Uveitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Uveitis is a broad term for inflammation of one or all parts of the uvea, or the vascular area between the retina and sclera of the eye. Anterior uveitis involves inflammation of the iris and ciliary body. Intermediate uveitis involves the posterior ciliary body and pars plana. Posterior uveitis involves the posterior vitreous, retina, choroid, retinal vasculature, and optic nerve. Panuveitis involves inflammation in the anterior, intermediate, and posterior segments of the eye.
Uveitis can be acute, recurrent, or chronic. Acute uveitis is characterized by sudden onset (over hours or days) and limited duration (≤3 months' duration). In recurrent uveitis, there are repeated episodes separated by disease inactivity ≥3 months, whether on or off treatment. Chronic uveitis is defined as persistent uveitis (>3 months' duration) characterized by relapse within 3 months of therapy termination.
All types of uveitis are potentially blinding conditions and should be referred to and managed by an experienced ophthalmologist.
Diagnosis is clinical. Acute anterior uveitis may be idiopathic, or associated with human leukocyte antigen-B27-related disease or viral eye disease. Posterior uveitis is associated with localized infections or systemic infection, or systemic inflammatory disease. Onset and duration of the ocular symptoms offer clues to the etiology. Diagnosis of underlying disease may require investigation. In the clinical setting of multiple recurrences or strong suspicion based on history and review of systems, a targeted workup should be undertaken to rule out an underlying infectious cause or coexistent autoimmune disease. Rarely, uveitis can be caused by a previous eye injury or underlying neoplasm.
Even after full laboratory and diagnostic workup and treatment, etiology may not be determined.

Anterior uveitis with posterior synechiae

Courtesy of Mr Hugh Harris; used with permission

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Comparison of common symptoms and causes of anterior and posterior uveitis
Anterior uveitis with posterior synechiae
Posterior synechiae (iris adhesions to anterior lens capsule) in this patient as a result of uveitis

Citations

Key Articles

Deschenes J, Murray PI, Rao NA, et al; International Uveitis Study Group. International Uveitis Study Group (IUSG): clinical classification of uveitis. Ocul Immunol Inflamm. 2008 Jan-Feb;16(1):1-2.[Abstract]
Jabs DA, Nussenblatt RD, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005 Sep;140(3):509-16.[Abstract]
Kempen JH, Altaweel MM, Holbrook JT, et al; Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. Ophthalmology. 2011 Oct;118(10):1916-26.[Abstract][Full Text]

Referenced Articles

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2. Jabs DA, Nussenblatt RD, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005 Sep;140(3):509-16.[Abstract]
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22. Smith JR, Rosenbaum JT. Management of uveitis: a rheumatologic perspective. Arthritis Rheum. 2002 Feb;46(2):309-18.[Abstract]
23. Gui W, Dombrow M, Marcus I, et al. Quality of life in patients with noninfectious uveitis treated with or without systemic anti-inflammatory therapy. Ocul Immunol Inflamm. 2015 Apr;23(2):135-43.[Abstract]
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25. Jaffe GJ, Martin D, Callanan D, et al. Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis: thirty-four-week results of a multicenter randomized clinical study. Ophthalmology. 2006 Jun;113(6):1020-7.[Abstract]
26. Dick AD, Rosenbaum JT, Al-Dhibi HA, et al. Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative. Ophthalmology. 2018 May;125(5):757-73.[Abstract][Full Text]
27. Rathinam SR, Gonzales JA, Thundikandy R, et al. Effect of corticosteroid-sparing treatment with mycophenolate mofetil vs methotrexate on inflammation in patients with uveitis: a randomized clinical trial. JAMA. 2019 Sep 10;322(10):936-45.[Abstract][Full Text]
28. Ramanan AV, Dick AD, Jones AP, et al. Adalimumab in combination with methotrexate for refractory uveitis associated with juvenile idiopathic arthritis: a RCT. Health Technol Assess. 2019 Apr;23(15):1-140.[Abstract][Full Text]
29. Jaffe GJ, Dick AD, Brézin AP, et al. Adalimumab in patients with active noninfectious uveitis. N Engl J Med. 2016 Sep 8;375(10):932-43.[Abstract][Full Text]
30. Nguyen QD, Merrill PT, Jaffe GJ, et al. Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial. Lancet. 2016 Sep 17;388(10050):1183-92.[Abstract]
31. National Institute for Health and Care Excellence (UK). Adalimumab and dexamethasone for treating non-infectious uveitis. 26 July 2017 [internet publication].[Full Text]
32. Boiten HJ, Amini S, Wolfhagen FHJ, et al. Adalimumab-induced platelet antibodies resulting in severe thrombocytopenia. Br J Clin Pharmacol. 2021 Feb 18 [Epub ahead of print]. [Abstract]
33. Durrani K, Zakka FR, Ahmed M, et al. Systemic therapy with conventional and novel immunomodulatory agents for ocular inflammatory disease. Surv Ophthalmol. 2011 Nov-Dec;56(6):474-510.[Abstract]
34. Kempen JH, Altaweel MM, Holbrook JT, et al; Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. Ophthalmology. 2011 Oct;118(10):1916-26.[Abstract][Full Text]
35. Brady CJ, Villanti AC, Law HA, et al. Corticosteroid implants for chronic non-infectious uveitis. Cochrane Database Syst Rev. 2016 Feb 12;(2):CD010469.[Abstract][Full Text]
36. Kempen JH, Altaweel MM, Holbrook JT, et al; Writing Committee for the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study Research Group. Association between long-lasting intravitreous fluocinolone acetonide implant vs systemic anti-inflammatory therapy and visual acuity at 7 years among patients with intermediate, posterior, or panuveitis. JAMA. 2017 May 16;317(19):1993-2005.[Abstract]
37. Constantin T, Foeldvari I, Anton J, et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann Rheum Dis. 2018 Aug;77(8):1107-17.[Abstract][Full Text]
38. Heiligenhaus A, Minden K, Tappeiner C, et al. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin Arthritis Rheum. 2019 Aug;49(1):43-55.[Abstract][Full Text]
39. Angeles-Han ST, Ringold S, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res (Hoboken). 2019 Jun;71(6):703-16.[Abstract][Full Text]
40. Ramanan AV, Dick AD, Jones AP, et al. Adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis. N Engl J Med. 2017 Apr 27;376(17):1637-46.[Abstract][Full Text]
41. Chiam NP, Lim LL. Uveitis and gender: the course of uveitis in pregnancy. J Ophthalmol. 2014;2014:401915.[Abstract][Full Text]
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44. Maya JR, Sadiq MA, Zapata LJ, et al. Emerging therapies for noninfectious uveitis: what may be coming to the clinics. J Ophthalmol. 2014 Apr 24;2014:310329.[Abstract][Full Text]
45. De Benedetti F, Brunner HI, Ruperto N, et al; PRINTO; PRCSG. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Engl J Med. 2012 Dec 20;367(25):2385-95. [Abstract][Full Text]
46. Ramanan AV, Dick AD, Guly C, et al. Tocilizumab in patients with anti-TNF refractory juvenile idiopathic arthritis-associated uveitis (APTITUDE): a multicentre, single-arm, phase 2 trial. Lancet Rheumatol. 2020 Mar;2(3):e135-41.[Abstract][Full Text]
47. Jackson ML, Virgili G, Shepherd JD, et al. Vision rehabilitation preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P271-335.[Abstract][Full Text]
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49. Rothova A, Suttorp-van Schulten MS, Frits Treffers W, et al. Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol. 1996 Apr;80(4):332-6.[Abstract][Full Text]
50. Gopalakrishnan S, Sudharshan S, Raman R, et al. Visual rehabilitation of patients with low vision in uveitis. Indian J Ophthalmol. 2019 Jan;67(1):101-4.[Abstract][Full Text]