Uveitis: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino Last updated Jun 20, 2023

Let’s talk about uveitis: the uvea represents the vascular tonaca of the eyeball and is composed of iris, ciliary body and choroid

Since it is richly vascularised, it lends itself to contact with external pathogens and immunocompetent cells, and is therefore the specific site of autoimmune or infectious diseases of the eyeball.

For this reason, diseases of the uvea are largely characterised by an inflammatory involvement, which is referred to as uveitis.

To a lesser extent, however, there are congenital, degenerative or neoplastic diseases of the uvea.

Uveitis is a disease that can lead to involvement of the retina, vitreous and fluid within the anterior chamber.

The causes of uveitis are many and can change depending on previous diseases and factors such as age.

Uveitis is diagnosed following a visit to the ophthalmologist, who may prescribe specific tests to determine the best treatment, if any.

What is uveitis

Uveitis can be defined as one of the most common inflammations of the eye.

In fact, this condition affects between 8 and 15 patients per 10,000 people per year, making it one of the most common forms of inflammation.

The uvea is a membrane that lies between the cornea and the sclera, which then consists of three parts: the ciliary body, choroid and iris.

Inflammation of the uvea can be localised to only one of its parts or involve the entire bulb, panuveitis.

The most commonly used classification is therefore on an anatomical basis and distinguishes them into anterior uveitis, posterior uveitis and, as mentioned, panuveitis.

This disease affects men and women equally and mainly affects adults between the ages of 20 and 50.

Inflammatory forms in children, usually related to other diseases, are also not uncommon.

Fifty per cent of patients have an anterior form of uveitis, 25 per cent a posterior form, 20 per cent panuveitis and the remainder intermediate forms of uveitis.

Types of uveitis

As mentioned above, the uvea consists of different parts of the eye.

The inflammation can be total or partial, and from these different types comes the distinction between different types of uveitis.

Among the most common forms of this inflammation are:

anterior uveitis, also called iridocyclitis, is probably the most common form of eye inflammation. This condition is manifested by inflammation of the iris and ciliary body and includes iritis, iridocyclitis and anterior uveitis. Anterior uveitis can often be autoimmune, so the inflammation is caused by endogenous immunocompetent cells.
Posterior uveitis, on the other hand, includes various inflammations of the optic disc, retina and choroid. One therefore speaks of choroiditis, chorioretinitis, neuroretinitis.
Intermediate uveitis is inflammation that affects the vitreous cavity and can lead to different symptoms from the previous ones, including parsplanitis, posterior cyclitis and hyalitis.

Finally, another form is panuveitis, which can be defined as the inflammation of the entire uvea affecting the anterior chamber, vitreous and retina or choroid

Causes of uveitis

The causes of uveitis can be diverse and it is not always easy to identify them as they often have common clinical manifestations.

They are often secondary to infectious diseases (tuberculosis, toxocariasis, fungal infections, parasites, syphilis), autoimmune diseases (Reiter’s syndrome, Behcet’s disease, rheumatoid arthritis, SLE, sarcoidosis), trauma, drugs, paraneoplastic diseases that mimic an inflammatory pathology (masquerade syndrome).

Depending on the type of uveitis, more specific and common causes can then be identified:

causes of anterior uveitis include trauma, juvenile idiopathic arthritis, spondyloarthropathy, herpes infections and a post-surgical or idiopathic cause;
intermediate uveitis, on the other hand, includes causes such as tuberculosis, syphilis, sarcoidosis, Lyme disease, multiple sclerosis;
posterior uveitis, on the other hand, presents involvement of individual retinal and choroidal layers, or the vascular tree (vasculitis). The cause may be infectious (TB, syphilis) or secondary to rheumatic disease (SLE, sarcoidosis, Behcet’s disease). There are also primary inflammatory forms of the choroid such as Birdhsot-type chorioretinopathy and Vogt-Koyanagi-Harada disease.

Diagnosis of uveitis

The diagnosis of uveitis is not straightforward, which is why people with symptoms such as redness, eye pain, hypersensitivity to light, decreased vision and vitreous motile bodies are suspected of this inflammation.

The symptoms of uveitis can then change depending on the type, e.g. in unilateral anterior uveitis the symptom of eye pain is very present, especially in strong light.

The first step to a correct diagnosis is a visit to the ophthalmologist, who can perform tests such as visual acuity, intraocular pressure and pupil dilation tests.

It is not uncommon for an ophthalmologist to also prescribe blood or systemic tests to make sure that this inflammation is idiopathic and not the cause of a more complex and serious disease.

To diagnose uveitis one must certainly recognise the clinical signs related to inflammation of the eye or a specific portion of the eyeball.

This requires a specific examination, a slit-lamp objective test, which involves the use of a narrow, very bright light on the anterior chamber

In many cases, the eye fundus is also tested after dilation of the pupil to look for signs of inflammation in the posterior segment of the eye.

In some forms of uveitis, there may also be an increase in intraocular pressure, so a correct diagnosis is important to avoid glaucoma secondary to this condition.

Prevention of Uveitis

Preventing uveitis is not easy.

There are in fact no particular behaviours to stop this particular disease.

One way to prevent uveitis is certainly to request constant check-ups, especially if one of the aforementioned symptoms related to eye redness, photophobia, and/or decreased visual acuity occur.

In addition, patients with a history of rheumatic or autoimmune diseases can then be referred periodically for an eye examination by their treating physician to rule out ocular involvement.

Constant eye check-ups can lead to early diagnosis, which is crucial for effective treatment.

Treatments and cures

The treatment of uveitis can vary greatly depending on the cause of the inflammation.

Each cause may in fact require a specific treatment, which is prescribed by a specialist in the field.

Treatments for this type of inflammation can be classified into two types:

local treatments, such as eye drops
systemic treatments, drugs that are taken orally or in a vein

The type of treatment can change considerably depending on the type of diagnosis, i.e. the cause of the condition.

Among the most common treatments for uveitis are:

antiviral therapies, which are prescribed in cases such as chickenpox or herpes
antibiotic therapies, which are administered when the cause of inflammation is bacterial
antifungal therapies, which are used when the cause of the disease is a fungus
antimalarial therapies are prescribed instead in cases of diagnoses such as toxoplasmosis
uveitis may be caused by autoimmune diseases, in which case the doctor may require cortisone and immune-system suppressing drugs.
surgery, in special cases when, for instance, uveitis is caused by cataracts or diseases such as retinal detachment

Complications and other information

As mentioned above, uveitis is a common inflammation and can be a symptom of another systemic disease.

This is why it is essential to diagnose it in time and identify its causes.

If neglected, this type of inflammation can lead to significant complications, the most common of which is irreversible vision loss.

Many cases of uveitis are in fact the cause of blindness: this disease accounts for 10 per cent of all causes of vision loss.

Persistent inflammation of the eyeball alters the different structures of the eye, for example the crystalline lens, causing a cataract, the retina and choroid causing cystoid macular oedema, retinal ischaemia, retinal detachments, and the optic nerve.

Early diagnosis allows more treatment options before the damage to these ocular structures is irreversible.

What Is Presbyopia And When Does It Occur?

False Myths About Presbyopia: Let’s Clear The Air

Eye Diseases: Overview Of Pinguecula

Droopy Eyelids: How To Cure Eyelid Ptosis?

Presbyopia: What Are The Symptoms And How To Correct It

Presbyopia: An Age-Related Visual Disorder

Eye Diseases: What Is Iridocyclitis?

Conjunctival Hyperemia: What Is It?

Eye Diseases: The Macular Hole

What Is Ocular Pterygium And When Surgery Is Necessary

Tear Film Dysfunction Syndrome, The Other Name For Dry Eye Syndrome