Most cases of uveitis can be treated with steroid medication (corticosteroids). A medicine called prednisolone is usually used.
Corticosteroids work by disrupting the normal function of the immune system so 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 affected by uveitis.
Corticosteroid eyedrops are usually the first treatment used for uveitis that affects the front of the eye (anterior uveitis) and isn't caused by an infection.
Depending on your symptoms, the recommended dose can range from having to use eyedrops every hour to once every two days.
You may have temporary blurred vision after using the drops. Don't drive or operate machinery until your vision returns to normal.
In some people, steroid eyedrops can increase pressure in the eye. The ophthalmologist will check for this and advise you if this happens.
Don't stop using your eyedrops until your GP or ophthalmologist tells you it's safe to do so, 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 (intermediate or posterior uveitis), or corticosteroid eyedrops haven't worked, you may need corticosteroid injections.
Local anaesthetic eyedrops are used to numb your eye so you won't feel any pain or discomfort.
You'll usually only require one injection while your symptoms are at their worst.
Corticosteroid 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.
Corticosteroids tablets or capsules
Corticosteroids tablets or capsules (oral corticosteroids) are the strongest form of corticosteroids. They're usually used if steroid eyedrops and injections haven't worked or are unsuitable, or for uveitis affecting the back of the eye.
Corticosteroids 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 (see complications of uveitis for more information).
How long you'll have to take oral corticosteroids for depends 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.
Short-term side effects of corticosteroids 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 the side effects of corticosteroids.
Don't stop taking corticosteroids until your doctor says it's safe to do so. Suddenly stopping your medication can cause unpleasant withdrawal effects.
When your GP or ophthalmologist thinks you can stop the treatment, they'll advise you about how to gradually reduce the amount of corticosteroids you're taking.
If you have uveitis that affects the front of your eye (anterior uveitis), you may be given mydriatic (or dilating) eyedrops in addition to steroid medication.
These drops 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 your uveitis, the infection may also need to be treated.
Immunosuppressant may be recommended if you're among the few people who don't 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 your GP. You should also have the annual flu jab.
Immunosuppressants can also affect the functioning of some organs and systems, such as the lungs, liver, kidneys and bone marrow. Blood tests are needed at regular intervals 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.
A vitrectomy involves gently sucking out the vitreous humour (the jelly-like substance that fills the inside of the eye). It can be carried out using either general anaesthetic or local anaesthetic.
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 two), 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