Uveitis, Iritis and Eye Inflammation

By Gina White; updates by Marilyn Haddrill;
reviewed by Michael DePaolis, OD

Uveitis is inflammation of the uvea — the eye's middle layer that consists of the iris, ciliary body and choroid.

Uveitis can have many causes, including eye injury and inflammatory diseases. Toxic exposure such as to acids used in manufacturing processes and pesticides also can cause uveitis.

The type of uveitis you have is classified by where inflammation occurs in the uvea:

• Anterior uveitis refers to inflammation of the iris alone (iritis) or the iris and ciliary body.
• Intermediate uveitis refers to inflammation of the ciliary body.
• Posterior uveitis is inflammation of the choroid.
• Diffuse uveitis is inflammation in all areas of the uvea.

Many cases of uveitis are chronic, and they can produce numerous possible complications, including clouding of the lens (cataract) or cornea, elevated intraocular pressure (IOP), glaucoma, and retinal problems (such as swelling of the retina or retinal detachment). These complications can result in vision loss.

Uveitis occurs most frequently in people ages 20 to 50. A California study* estimated that more than 280,000 people in the United States are affected by uveitis each year, which is almost three times greater than previously thought. The study, based on medical records from six northern California communities, also estimated that uveitis is the reason for 30,000 new cases of blindness a year and up to 10 percent of all the cases of blindness.

Anterior uveitis is the most common form, and occurs annually at a frequency of about 8 to 15 cases per 100,000 people. This type of uveitis affects men and women equally.**

Symptoms of Uveitis

About half of all uveitis cases — with most occurring in the anterior uvea — don't have an obvious cause.** Symptoms of anterior uveitis include light sensitivity, decreased visual acuity and eye pain.

However, intermediate and posterior uveitis usually are painless. Symptoms of these types of uveitis include blurred vision and floaters, typically in both eyes. Most people who develop intermediate uveitis are in their teens, 20s or 30s.

Diffuse uveitis has a combination of symptoms of all types of uveitis.

What Causes Uveitis?

Uveitis has dozens of causes, including viral, fungal and bacterial infections. But, in many cases, the cause is unknown (idiopathic). Eye care practitioners can sometimes identify the cause if there has been trauma to the eye, such as from surgery or a blow, or if you have an infectious or immunological systemic disorder.

Some of the many different systemic disorders that can cause uveitis include:

New evidence shows that smoking also appears linked to development of uveitis, according to a study reported in the March 2010 issue of Ophthalmology.

"Cigarette smoke includes compounds that stimulate inflammation within the blood vessels, and this may contribute to immune system disruption and uveitis," said University of California San Francisco (UCSF) researcher and ophthalmologist Dr. Nisha Acharya.

Uveitis and Iritis Treatment

Your doctor likely will prescribe a steroid to reduce the inflammation in your eye. Whether the steroid is administered as an eye drop, pill or injection depends on the type of uveitis you have. Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops.

Posterior uveitis usually requires tablets or injections. Depending on your symptoms, any of these treatments might be used for intermediate uveitis.

This tiny drug implant (Retisert, Bausch & Lomb) is surgically implanted in the back of the eye, where it delivers sustained amounts of anti-inflammatory medication for treatment of uveitis.

Steroids and other immunosuppressants can produce many serious side effects, such as kidney damage, high blood sugar, high blood pressure, osteoporosis and glaucoma.

This is especially true of steroids in pill form because the dose must be relatively high in order for enough of the drug to find its way to the back of the eye. So it is important to follow your doctor's dosage instructions carefully and to keep visiting him or her regularly to monitor the progress of the treatment.

Retisert (Bausch & Lomb) for chronic, non-infectious posterior uveitis is a drug implant representing the first of its kind as a treatment for uveitis.

Implanted in the back of the eye, Retisert is a drug reservoir that delivers sustained amounts of fluocinolone acetonide, an anti-inflammatory corticosteroid, for about two and a half years.

During clinical trials, the recurrence of uveitis fell from 40-54 percent to 7-14 percent. The most common side effects noted during those studies were cataract progression, increased intraocular pressure, procedural complications and eye pain.

If you have anterior uveitis, your doctor will likely prescribe, in addition to the steroids, pupil-dilating eye drops to reduce pain. You may also need eye drops to lower your intraocular pressure if it's elevated.

If you have a known systemic condition that may be contributing your uveitis, your doctor will treat that as well.

*"Incidence and prevalence of uveitis in Northern California: the Northern California Epidemiology of Uveitis Study." Ophthalmology. March 2004.

**Idiopathic and other anterior uveitis syndromes. Ophthalmology, 3rd ed. 2008.

Gary Heiting, OD, also contributed to this article.

[Page updated March 2010]