Uveitis: Inflammation Inside the Eye

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Uveitis: Inflammation Inside the Eye

Is your eye red, painful, and sensitive to light? Are you experiencing blurry vision that won't seem to clear up? These could be signs of uveitis, an inflammatory condition affecting the inside of your eye that requires prompt attention. Unlike the common "pink eye" that affects the surface, uveitis involves inflammation of the uvea, the middle layer of your eye that contains critical blood vessels supplying your retina. While the name might be unfamiliar, uveitis is a significant cause of vision loss, particularly when left untreated.

The good news? When diagnosed early and managed properly, most people with uveitis can preserve their vision and prevent serious complications. At Retina Consultants of Southern Colorado, our fellowship-trained specialists have extensive experience diagnosing and treating all forms of uveitis, working closely with you to identify the underlying cause and develop a treatment plan that protects your sight.

What Is Uveitis?

To understand uveitis, it helps to know a bit about your eye's anatomy. The uvea is the middle layer of your eye wall, sandwiched between the white outer layer (sclera) and the inner retina. It's made up of three parts: the iris (the colored part of your eye), the ciliary body (which produces the fluid inside your eye and helps your lens focus), and the choroid (a layer packed with blood vessels that nourish your retina). Uveitis is inflammation of any or all of these structures.

Think of it like your eye's immune system going into overdrive, sometimes fighting an actual infection, but more often mistakenly attacking healthy eye tissue. This inflammatory response causes swelling, tissue damage, and a cascade of problems that can threaten your vision if not controlled. What makes uveitis particularly concerning is that it can affect people of all ages, from children to older adults, and it has the potential to cause permanent damage surprisingly quickly. Unlike conditions that develop slowly over years, uveitis can escalate within days or weeks, making early recognition and treatment absolutely critical.

Types of Uveitis

Uveitis isn't just one condition; it's classified based on which part of the uvea is primarily inflamed. Where the inflammation occurs affects what symptoms you experience, what complications you might face, and how your doctor approaches treatment.

• Anterior Uveitis (Iritis)

  This is the most common type, accounting for about 75% of uveitis cases. Anterior uveitis affects the front part of your eye, specifically the iris and ciliary body. It typically comes on suddenly and is often the most painful form of uveitis.

  You'll likely notice a red eye, significant light sensitivity, and a deep, aching pain (different from the scratchy feeling of surface irritation). Vision may be blurry, but anterior uveitis caught early usually responds well to treatment and doesn't typically threaten long-term vision.

• Intermediate Uveitis (Vitritis)

  This form involves inflammation primarily in the vitreous, or the gel-like substance filling the middle of your eye, and its surrounding structures. It's less common than anterior uveitis and tends to affect younger adults and children.

  Intermediate uveitis is often less dramatic in its presentation. Rather than severe pain and redness, you might notice floaters, blurred vision, or difficulty seeing in your peripheral vision. Because symptoms can be relatively mild, people sometimes delay seeking treatment, which is risky because this type can lead to serious complications like macular edema or cataracts.

• Posterior Uveitis (Choroiditis)

  When inflammation affects the back of your eye — the choroid and often the retina — it's called posterior uveitis. This is potentially the most serious type because it directly involves the structures responsible for your central vision.

  Posterior uveitis is typically painless because there are no pain-sensing nerves in the back of your eye, but it can cause significant vision problems: blurriness, blind spots, distorted vision, and floaters. Because you might not feel pain, it's easy to downplay symptoms, but this type requires aggressive treatment to prevent permanent retinal damage.

• Panuveitis

  Sometimes inflammation doesn't discriminate — it affects the entire uvea, front to back. This is called panuveitis, and it's the most severe form. You'll experience symptoms from all three types: pain, redness, light sensitivity, floaters, and vision loss. Panuveitis often indicates a serious underlying systemic condition and requires comprehensive evaluation and treatment.

What Causes Uveitis?

One of the most frustrating aspects of uveitis is that pinpointing the exact cause can be challenging. However, understanding potential triggers helps guide both treatment and prevention of future episodes.

• Autoimmune and Inflammatory Diseases

  In many cases, uveitis results from your immune system mistakenly attacking your own eye tissue. This can occur as part of systemic autoimmune conditions such as:

  • Ankylosing spondylitis (a type of arthritis affecting the spine)
  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • Lupus
  • Sarcoidosis
  • Multiple sclerosis

  If you have one of these conditions, you're at higher risk for developing uveitis, and managing your underlying disease becomes part of managing your eye health.

• Infections

  While less common in developed countries, infections can trigger uveitis. These include:

  • Toxoplasmosis (often from undercooked meat or cat feces)
  • Herpes viruses (including shingles)
  • Tuberculosis
  • Syphilis
  • Lyme disease
  • HIV-related infections
  • Fungal infections (more common in immunocompromised individuals)

  When infection is the cause, treating the infection directly is crucial for resolving the uveitis.

• Trauma or Injury

  A penetrating eye injury or blunt trauma can trigger inflammatory uveitis, sometimes immediately or even months after the initial injury. This can also occasionally affect the uninjured eye through a phenomenon called sympathetic ophthalmia, though this is rare.

• Other Risk Factors

  • Certain genetic markers
  • Smoking
  • Recent viral illnesses
  • Certain medications
  • Exposure to toxins or chemicals

• Idiopathic (Unknown Cause)

  Despite thorough testing, roughly 30-40% of uveitis cases have no known cause. These are labeled as "idiopathic," which simply means the trigger remains unknown. While this can feel frustrating, we can still treat the inflammation effectively even without knowing exactly what started it.

Recognizing the Symptoms of Uveitis

Uveitis symptoms can vary dramatically depending on which type you have, but certain warning signs should always prompt an immediate call to your eye doctor.

Common Symptoms Include:

• Eye Pain: This can range from a dull ache to severe, sharp pain, particularly in anterior uveitis. The pain often worsens with eye movement or bright light exposure.
• Redness: Your eye may appear pink or red, particularly around the iris. This is most noticeable in anterior uveitis.
• Light Sensitivity (Photophobia): Many people with uveitis find even normal lighting uncomfortable. Bright lights can feel almost painful, making you want to stay in dimly lit rooms or wear sunglasses indoors.
• Blurred Vision: Your vision might be hazy, foggy, or simply not as sharp as usual. This can affect one or both eyes.
• Floaters: You might notice new spots, specks, cobwebs, or clouds drifting across your vision, particularly with intermediate or posterior uveitis.
• Decreased Vision: In more severe cases or when inflammation affects the macula, you might experience significant vision loss or blind spots.
• Headache: Some people experience headaches along with their eye symptoms.

Symptoms can develop suddenly (over hours or days) or gradually. Some forms of uveitis, particularly posterior uveitis, can be relatively painless despite causing significant vision problems. But it’s important that you don't wait for symptoms to become unbearable, as early treatment makes a significant difference in outcomes.

If you develop sudden eye pain, redness, and light sensitivity, or if you notice sudden vision changes, contact an eye care professional immediately.

How Uveitis Is Diagnosed

Diagnosing uveitis requires a few steps — your doctor needs to confirm inflammation is present, determine which type you have, assess the severity, and ideally identify what's causing it.

• Comprehensive Eye Examination

  Your doctor will perform a thorough examination using a slit lamp, a specialized microscope that allows detailed viewing of the front and inside of your eye. They're looking for:

  • White blood cells floating in the fluid inside your eye (a key sign of inflammation)
  • Protein deposits or "flare" in the anterior chamber
  • Inflammatory deposits on the back of your cornea or lens
  • Swelling or damage to the iris, vitreous, or retina

  Your pupils will be dilated so your doctor can examine the back of your eye for signs of posterior involvement.

• Optical Coherence Tomography (OCT)

  This non-invasive imaging creates detailed cross-sections of your retina, revealing swelling (macular edema) or structural changes that might not be visible during examination alone.

• Fluorescein Angiography

  If posterior uveitis is suspected, this test uses injected dye to highlight inflammation, leakage from blood vessels, and areas of retinal damage.

• Laboratory Testing

  Because uveitis can be associated with systemic diseases or infections, your doctor may order blood tests, imaging studies, or other diagnostic work to search for underlying causes. This might include:

  • Blood tests for autoimmune markers, infections, or inflammatory diseases
  • Chest X-rays to check for sarcoidosis or tuberculosis
  • HLA typing (genetic testing for certain markers)
  • Specialized tests based on your medical history

  The goal isn't just to treat your eye; it's to identify and address any underlying condition that might be contributing to the inflammation.

Uveitis Treatment Options

The primary goal of uveitis treatment is straightforward: control inflammation as quickly as possible to prevent permanent damage, then maintain that control over time. Treatment intensity depends on the type, severity, and underlying cause of your uveitis and can include:

• Corticosteroid Medications: Steroids are the first-line treatment for most types of uveitis because they're powerful anti-inflammatory medications.
• Eye Drops: For anterior uveitis, prescription steroid eye drops (like prednisolone acetate) are typically started frequently — sometimes every hour initially — then gradually tapered as inflammation improves. You might also receive dilating drops to prevent your iris from sticking to your lens and to reduce pain.
• Injections: For more severe inflammation or posterior uveitis, steroid medications can be injected around or into the eye. These deliver higher doses directly where they're needed.
• Oral Steroids: When inflammation affects the back of the eye or both eyes, or when topical treatment isn't sufficient, oral prednisone may be prescribed. This provides a systemic anti-inflammatory effect, but comes with more potential side effects.
• Steroid Implants: For chronic uveitis requiring long-term steroid treatment, slow-release implants can be placed inside the eye to provide sustained medication delivery over months.
• Immunosuppressive Medications: When uveitis is severe, recurrent, or doesn't respond adequately to steroids, or when the side effects of long-term steroid use become problematic, your doctor may recommend immunosuppressive drugs. Medications like Methotrexate, Azathioprine, Mycophenolate, Cyclosporine, and Tacrolimus work by dampening your overall immune response. These medications require regular monitoring through blood tests and are typically managed in collaboration with a rheumatologist or immunology specialist.
• Biologic Therapies: Newer biologic medications that target specific parts of the immune system have revolutionized treatment for severe, chronic uveitis. These are typically reserved for cases that don't respond to conventional treatments or when trying to avoid long-term steroid use.
• Treating Underlying Infections: If your uveitis is caused by an infection, treating that infection is paramount. You may be prescribed antiviral medications for herpes-related uveitis, antibiotics for bacterial infections, or antimicrobial therapy for toxoplasmosis or other parasitic causes.
• Surgical Intervention: Surgery isn't typically used to treat uveitis itself, but the following may be necessary to address complications:
  • Cataract surgery if inflammation has caused lens clouding
  • Glaucoma procedures if increased eye pressure develops
  • Vitrectomy for severe vitreous inflammation or complications
  • Retinal surgery for detachment or other structural problems

Potential Complications: Why Treatment Matters

Untreated or poorly controlled uveitis can lead to serious, vision-threatening complications. Understanding these risks underscores why taking your treatment seriously is so important.

• Cataracts

  Both chronic inflammation and corticosteroid treatment can cause the lens of your eye to become cloudy, leading to cataracts. This is one of the most common complications of uveitis, but fortunately, cataracts can be surgically removed once inflammation is controlled.

• Glaucoma

  Inflammation can block the drainage system in your eye, causing pressure to build up. Additionally, long-term steroid use can increase eye pressure in some people. Uncontrolled glaucoma damages the optic nerve and can lead to permanent vision loss.

• Macular Edema

  Swelling in your macula, the central part of your retina responsible for detailed vision, is a frequent complication that causes blurred central vision. This requires additional treatment beyond controlling the inflammation itself.

• Band Keratopathy

  Chronic anterior uveitis can cause calcium deposits on the cornea, creating a cloudy band across your vision.

• Posterior Synechiae

  This occurs when your iris sticks to the lens due to inflammation. It can affect pupil function and increase the risk of glaucoma. This is why dilating drops are often prescribed, as they keep your pupil moving and prevent adhesions.

• Retinal Damage or Detachment

  Severe or prolonged inflammation can damage retinal tissue directly or cause scar tissue formation that leads to retinal detachment.

• Vision Loss

  The ultimate concern: permanent vision loss can result from any of these complications or from the inflammatory damage itself. Uveitis is responsible for approximately 10-15% of blindness in the United States, making it a leading cause of preventable vision loss.

  The encouraging news? Most of these complications are preventable with prompt, appropriate treatment and careful monitoring.

The Critical Importance of Early Treatment and Follow-Up

If there's one message to take away about uveitis, it's this: timing is everything. The difference between seeking treatment immediately versus waiting to see if it gets better can literally be the difference between preserving your vision and losing it permanently.

• Cataracts

  Both chronic inflammation and corticosteroid treatment can cause the lens of your eye to become cloudy, leading to cataracts. This is one of the most common complications of uveitis, but fortunately, cataracts can be surgically removed once inflammation is controlled.

• Why Early Treatment Is Essential

  Inflammation causes damage quickly. Every day that uveitis goes untreated, inflammatory cells and chemical mediators are actively damaging delicate eye structures. Some of this damage can be permanent as scar tissue forms, cells die, and structures become permanently altered. Starting treatment early stops this destructive process before irreversible harm occurs.

  Many complications of uveitis develop gradually and silently. You might not notice glaucoma developing or macular edema worsening until significant damage has occurred. Early, aggressive treatment prevents these complications from starting in the first place.

• Why Follow-Up Care Is Non-Negotiable

  Uveitis is often a chronic or recurrent condition. Even after your initial episode is treated and symptoms resolve, the inflammation can return, sometimes months or years later. Regular follow-up appointments allow your doctor to:

  • Detect inflammation returning before you notice symptoms
  • Monitor for steroid-related side effects like increased eye pressure or cataract formation
  • Adjust medications to find the minimum dose that keeps inflammation controlled
  • Screen for complications like macular edema or glaucoma
  • Coordinate with other specialists managing underlying systemic conditions

• Sticking With Your Treatment Plan

  Uveitis treatment often requires patience and commitment. You might need to:

  • Use eye drops multiple times daily for weeks or months
  • Take oral medications with potential side effects
  • Undergo regular blood tests to monitor medication effects
  • Return for frequent check-ups, especially during active inflammation

  It's tempting to stop treatment once you feel better, but inflammation can linger even after symptoms disappear. Stopping medication too soon often leads to rebound inflammation that's harder to control than the original episode.

Advanced Care for Uveitis in Southern California

Uveitis is a serious condition, but with the right care, most people maintain good vision and quality of life. The key factors in successful outcomes are early recognition of symptoms, prompt treatment, commitment to your medication regimen, and consistent follow-up care. If you're experiencing eye pain, redness, light sensitivity, or vision changes, don't wait; these symptoms deserve immediate professional evaluation.

At Retina Consultants of Southern Colorado, we understand that dealing with uveitis can feel overwhelming, especially when it's chronic or recurrent. Our experienced team specializes in diagnosing and managing all forms of uveitis, using the latest diagnostic technology and evidence-based treatments to control inflammation and protect your vision. We work collaboratively with other specialists when needed to address any underlying systemic conditions contributing to your eye inflammation.

Whether you're experiencing your first episode or managing chronic uveitis, we're here to provide the expert care and ongoing support you need. Contact us today to schedule a comprehensive evaluation — your vision is too precious to risk, and early intervention makes all the difference.