Uveitis

Uveitis is inflammation of the uvea — the middle layer of the eye. It can affect the front of the eye (iritis / anterior uveitis), the middle (intermediate uveitis), the back (posterior uveitis), or all of these (panuveitis). Uveitis is a significant cause of vision loss and can develop quickly — it needs prompt assessment by an ophthalmologist.

Symptoms

• Red, painful eye
• Blurred vision
• Sensitivity to light (photophobia)
• Seeing floaters
• Decreased vision
• Pupil may look irregular in severe anterior uveitis
• Usually one eye, sometimes both

Any red, painful eye with vision change needs same-day ophthalmology review.

Causes

Uveitis can be infectious or non-infectious (autoimmune/inflammatory). Common causes include:

• Idiopathic — no cause identified (a significant proportion)
• Autoimmune conditions — ankylosing spondylitis, sarcoidosis, Behçet's disease, multiple sclerosis, juvenile idiopathic arthritis, lupus, reactive arthritis
• Infections — herpes simplex, herpes zoster, toxoplasmosis, tuberculosis, syphilis, HIV, Lyme disease. In India, tuberculous uveitis is a particular consideration — TB is a relatively common cause of posterior uveitis and requires long-term TB treatment.
• Eye injury or surgery
• Certain medicines
• Cancers — rarely (e.g. intraocular lymphoma)

Diagnosis

• Slit-lamp examination — the key test
• Dilated retinal examination
• Blood tests, tuberculin skin test (Mantoux), chest X-ray — to look for systemic causes
• Imaging of the eye — OCT, fluorescein angiography
• Sometimes aqueous or vitreous sampling for infection

Treatment

Depends entirely on the cause — urgency is in identifying it correctly:

• Corticosteroid eye drops — for anterior uveitis; very effective
• Oral or injected steroids — for severe or posterior disease
• Pupil-dilating drops — reduce pain and prevent complications
• Immunosuppressive medicines or biologics — for autoimmune or steroid-resistant uveitis
• Antibiotics or antivirals — for infectious causes
• Anti-tuberculous therapy — for TB uveitis; usually 6-9 months
• Surgery — rarely, for complications like cataract, glaucoma, or retinal problems from chronic uveitis

Untreated or delayed treatment can lead to cataract, glaucoma, retinal damage, and permanent vision loss. Regular follow-up is essential, even when symptoms settle — uveitis often recurs and chronic inflammation causes long-term damage.