye. Where flares are frequent, or where there is an underlying condition affecting the whole body, treatment moves on to medicines that damp down the immune system and to biologic medicines; these are managed by rheumatologist and eye specialist together, with regular blood monitoring. Laser, freezing treatment and surgery are needed rarely and usually for complications rather than for the inflammation itself. What does nothing at all are decongestant drops sold for red eyes and antibiotics used on spec: the first simply mask the picture.
If uveitis keeps coming back
Anterior uveitis has a habit of recurring, especially the HLA-B27 associated kind. People live with it for years and keep good sight, provided a few straightforward things are in place.
- Learn your own first warning. For most people it is always the same: a mild ache or a touch of light sensitivity the day before the eye turns red. Treatment starts at that point, not a week later.
- Agree in advance with your eye specialist how to get hold of them in a flare: a route already worked out saves exactly those days.
- Do not stretch an old bottle of drops across a new episode — dose and duration are set each time by what the examination shows.
- Keep the routine appointments even when the eye is quiet: both raised pressure and cataract announce themselves late.
- Treat the underlying condition. In spondyloarthritis and inflammatory bowel disease, keeping them controlled also reduces the number of eye flares.
- Children with juvenile arthritis are given scheduled eye checks precisely because their uveitis neither hurts nor reddens.
Sunglasses treat nothing, but in the acute phase they genuinely make light easier to bear, and wearing them is sensible. Smoking makes uveitis run a harder course — one more reason to stop.
Online consultation
With eye problems, an online appointment answers the question that matters most: how urgent is this, and who should be seen. From your description a doctor can weigh up whether this looks more like uveitis or like ordinary conjunctivitis, what the pattern of redness, pain and light sensitivity is telling you, and whether an eye specialist needs to be found today. Online is also a good setting for sorting out treatment already started: how to follow the reducing schedule of drops, which side effects deserve attention, why the eye specialist referred you to a rheumatologist and what the test results mean. If uveitis recurs, you can build a plan together for the next flare. What cannot be replaced is the slit lamp and the pressure reading: when there is pain, light sensitivity and vision that is dropping, an online consultation is there to get you into a face-to-face appointment sooner, not instead of one.
This material is for information only and does not replace medical advice.
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