Overview of Uveitis

Causes of anterior uveitis include

Causes of intermediate uveitis include

Causes of posterior uveitis (retinitis) include

Causes of panuveitis include

Infrequently, systemic drugs cause uveitis (usually anterior). Examples are sulfonamides, bisphosphonates (inhibitors of bone resorption), rifabutin, cidofovir, and checkpoint inhibitors such as nivolumab and ipilimumab.

Symptoms and signs may be subtle and vary depending on the site and severity of inflammation.

Anterior uveitis tends to be the most symptomatic (especially when acute), usually manifesting with

Chronic anterior uveitis may have less dramatic symptoms and present with irritation or decreased vision.

Signs include hyperemia of the conjunctiva adjacent to the cornea (ciliary flush or limbal injection). Slit-lamp findings include keratic precipitates (white blood cell clumps on the inner corneal surface), cells and flare (a haze) in the anterior chamber (aqueous humor), and posterior synechiae. With severe anterior uveitis, white blood cells may layer in the anterior chamber (hypopyon).

Intermediate uveitis is typically painless and manifests with

The primary sign is cells in the vitreous humor. Aggregates and condensations of inflammatory cells often occur, appearing as "snowballs." Vision may be decreased because of floaters Floaters Floaters are opacities that move across the visual field and do not correspond to external visual objects. With aging, the vitreous humor can contract and separate from the retina. The age at... read more or cystoid macular edema, which results from fluid leakage from blood vessels in the macula. Confluent and condensed vitreous cells and snowballs over the pars plana (part of the ciliary body that extends posteriorly beyond the junction of the iris and sclera) may cause a classic "snowbank" appearance, which can be associated with neovascularization of the retinal periphery.

Posterior uveitis may give rise to diverse symptoms but most commonly causes floaters and decreased vision as occurs in intermediate uveitis. Signs include

Panuveitis may cause any combination of the previously mentioned symptoms and signs.

Uveitis should be suspected in any patient who has ocular ache Eye Pain Eye pain may be described as sharp, aching, or throbbing and should be distinguished from superficial irritation or a foreign body sensation. In some disorders, pain is worsened by bright light... read more , redness Red Eye Red eye refers to a red appearance of the opened eye, reflecting dilation of the superficial ocular vessels. Dilation of superficial ocular vessels can result from Infection Allergy Inflammation... read more , photophobia, new onset or changing floaters Floaters Floaters are opacities that move across the visual field and do not correspond to external visual objects. With aging, the vitreous humor can contract and separate from the retina. The age at... read more , or decreased vision. Patients with unilateral anterior uveitis have ocular ache in the affected eye if light is shined in the unaffected eye (true photophobia), which is uncommon in conjunctivitis.

Diagnosis of anterior uveitis is by recognizing cells and flare in the anterior chamber. Cells and flare are seen with a slit lamp and are most evident when using a narrow, intensely bright light focused on the anterior chamber in a dark room. Findings of intermediate and posterior uveitis are most easily seen after dilating the pupil. Indirect ophthalmoscopy Ophthalmoscopy The eye can be examined with routine equipment, including a standard ophthalmoscope; thorough examination requires special equipment and evaluation by an ophthalmologist. History includes location... read more (usually done by an ophthalmologist) is more sensitive than direct ophthalmoscopy. (NOTE: If uveitis is suspected, patients should be referred immediately for complete ophthalmologic evaluation.)

Many conditions that cause intraocular inflammation can mimic uveitis and should be considered in the appropriate clinical settings. Such conditions include severe conjunctivitis Overview of Conjunctivitis Conjunctival inflammation typically results from infection, allergy, or irritation. Symptoms are conjunctival hyperemia and ocular discharge and, depending on the etiology, discomfort and itching... read more (eg, epidemic keratoconjunctivitis), severe keratitis (eg, herpetic keratoconjunctivitis, peripheral ulcerative keratitis Peripheral Ulcerative Keratitis Peripheral ulcerative keratitis is inflammation and ulceration of the cornea that often occurs with chronic connective tissue diseases. Irritation and decreased vision result. Peripheral ulcerative... read more ), and severe scleritis Scleritis Scleritis is a severe, destructive, vision-threatening inflammation involving the deep episclera and sclera. Symptoms are moderate to marked pain, hyperemia of the globe, lacrimation, and photophobia... read more .

Acute angle-closure glaucoma Angle-Closure Glaucoma Angle-closure glaucoma is glaucoma associated with a physically obstructed anterior chamber angle, which may be chronic or, rarely, acute. Symptoms of acute angle closure are severe ocular pain... read more can cause redness and severe pain similar to that of uveitis, which is why it is important to check intraocular pressure at every visit. Uveitis is often (but not always) associated with a low intraocular pressure, whereas pressure is typically high in acute angle-closure glaucoma. Uveitis also can be distinguished from angle-closure glaucoma by the absence of corneal haze and the presence of a deeper anterior chamber.

Other masqueraders include intraocular cancers Tumors of the Orbit Orbital tumors can be benign or malignant and arise primarily within the orbit or secondarily from an adjacent source, such as the eyelid, paranasal sinus, or intracranial compartment. Orbital... read more in the very young (typically retinoblastoma and leukemia) and in older people (intraocular lymphoma). Much less commonly, retinitis pigmentosa Retinitis Pigmentosa Retinitis pigmentosa is a slowly progressive, bilateral degeneration of the retina and retinal pigment epithelium caused by various genetic mutations. Symptoms include night blindness and loss... read more can manifest with mild inflammation, which may be confused with uveitis.

Treatment of active inflammation usually involves corticosteroids given topically (eg, prednisolone acetate 1% one drop as frequently as every hour while awake for severe inflammation) or by periocular or intraocular injection along with a cycloplegic-mydriatic drug (eg, homatropine 2% or 5% drops or cyclopentolate 0.5% or 1.0% drops, either drug given 2 to 4 times/day depending on severity). Antimicrobial drugs are used to treat infectious uveitis.

Particularly severe or chronic cases may require systemic corticosteroids or systemic noncorticosteroid immunosuppressive drugs. For example,

Additional treatment for severe or chronic cases may require laser phototherapy, cryotherapy applied transsclerally to the retinal periphery, or surgical removal of the vitreous (vitrectomy) (1–3 Treatment references Uveitis is defined as inflammation of the uveal tract—the iris, ciliary body, and choroid. However, the retina and fluid within the anterior chamber and vitreous are often involved as well.... read more ).