Uveitis

Also called Iritis, Inflammation of the eye

Inflammation inside the eye and a leading preventable cause of sight loss. A painful red eye with light sensitivity is a same-day emergency.

What it is

Inflammation of the uvea, the middle layer of the eye. It is a significant cause of sight loss in working-age people in the UK, and much of that loss is preventable with prompt treatment.

Anterior uveitis, or iritis, is the commonest form: a painful, red eye with light sensitivity and blurred vision, usually one eye at a time.

It matters because of what it is attached to. Around half of cases are associated with a systemic condition, most often ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease, sarcoidosis, multiple sclerosis or an infection. A first episode of uveitis is therefore a reason to look for those, and for people who already have one, knowing the eye symptoms is essential.

The distinction from conjunctivitis matters enormously. Conjunctivitis is gritty, sticky and not usually painful, and vision is normal. Uveitis is genuinely painful, light hurts, vision is affected, and the redness is concentrated around the iris. Treating uveitis as conjunctivitis loses time, and treating it with over-the-counter drops does nothing.

**Never use steroid eye drops without an eye examination**, because they cause serious harm if the problem is a herpes eye infection.

In children, uveitis linked to juvenile idiopathic arthritis is often completely painless and symptomless, which is why those children need regular screening slit-lamp examinations even when their eyes look and feel fine.

Signs you might notice

A red eye, with redness most intense around the coloured part.

Pain, often described as a deep ache rather than grittiness.

Marked sensitivity to light, so that even indoor light hurts.

Blurred vision.

Floaters.

A small, irregular or sluggish pupil.

Usually one eye, though it can affect both.

Same-day eye assessment for any of these. Go to an eye casualty, an optometrist, or A and E, not a GP appointment next week.

In a child with juvenile idiopathic arthritis: no symptoms at all may be present, and screening appointments must be kept.

How it can affect day-to-day life

Recurrence is common, and people who have had it learn to recognise the first ache and get treatment started within a day, which limits the damage. Having a plan for rapid access matters more than anything else.

Steroid drops are given very frequently at first, sometimes hourly, then tapered slowly. Stopping early is a common cause of rebound inflammation.

Long-term steroid drops carry their own risks, including cataract and glaucoma, so monitoring is part of treatment.

For chronic or recurrent uveitis, immunosuppressive and biologic treatment shared with rheumatology is often needed, and getting to a specialist uveitis service is worth pushing for.

For anybody with a spondyloarthritis or inflammatory bowel disease, knowing these symptoms in advance is the single most useful piece of information they can be given, and it is often never mentioned.

Supporting someone well

Go the same day for a painful red eye with light sensitivity. Do not wait, and do not treat it as conjunctivitis.

Never use steroid eye drops without an eye examination.

Use the drops exactly as prescribed, including the frequent early doses and the slow taper.

Wear dark glasses for comfort; light sensitivity is genuinely painful.

Tell the eye team about any joint, bowel, skin or neurological symptoms; the association matters and changes investigation.

For anybody with ankylosing spondylitis, psoriatic arthritis or inflammatory bowel disease, learn these symptoms now and know where the nearest eye casualty is.

Keep children's screening appointments for juvenile idiopathic arthritis, even when the eyes look fine.

Ask for a specialist uveitis service for recurrent or chronic disease.

Where to get help

An eye casualty department, an optometrist, or A and E the same day.

Ophthalmology, and rheumatology where there is an associated condition.

RNIB helpline: 0303 123 9999.

National Axial Spondyloarthritis Society and Arthritis UK for the associated conditions.