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Uveitis symptoms: when a red, aching eye is inflammation inside the eye

The uvea is the middle layer of the eye, between the tough white outer coat and the retina. It has three parts: the iris (the coloured ring around the pupil), the ciliary body just behind it, and the choroid, a layer of blood vessels behind the retina. Uveitis means inflammation of any part of the uvea. It is much less common than eye flu but more serious, and it often affects people of working age.

What are the symptoms of uveitis?

Front of the eye (anterior uveitis, or iritis)

This is the most common type. It usually comes on over hours or a day or two, often in one eye:

• redness, often strongest in a ring around the edge of the cornea
• a deep ache in or around the eye, sometimes with a headache
• pain in bright light
• blurred vision
• a small or irregular pupil
• watering, but usually little sticky discharge

Middle and back of the eye

Inflammation further back often causes little redness or pain, but brings:

• floaters: spots, threads or cobwebs drifting across your vision
• blurred or misty vision
• sometimes dark patches or loss of part of the vision

In children with juvenile arthritis, uveitis may cause no symptoms at all, which is why these children need regular eye check-ups.

How is uveitis different from eye flu?

Eye flu usually feels gritty, comes with sticky or watery discharge, often affects both eyes and leaves vision normal. Uveitis usually aches, makes bright light painful, blurs vision and has little discharge. Uveitis is not contagious. For the other common causes of a red eye, see eye flu: what to do and corneal ulcer symptoms.

What causes uveitis?

In many people no cause is found, even after tests. Known causes include:

• Immune conditions, in which the body's defences attack its own tissues: ankylosing spondylitis and related back and joint conditions, sarcoidosis, inflammatory bowel disease, psoriasis, juvenile arthritis in children, and some others.
• Infections, including tuberculosis, which is still common in India, toxoplasmosis, the herpes and shingles viruses, and syphilis.
• Eye injury or eye surgery, which can set off inflammation inside the eye.

A gene marker called HLA-B27 is linked with repeated attacks of anterior uveitis and with some back and joint conditions. Tell the eye doctor if you have back stiffness in the mornings, joint pains, skin rashes, bowel problems, a long-lasting cough or weight loss.

Why does uveitis need prompt treatment?

Treated early, an attack of anterior uveitis often settles within a few weeks. Untreated, or if it keeps coming back, uveitis can cause:

• raised eye pressure and glaucoma
• cataract (see cataract surgery in Vasco)
• the iris sticking to the lens behind it, which can block the flow of fluid inside the eye
• swelling at the centre of the retina (macular oedema), which blurs central vision
• in severe cases, lasting loss of sight

So a red, aching eye with pain in bright light and blurred vision should be seen by an eye doctor within a day, and straight away if it is severe. Emergency eye care at ReNew Vision is available 24 hours; see 24-hour emergency eye care.

How is uveitis diagnosed?

The eye doctor examines the front of the eye under the slit lamp microscope, where inflammatory cells can be seen floating in the fluid inside the eye. Eye pressure is measured, and drops are put in to widen the pupil so that the back of the eye can be examined. These drops blur vision for a few hours, so do not drive yourself home. If a cause elsewhere in the body is suspected, especially when uveitis keeps coming back or affects the back of the eye, blood tests, a chest X-ray or other tests may be advised, often together with a physician or a rheumatologist.

How is uveitis treated?

• Anti-inflammatory steroid drops are the main treatment for anterior uveitis. They are used often at first and then reduced slowly, exactly as the eye doctor advises. Stopping them suddenly can bring the inflammation back.
• Drops that widen the pupil ease the ache by relaxing the focusing muscle, and stop the iris sticking to the lens. They blur near vision while you use them.
• Drops to lower eye pressure, if the pressure has gone up.
• Treatment by mouth, or other treatment arranged with a physician, may be needed for uveitis at the back of the eye, for severe or repeated attacks, or when an infection such as tuberculosis is the cause.

Because steroid drops can raise eye pressure and, over long periods, cause cataract, check-ups during treatment are essential. Never restart steroid drops left over from an earlier attack without seeing the eye doctor.

Can uveitis come back?

Yes, especially anterior uveitis linked with HLA-B27 or a joint condition. Many people learn to recognise the first signs of an attack. If the symptoms return, see the eye doctor early instead of restarting old drops on your own; early treatment can shorten an attack.

Uveitis care at ReNew Vision

Uveitis is diagnosed, treated and followed up at ReNew Vision Eye Hospital, 2nd floor, Pai Hospital building, Vaddem, Vasco da Gama. Routine follow-up is in the Eye OPD, Monday to Saturday, 4 pm to 7 pm; a new red, aching eye can be seen at any hour, because emergency eye care is available 24 hours. Call or WhatsApp 072489 88039. Bring a list of your medicines and any reports from your physician. More about red eyes is on the red eye, dry eye and cornea page.

Questions patients ask

Is uveitis contagious?

No. Uveitis is inflammation inside the eye and does not pass from one person's eyes to another's. If an infection such as tuberculosis turns out to be the cause, the doctor treating that infection will advise you about it.

Can uveitis cause blindness?

It can, if it is severe, untreated or keeps coming back, through glaucoma, cataract or swelling of the retina. Early treatment and regular check-ups lower that risk considerably.

How long does uveitis last?

An attack of anterior uveitis often settles in a few weeks with treatment. Uveitis at the back of the eye, or linked with a general condition, can last months or longer and need long-term care. The steroid drops are reduced slowly, as advised.

Is uveitis related to arthritis?

Sometimes. Uveitis is linked with ankylosing spondylitis and related back and joint conditions, and with juvenile arthritis in children. Tell the eye doctor about back stiffness, joint pains, or skin or bowel problems.

Is iritis the same as uveitis?

Iritis is the most common kind of uveitis and affects the iris at the front of the eye. Uveitis is the wider term for inflammation of any part of the uvea, including the back of the eye.

This page is general eye-health information, not personal medical advice. Your eye doctor advises you after examining your eyes.