Eye inflammation
Uveitis — the inflammation you do not treat yourself
Uveitis is an inflammation inside the eye. From the outside it sometimes looks like a trivially red eye, but it behaves completely differently: it does not go away on its own, it can leave lasting damage, and at best it does not respond at all to over-the-counter eye drops. With this suspicion the rule is: have it examined today.
What uveitis is
The uvea is the middle of the three coats of the eye — the layer rich in blood vessels between the sclera on the outside and the retina on the inside. It consists of the iris, the ciliary body (corpus ciliare) and the choroid (choroidea). If one of these structures becomes inflamed, the name for that is Uveitis. Among the inflammations of the eye it is the form that lies inside the eye.
That is the decisive difference from a conjunctivitis: There the mucous membrane over the eye is inflamed. With an inflammation of the eyelid margin (blepharitis), the eyelid margin itself is inflamed. With uveitis the inflammation is in the eye — where the aqueous humour, the lens, the vitreous and the retina lie, and where any persistent inflammation can permanently alter structure and function.
Uveitis is markedly less common than conjunctivitis. And it is markedly more serious.
Warning signs: when it has to be today
- Dull, deep ache in or behind the eye — different from the superficial burning of a conjunctivitis
- Marked light sensitivity that makes you screw up your eyes
- Blurred vision, or vision as if veiled by fog
- Redness mainly around the cornea, not spread evenly across the whole white of the eye
- Suddenly many new floaters in the field of vision
- Usually one eye affected, beginning over hours to a few days
If these signs apply, the eye must be examined the same day and no later. Call us: +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30. Outside these hours, contact the ophthalmic emergency service or the emergency department of an eye hospital. It is not a finding to watch over the weekend.
Forms: anterior, intermediate and posterior uveitis
Classification goes by the site of the inflammation — and that site determines both the symptoms and the treatment.
Anterior uveitis (iritis, iridocyclitis)
The most common form. The iris and the ciliary body are inflamed. Typical is the combination of a dull ache, strong light sensitivity, redness around the cornea and a small pupil that reacts sluggishly. It often begins rapidly and is the form most likely to bring people to a doctor — because it is decidedly unpleasant.
Intermediate uveitis
The inflammation lies in the vitreous cavity. It often hardly hurts at all and frequently does not even make the eye red. It is perceived as increasing floaters and as blurred vision. That is exactly why it is noticed late — here the alarm signal the anterior form brings with it is missing.
Posterior uveitis (chorioretinitis)
Affected are the choroid and retina. Pain and redness are often absent altogether, but vision declines, in part with losses in the visual field or distorted vision. Because the retina is directly involved, this form carries particular weight for eyesight.
Panuveitis
All segments are inflamed at the same time. This form as a rule calls for a particularly careful search for the cause.
We also distinguish by the course: an acute uveitis begins suddenly and lasts a limited time; a chronic one runs over months and tends to relapse, often without the symptoms disappearing completely in between.
Causes, and connections with the rest of the body
In some of those affected the cause remains unclear despite a thorough assessment — that is called idiopathic, and it is not an oversight but a common result. In others the uveitis is connected with a condition elsewhere in the body.
Inflammatory rheumatic links. The link to the tissue-marker constellation HLA-B27 is well known; it is associated with conditions such as ankylosing spondylitis and related forms. Sarcoidosis, chronic inflammatory bowel disease or a juvenile idiopathic arthritis in childhood can also show themselves in the eye.
Infections. Herpes viruses, toxoplasmosis, Lyme disease, tuberculosis and syphilis come into consideration as triggers. This distinction is not an academic exercise: an infectious uveitis is treated differently from a non-infectious one — anti-inflammatory treatment without treating the pathogen can make matters worse.
After injuries or procedures to the eye, uveitis can also develop.
One important special case: In children with juvenile idiopathic arthritis, uveitis can run its course entirely without symptoms — with no pain, no redness, and without the child noticing anything. That is why these children belong in regular ophthalmic monitoring, even when they are well.
How we assess
The examination at the slit lamp is the decisive step. Only there can inflammatory cells in the aqueous humour be made visible, deposits on the back surface of the cornea be recognised and adhesions between the iris and the lens (synechiae) be assessed. That is the finding that separates uveitis from conjunctivitis — and it simply cannot be established from the outside.
In addition, depending on the situation:
- Measurement of the intraocular pressure, because uveitis can change the pressure in either direction
- Examination of the back of the eye with the pupil dilated (mydriasis), to assess the vitreous, the retina and the choroid
- OCT (optical coherence tomography) to show the macula — inflammatory macular oedema is the most common cause of worsening vision in uveitis, and it can be made visible with OCT and compared over time
- Laboratory tests and an assessment in internal medicine or rheumatology, when the finding, the course or symptoms outside the eye argue for it
We coordinate that route out of the clinic for you, instead of handing you a list. And we also tell you when broad laboratory testing adds nothing in your situation — not every first, uncomplicated anterior uveitis has to be tested for everything.
Treatment
The treatment is guided by the site, the severity and the cause. As a rule it includes:
- Anti-inflammatory eye drops, usually containing a steroid, frequently at first and then reduced step by step. The tapering off is part of the treatment, not an optional final stage.
- Pupil-dilating drops, to prevent adhesions between the iris and the lens and to ease the pain caused by the cramping ciliary muscle.
- Treating the cause, when one is found — where the origin is infectious, targeted against the pathogen.
- Systemic treatment in severe, posterior or recurrent courses, in collaboration with rheumatology or internal medicine.
- Close monitoring, even when the symptoms subside. Uveitis can carry on quietly while the eye settles subjectively.
What is treated is not only the inflammation but also what it can do: raised intraocular pressure, clouding of the lens, swelling of the macula, adhesions of the iris. That is exactly why follow-up is not an addition but the actual treatment over time.
Assessment and treatment are medical services; where there is a medical indication the cost is covered by basic health insurance (OKP). Deductible and co-payment apply as at any doctor's appointment.
Why uveitis is not a case for self-treatment
Over-the-counter 'eye drops for red eyes' work by narrowing the blood vessels. They make the eye whiter without affecting the inflammation — and so take away precisely the sign by which the course is judged.
Riskier still are steroid preparations left over from an earlier treatment. If an infection of the cornea is behind the red eye — from herpes viruses, for instance — steroids without a confirmed diagnosis can do considerable damage. That is the reason we do not prescribe steroids 'on suspicion', and why leftovers in the medicine cupboard are dangerous here.
And the practical point: uveitis treated too late or for too short a time leaves changes that cannot be taken back afterwards. Time is a treatment factor in this condition.
Related topics
Related conditions
Medically reviewed by PD Dr. med. Andrea von Rückmann · Last reviewed
Frequently asked questions
- Most often the combination of a dull ache in the eye, marked light sensitivity, blurred vision and a redness that lies mainly around the cornea. Usually one eye is affected, and the symptoms develop over hours to a few days. In the posterior forms pain and redness can be absent altogether — then the only thing people notice is increasing floaters or slowly worsening vision.
- It is to be taken seriously. Untreated or inadequately treated uveitis can lead to raised intraocular pressure, to clouding of the lens, to swelling of the macula and to adhesions inside the eye — changes that can impair vision permanently. Recognised in time and treated consistently, it can as a rule be controlled well. The difference between those two courses lies above all in when the first examination happens.
- No. Uveitis is an inflammation inside the eye and is not passed from person to person — not even when an infection underlies it. What may be transmissible is the underlying condition that triggered it, not the involvement of the eye. So you need neither keep your distance nor keep your towels separate; you need to come for an examination.
- That depends strongly on the form and the cause. An acute anterior uveitis often improves under treatment within a few weeks, with the drops then slowly tapered off. Chronic and posterior forms accompany those affected over months or years and tend to relapse. Reliable statements are possible only after the examination — blanket timescales help nobody with this condition.
- Not always, but often enough that the question deserves to be asked. If the finding, the course or symptoms outside the eye — back and joint pain, skin changes, bowel symptoms — argue for a connection, we arrange an assessment in internal medicine or rheumatology and coordinate it for you. With a first, uncomplicated anterior uveitis we often deliberately do without it, and tell you why.
- Yes, relapses are typical in several forms — particularly in the chronic courses and in those linked to an underlying condition. That is why it matters that you know the warning signs and get in touch immediately when they appear again, instead of waiting for a follow-up appointment. People with known uveitis usually recognise their own onset reliably; take that judgement seriously, we do too.
With this suspicion, today counts.
A dull ache, light sensitivity, blurred vision: call and describe your symptoms to us. For findings like these we keep short-notice appointments free.
+41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30. Or book an appointment online.