Iritis - Treating uveitis

Treatment for uveitis will depend on which areas of the eye are affected and what caused the condition.

Medication is the main treatment, but surgery can be used in particularly severe cases.

Steroid medication

Steroid medication (corticosteroids) is used to treat most cases of uveitis. A medicine called prednisolone is usually used.

Corticosteroids work by disrupting the normal functioning of the immune system so that it no longer releases the chemicals that cause inflammation.

Corticosteroids are available in a number of forms, and the type used will often depend on the areas of your eye that are affected by uveitis.

Corticosteroid eye drops

Corticosteroid eye drops are usually the first treatment recommended for cases of uveitis affecting the front of the eye (anterior uveitis) that are not caused by an infection.

Depending on the severity of your symptoms, the recommended dose can range from having to use eye drops every hour to once every two days.

You may experience temporary blurred vision after using corticosteroid eye drops. If this happens, don't drive or operate machinery until your vision returns to normal.

Don't stop using your eye drops until your GP or ophthalmologist advises that it's safe to do so, even if your symptoms disappear. Stopping treatment too soon could lead to your symptoms returning.

Corticosteroid injections

If the middle or back of your eye is affected (intermediate or posterior uveitis) or your symptoms fail to respond to corticosteroid eye drops, you may need to have corticosteroid injections.

The injection is given to the side of the eye. Local anaesthetic is used to numb your eye and surrounding tissue so that you won't feel any pain or discomfort.

You'll usually require one injection every two to three weeks until your symptoms start to improve.

Corticosteroid injections rarely cause significant side effects.

Oral corticosteroids

Oral corticosteroids (tablets or capsules) are the strongest form of corticosteroids. They are usually only used if steroid eye drops and injections are ineffective or unsuitable.

While they work well in relieving inflammation, the effect is not confined to the eye, so they can cause a wide range of side effects.

Oral corticosteroids may also be recommended if it's thought that uveitis may pose a risk of permanent damage to your vision (see complications of uveitis for more information).

How long you'll have to take oral corticosteroids will depend on how well you respond to treatment and whether you have an underlying autoimmune condition. Some people only need a three- to six-week course, while others need to have a course lasting months or possibly years.

Side effects of oral corticosteroids can include weight gain, mood changes (such as feeling irritable or anxious) and osteoporosis (fragile bones).

To minimise the impact of side effects, you will be prescribed the lowest possible dose that's thought to be effective enough to control your symptoms.

Read more about the side effects of corticosteroids.

Don't suddenly stop taking your oral corticosteroids. If your GP or ophthalmologist decides to end your treatment, they'll gradually reduce the amount of corticosteroids that you're taking.

Cycloplegic-mydriatic eye drops

If you have uveitis affecting the front of your eye (anterior uveitis), you may be given special eye drops called cycloplegic or mydriatic eye drops in addition to steroid medication.

These drops dilate your pupils and relieve pain by relaxing the muscles in your eye. They can also reduce the risk of the iris (the coloured part of the eye) "sticking" to the lens (the transparent section at the front of the eye). This can result in a condition called glaucoma, which affects vision.

However, these drops can cause some temporary blurring of your vision and problems focusing your eyes.

Treating infection

If the cause of your uveitis is known to be an underlying infection, the infection may also need to be treated.

Viruses can be treated with antiviral medication, bacterial infections can be treated with antibiotics, and fungal infections can be treated with antifungal medication.

The medications will usually be used alongside appropriate steroid medication and cycloplegic or mydriatic eye drops.

Immunosuppressants

A very small number of people with uveitis fail to respond to the treatments described above. In such circumstances, a type of medication called an immunosuppressant may be recommended.

Immunosuppressants are a type of medication that suppress (control) the immune system and disrupt the process of inflammation.

If you are having steroid treatment that is causing significant side effects, immunosuppressants can also be used to allow your dose of steroids to be reduced.

Side effects of immunosuppressants include:

• hair loss
• skin rash
• numbness or tingling in different parts of your body
• loss of appetite
• nausea and vomiting
• high blood pressure
• headaches 

Taking immunosuppressants will make you more vulnerable to infection, so you should try to avoid close contact with anyone who has a known infection.

You should also report any symptom of a potential infection, such as a high temperature or inflammation in other parts of your body, to your GP.

Read more about the medications used to treat uveitis.

Surgery

In rare cases, surgery may be needed to treat uveitis. However, this is usually only recommended if you have repeated or severe uveitis, or if the condition is caused by a fungal infection.

An operation called a vitrectomy can be used to treat uveitis. This involves gently sucking out the jelly-like substance that fills the inside of the eye (the vitreous humour). It can be carried out either using general anaesthetic or local anaesthetic.

The fluid inside the eye will be temporarily replaced during the operation with either a bubble of air or gas, or a liquid substitute. Eventually, the eye will naturally replace the vitreous humour with a slightly different clear fluid called aqueous humour. 

Like all operations, a vitrectomy carries a risk of complications. These include needing further surgery and an increased risk of developing cataracts (cloudy patches in the lens of the eye).