Steroids work by disrupting the normal function of the immune system so it no longer releases the chemicals that cause inflammation.
Steroid medicines come in different forms, and the type used will often depend on the areas of your eye affected by uveitis.
Steroid eyedrops are usually the first treatment used for uveitis that affects the front of the eye and is not caused by an infection.
Depending on your symptoms, the recommended dose can range from having to use eyedrops every hour to once every 2 days.
You may have temporary blurred vision after using the drops. Do not drive or operate machinery until your vision returns to normal.
In some people, steroid eyedrops can increase pressure in the eye. The eye specialist (ophthalmologist) will check for this and advise you if this happens.
Do not stop using your eyedrops until a GP or ophthalmologist tells you it's safe to do stop, even if your symptoms disappear. Stopping treatment too soon could lead to your symptoms returning. The frequency of drops will usually be slowly reduced over a number of weeks.
If the middle or back of your eye is affected or steroid eyedrops have not worked, you may need steroid injections.
Local anaesthetic eyedrops are used to numb your eye so you will not feel any pain or discomfort.
You'll usually only require 1 injection while your symptoms are at their worst.
Steroid injections rarely cause significant side effects, but in some people they can make the pressure in the eye increase. The ophthalmologist will check for this and advise you if this happens.
Steroids tablets or capsules
Steroids tablets or capsules are the strongest form of steroids. They're usually used if steroid eyedrops and injections have not worked or are unsuitable, or for uveitis affecting the back of the eye.
Steroids tablets can cause a wide range of side effects, so will only be recommended if it's thought there's a risk of permanent damage to your vision.
How long you'll have to take steroid tablets for depends on how well you respond to treatment and whether you have an underlying autoimmune condition.
Some people only need to take them for 3 to 6 weeks, while others need to take them for months or possibly years.
Short-term side effects of steroids tablets or capsules can include weight gain, increased appetite, insomnia and mood changes such as feeling irritable or anxious.
In the long term they can cause osteoporosis, thinning of the skin, and an increased risk of infection.
To minimise any side effects, you'll be prescribed the lowest possible dose to control your symptoms.
Read more about steroids.
Do not stop taking steroids until a doctor says it's safe to do so. Suddenly stopping your medicine can cause unpleasant withdrawal effects.
When a GP or ophthalmologist thinks you can stop the treatment, they'll advise you about how to gradually reduce the amount of steroids you're taking.
If you have uveitis that affects the front of your eye (anterior uveitis), you may be given mydriatic eyedrops as well as steroid medicine.
These eyedrops enlarge (dilate) your pupils and relieve pain by relaxing the muscles in your eye. They can also reduce your risk of developing glaucoma, which affects vision.
However, mydriatic eyedrops can cause some temporary blurring of your vision and problems focusing your eyes.
If an underlying infection is causing uveitis, the infection may also need to be treated.
Immunosuppressant may be recommended if you're among the few people who do not respond to the treatments described above.
Immunosuppressants work by controlling the immune system and disrupting the process of inflammation.
If steroid treatment is causing significant side effects, immunosuppressants can also be used to allow your dose of steroids to be reduced.
Possible side effects of immunosuppressants include:
- skin rash
- numbness or tingling in different parts of your body
- loss of appetite
- nausea and vomiting
- high blood pressure
- hair loss
Taking immunosuppressants will make you more vulnerable to infection, so you should try to avoid close contact with anyone who has a known infection.
Report any symptoms of a potential infection, such as a high temperature, cough, or inflammation in other parts of your body, to a GP. You should also have the annual flu vaccine.
Immunosuppressants can also affect the functioning of some of your organs and systems in your body, such as your lungs, liver, kidneys and bone marrow. Regular blood tests are needed to check these systems remain healthy.
A small number of people with uveitis can benefit from treatment with immunosuppressants known as biologics.
Rarely, an operation called a vitrectomy may be needed to treat uveitis. It's usually only recommended if you have repeated or severe uveitis, or if the condition is caused by certain infections.
During the operation, the fluid inside your eye will be temporarily replaced with either a bubble of air or gas (or a mixture of the 2), or a liquid substitute. Eventually, the vitreous humour will naturally replace itself.
Like all operations, a vitrectomy carries a risk of complications. These include needing further surgery and an increased risk of developing cataracts.
The following measures may help relieve your symptoms:
- wearing dark glasses if your eye becomes sensitive to light
- placing a warm flannel over your eye to soothe it
- taking painkillers, such as ibuprofen, to relieve pain