Rheumatology Conditions
      Back to home
      1. VCT Resource Library
      2. Rheumatology Conditions

      Uveitis

      Brief Overview:
      Uveitis refers to inflammation of the uvea, the middle layer of the eye that includes the iris, ciliary body, and choroid. It can lead to redness, pain, light sensitivity, and vision changes. Severe cases of uveitis can cause permanent vision loss and blindness.

      Prevalence:
      Uveitis prevalence varies widely in the United States, from 58 to 1,231 per 100,000 population. It is more common in adults, and one study shows a higher prevalence in women than men. Uveitis accounts for an estimated 10% of blindness in the US.

      Etiology:
      Uveitis can be caused by autoimmune disorders, infections, trauma, medications, or exposure to toxins, and very rarely, a cancer that affects the eye, such as lymphoma. In many cases, the cause is idiopathic (unknown).

      Risk Factors:

      • Autoimmune conditions (e.g., ankylosing spondylitis, sarcoidosis, Behçet’s disease)
      • Infections (e.g., herpes simplex, syphilis, tuberculosis)
      • Smoking
      • Genetic predisposition (e.g., HLA-B27)
      • Trauma or eye surgery
      • Taking certain medications may increase your risk of developing uveitis, including: cidofovir, rifabutin, bisphosphonates, brimonidine eye drops, tyrosine kinase inhibitors

      Commonly Associated Conditions-Including but Not Limited To:

      • Juvenile idiopathic arthritis
      • Sarcoidosis
      • Psoriatic arthritis
      • Inflammatory bowel disease
      • Reactive arthritis
      • Herpes simplex virus, herpes zoster
      • Behçet’s disease
      • Syphilis
      • Toxoplasmosis, histoplasmosis
      • Ankylosing spondylitis

      Common Medications:

      • Corticosteroids
      • Immunosuppressants
      • Antivirals or antibiotics (if infectious etiology)
      • Cycloplegic agents to reduce pain and prevent spasms of parts of your eye

      Common Labs, Imaging, and Tests:

      • Visual acuity test
      • Tonometry – measures the pressure inside your eye
      • Ocular coherence tomography (OCT) – checks for changes in the rear structures of your eye
      • Fluorescein angiography – an exam used to study the retina’s blood flow
      • Slit-lamp examination – part of a routine eye exam, uses a bright light attached to a microscope to allow the eye doctor to see all parts of the eye, including inside the eye
      • Ophthalmoscopy/funduscopy
      • Blood tests, which could include
        • Complete blood count (CBC)
        • Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)
        • HLA-B27, ANA, RF, ACE, and syphilis serology
      • Chest X-ray or CT (to evaluate for sarcoidosis or TB)
      • Brain MRI

      Common Symptoms:

      • Eye pain
      • Redness
      • Blurred vision
      • Photophobia (light sensitivity)
      • Floaters
      • Decreased vision

      Common Treatments:

      • Medications (see above)
      • Vitrectomy – surgery to remove some of the vitreous in your eye is rarely used to diagnose or manage the condition
      • Medication-releasing implant – may be an option for some people with difficult-to-treat posterior uveitis

      Physical Findings:

      • Conjunctival injection (especially around the limbus)
      • Possible decreased visual acuity in the affected eye
      • Direct photophobia, and consensual photophobia
      • Keratic precipitates
      • Cells and flare (anterior uveitis)
      • Posterior synechiae
      • Vitreous inflammation
      • Retinal changes (in posterior uveitis)

      Potential Complications and Contraindications:

      • If left untreated, uveitis can cause complications, including:
        • Increase in intraocular pressure
        • Glaucoma
        • Cataracts
        • Macular edema
        • Retinal scarring
        • Retinal detachment
        • Optic nerve damage
        • Permanent vision loss

      General Health and Lifestyle Guidance:

      • Adhere to medication regimen
      • Avoid smoking
      • Regular ophthalmologic monitoring
      • Manage underlying systemic diseases
      • Wear sunglasses to reduce light sensitivity
      • Report any visual changes immediately

      Suggested Questions to Ask Patients:

      • Have you noticed any vision changes, eye pain, or sensitivity to light?
      • Do you have a history of autoimmune or inflammatory diseases?
      • Have you recently had an infection or injury to your eye?
      • Are you currently taking any immunosuppressive or steroid medications?
      • Do you use tobacco or have you had exposure to environmental irritants?

      Suggested Talking Points:

      • Uveitis can be a sign of a systemic autoimmune or infectious condition.
      • Early and consistent treatment is key to preventing long-term damage.
      • We will work with your eye specialist and possibly a rheumatologist or infectious disease doctor to manage your care.
      • Tell us about any systemic symptoms you experience—joint pain, rashes, fever, or fatigue—as they may help pinpoint the underlying cause.

      Sources: