Uveitis: Symptoms, Causes, Therapy

Brief overview

  • What is uveitis? An inflammation of sections of the middle skin of the eye (uvea). This consists of iris, ciliary body and choroid.
  • Uveitis forms: anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis.
  • Complications: among others cataract, glaucoma, retinal detachment with risk of blindness.
  • Causes: usually no cause can be identified (idiopathic uveitis). Sometimes uveitis is the result of other conditions such as rheumatic diseases or infections.
  • Investigations: Medical history, ophthalmologic examinations and eye test, investigations to determine the cause, such as blood tests or imaging procedures, if necessary.
  • Is uveitis curable? Good chances of cure for acute uveitis. Chronic uveitis is often recognized and treated late, which is why the risk of complications is increased here. In the case of chronic underlying diseases, uveitis can always recur (relapse).

Uveitis: Description

The middle eye skin (uvea) is composed of three sections: Iris, Ciliary Body, and Choroid. In uveitis, these sections can be inflamed individually or in combination. Accordingly, physicians distinguish between different forms of uveitis (see below).

Uveitis is one of the rare eye diseases. Every year, about 15 to 20 out of 100,000 people contract this eye inflammation.

Uveitis can occur suddenly (acute) or develop over a long period of time. If it lasts longer than three months, it is called chronic. Chronic uveitis in particular can lead to complications such as cataracts or glaucoma – in the worst case, blindness.

In some cases, uveitis returns again and again, which is called recurrent.

Uveitis: duration and prognosis

The chronic form is usually recognized and treated later, as it is associated with significantly weaker symptoms. Therefore, the risk for complications such as lens opacification (cataract) or glaucoma is quite high.

If the disease occurs as part of a chronic condition, uveitis can recur even after successful treatment. Ophthalmologists therefore regularly check the eyes of patients who are at increased risk of uveitis.

Is uveitis contagious?

Uveitis forms

Depending on which area of the uvea is inflamed, physicians distinguish between three forms of uveitis, some of which are further subdivided:

  • Anterior uveitis (uveitis anterior): This includes inflammation in the anterior portion of the uvea – inflammation of the iris (iritis), inflammation of the ciliary body (cyclitis), and simultaneous inflammation of the iris and ciliary body (iridocyclitis).
  • Posterior uveitis:Posterior uveitis affects the choroid (chorioiditis), which supplies the retina with oxygen and nutrients through its vessels. Therefore, when the choroid is inflamed, the retina is often also affected (chorioretinitis or retinochorioiditis). Posterior uveitis can be chronic or relapsing.
  • Panuveitis: In this case, the entire middle eye skin (uvea) is inflamed.

Uveitis: Symptoms

Uveitis can affect one or both eyes. Often, the typical symptoms occur very suddenly, but sometimes the symptoms develop over a longer period of time. Depending on which part of the eye is affected, the symptoms also differ. In most cases, the symptoms are worse the further in the front of the eye the inflammatory process takes place.

Anterior uveitis

You can learn more about the symptoms and treatment options of anterior uveitis in the article Iritis.

Intermediate uveitis

Intermedial uveitis often progresses without symptoms at first. Occasionally, sufferers see flares or streaks in front of their eyes. Some complain of decreased visual acuity. Pain may also occur (but this is usually milder than in anterior uveitis).

Posterior uveitis

Patients with posterior uveitis often see everything “as if in a fog.” Sometimes shadows, dots or spots also appear in front of the eye. If the vitreous body also becomes inflamed, it can subsequently pull on the retina – a retinal detachment with the risk of blindness is imminent.

Uveitis: Causes and risk factors

In most other cases, the inflammation of the middle eye skin develops within the framework of a non-infectious disease that affects the entire body (non-infectious systemic disease). Often, these are autoimmune processes – processes in which the immune system turns against the body’s own structures due to a malfunction. For example, the following diseases may be associated with uveitis:

  • Ankylosing spondylitis (formerly Bekhterev’s disease)
  • reactive arthritis (formerly: Reiter’s disease)
  • Sarcoidosis
  • Behçet’s syndrome
  • chronic inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
  • multiple sclerosis

Sometimes uveitis is due to an infection with viruses (e.g. herpes viruses, cytomegaloviruses), bacteria, fungi or parasites. The inflammatory processes resulting from the infection then also affect the uvea. For example, the median eye skin can become inflamed in the course of Lyme disease, tuberculosis or syphilis.

Uveitis: examinations and diagnosis

  • Have you ever had uveitis?
  • Do you suffer from a chronic disease (such as rheumatoid arthritis, multiple sclerosis or Crohn’s disease)?
  • Do you have a family history of autoimmune or rheumatic diseases?
  • Have you ever had Lyme disease, tuberculosis or herpes infection?
  • Do you have problems with your joints?
  • Do you frequently suffer from abdominal cramps or diarrhea?
  • Do you frequently suffer from respiratory problems?
  • Slit lamp examination: During this microscopic examination, the anterior chamber of the eye is examined more closely. In anterior uveitis, inflammatory cellular material up to pus (hypopyon) and proteins can be seen in the anterior chamber of the eye (between the cornea and iris) (Tyndall phenomenon).
  • Examination of eyesight (by means of eye test)
  • Measurement of intraocular pressure (tonometry): This allows early detection of glaucoma as a possible complication of uveitis.
  • Fluorescein angiography: This is an imaging of the retinal vessels using a fluorescent dye. This makes it possible to determine whether the site of sharpest vision on the retina (macula) is affected by the inflammation.

Blood tests and imaging techniques (X-ray, magnetic resonance imaging, etc.) can provide clues to various rheumatic or inflammatory diseases. For example, if sarcoidosis is suspected, a chest x-ray (chest x-ray) is usually very informative.

Exclusion of other diseases

Some diseases cause symptoms similar to uveitis. The physician excludes these differential diagnoses during his or her examinations. For example, they include:

  • pure retinitis (inflammation of the retina)
  • Episcleritis (inflammation of the connective tissue layer between sclera and conjunctiva)
  • tenonitis (special form of inflammation of the sclera)
  • certain forms of glaucoma (angle-closure glaucoma, hemorrhagic glaucoma)

Uveitis: Treatment

Uveitis therapy depends on the cause of the eye inflammation.

Especially in severe cases of uveitis, the cortisone must be taken in tablet form or injected into or around the eye. Other immunosuppressants such as azathioprine or ciclosporin may also be used.

To prevent the iris from sticking to the lens, the doctor also prescribes pupil-dilating eye drops (mydriatics such as atropine or scopolamine) for anterior uveitis.

In some cases, further therapeutic measures are necessary, such as surgery or further medication. For example, if uveitis occurs in the context of a rheumatic disease (such as reactive arthritis, juvenile idiopathic arthritis, etc.), it must be treated appropriately – for example, with rheumatic drugs such as methotrexate. If the intraocular pressure is elevated, doctors also lower it with medication or by means of surgery.