Uveitis !
Uveitis is inflammation of the uvea, the middle layer of the eye (iris, ciliary body and choroid); it can cause a red, painful eye and vision loss.
Updated 2026-10-30
Structures involved
Tap one to see what it is and open it in 3D.
Microorganisms that cause it
In immunology
Why it happens
- Granulomatous inflammation: caseating vs non-caseating, the causes to know
- The eye wall: cornea, sclera, uvea and lens
What it is
Inflammation of the uvea, the pigmented middle layer of the eye made up of the iris, ciliary body and choroid, often with nearby structures. It can be infectious or non-infectious and is an important cause of preventable vision loss.
Who gets it
Most common in working-age adults. In Colombia, a study of 3,404 patients at seven referral centres (2010–2022) found the peak at ages 30–50; 39.4% of cases were infectious, and toxoplasmosis (25.3%) was the leading identified cause after idiopathic uveitis. Tuberculosis, syphilis and herpes viruses are other infectious causes.
Causes
- Idiopathic in many cases
- HLA-B27-associated: ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease
- Other systemic diseases: sarcoidosis, Behçet disease, Vogt-Koyanagi-Harada disease, juvenile idiopathic arthritis
- Infections: toxoplasmosis, herpes simplex and zoster, cytomegalovirus, tuberculosis, syphilis, toxocariasis
- Trauma, surgery or drugs
Risk factors
- HLA-B27 positivity
- Systemic autoimmune or inflammatory disease
- Juvenile idiopathic arthritis in children (often silent)
- Immunosuppression, including HIV infection
- Exposure to toxoplasma (undercooked meat, cat faeces, untreated water)
- Smoking
Pathophysiology
Immune or infectious inflammation breaks down the blood–ocular barrier, letting cells and protein into the anterior chamber and vitreous. Inflammatory cells deposit on the cornea (keratic precipitates) and the iris may stick to the lens (posterior synechiae). Posterior inflammation damages the retina and choroid directly, and macular oedema is a common cause of reduced vision.
Classification
- By location (SUN criteria): anterior, intermediate, posterior, panuveitis
- By course: acute, recurrent, chronic
- By cause: infectious or non-infectious; granulomatous or non-granulomatous
Symptoms and signs
- Anterior: painful red eye, light sensitivity, blurred vision, redness around the cornea (ciliary flush)
- Small or irregular pupil
- Intermediate and posterior: floaters and blurred vision, often with little pain or redness
- Retinal or choroidal lesions on fundus examination
- Juvenile arthritis-associated uveitis may cause no symptoms at all
Diagnosis
- Clinical
- Slit-lamp examination shows cells and flare in the anterior chamber, keratic precipitates and synechiae; dilated fundus examination looks for vitritis, retinitis or choroiditis. Classification by location guides the search for a cause.
- Tests
- Tests are chosen by the pattern: HLA-B27, syphilis serology, tuberculosis testing (interferon-gamma release assay or tuberculin skin test), toxoplasma serology, ACE and calcium for sarcoidosis. PCR of aqueous or vitreous fluid in suspected infectious retinitis.
- Imaging
- Optical coherence tomography for macular oedema, fluorescein angiography for vasculitis and leakage. Chest X-ray or CT for tuberculosis or sarcoidosis; sacroiliac imaging if spondyloarthritis is suspected.
Differential diagnosis
- Conjunctivitis
- Acute angle-closure glaucoma
- Keratitis
- Scleritis
- Masquerade syndromes (intraocular lymphoma, retinoblastoma)
- Endophthalmitis after surgery or trauma
Goal of treatment
Control the inflammation quickly, treat any infection, prevent complications such as synechiae, glaucoma and macular oedema, and reduce recurrences.
Treatment
- Medical
- Anterior uveitis: topical corticosteroids plus cycloplegic drops, which relieve pain and prevent posterior synechiae.
- Medical
- Infectious uveitis: targeted antimicrobials (antiparasitic for toxoplasmosis, antivirals, antituberculous or antisyphilitic treatment), with corticosteroids only alongside them when indicated.
- Medical
- Posterior or chronic non-infectious uveitis: periocular or intravitreal corticosteroids, systemic corticosteroids, and steroid-sparing immunosuppressants or biologics such as TNF inhibitors.
- Follow-up
- Regular checks of intraocular pressure (steroid response), the macula and the other eye, and screening of children with juvenile idiopathic arthritis.
- Surgical
- Surgery for complications: cataract extraction, glaucoma surgery or vitrectomy, once inflammation is controlled.
Drugs for this condition
Complications
- Cataract
- Glaucoma (inflammatory or steroid-induced)
- Cystoid macular oedema
- Posterior synechiae and band keratopathy
- Retinal detachment, retinal scarring
- Permanent vision loss
Prognosis
Acute anterior uveitis usually responds well, though it often recurs. Posterior, chronic and infectious forms carry a higher risk of permanent vision loss, mainly from macular oedema, cataract and glaucoma.
Prevention
- Regular eye screening for children with juvenile idiopathic arthritis
- Safe food and water to reduce toxoplasmosis
- Early ophthalmology review of a red painful eye in people with spondyloarthritis
Test yourself
Think of the answer, then tap the question to see it.
What are the parts of the uvea?
The iris, the ciliary body and the choroid.
Which genetic marker is linked to acute anterior uveitis and ankylosing spondylitis?
HLA-B27.
What is the commonest cause of posterior uveitis in Latin America?
Ocular toxoplasmosis, a necrotising retinochoroiditis often next to an old pigmented scar.
Why are cycloplegic drops used in anterior uveitis?
They relieve ciliary spasm pain and keep the pupil moving, preventing posterior synechiae.
Which childhood disease causes silent, chronic anterior uveitis that needs screening?
Juvenile idiopathic arthritis, especially the oligoarticular, ANA-positive form.
Related conditions
- Ankylosing spondylitis
- Tuberculosis
- Syphilis
- Herpes zoster (shingles)
- Cataract
- Acute angle-closure glaucoma
- Conjunctivitis
- Retinal detachment
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Uveitis (StatPearls (NCBI Bookshelf), 2023); Epidemiology, clinical features, and classification of 3,404 patients with uveitis: Colombian Uveitis Multicenter Study (COL-UVEA) (Graefe's archive for clinical and experimental ophthalmology, 2024) · adapted, CC BY 4.0.
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Representative model, for educational purposes only.
