Bright Sight

Oliver Backhouse, Consultant Eye Surgeon www.cataract.org.uk

Intermediate Uveitis

Uveitis is a term used to describe a variety of inflammations inside the eye. There are many different forms of uveitis, but even so, uveitis is not a common problem

Intermediate Uveitis is one form accounting for approximately 5% of uveitis types. It often first comes to notice in teenage or young adult years but can be in any age including children. Many patients may have had it for many years before seeing the Ophthalmologist.

Inflammation affecting the front of the eye usually causes it to be red and painful. If affecting the back of the eye it often causes visual loss. Intermediate uveitis affects a band around the inside of the eye between the front and back parts. It does not usually cause pain and redness and often does not cause blurred vision. Mostly both eyes are affected with one eye being worse than the other.

Intermediate uveitis causes clumps of cells to appear in the vitreous (clear jelly of the inside of the eye). These may be described as ‘floaters’, ‘spiders’ or ‘tadpoles’ which are black spots of all shapes and sizes floating around in the vision. They are more obvious if one ‘looks for them’, on bright days or against a white background such as a wall or book.

The severity of Intermediate uveitis varies enormously from patient to patient. Most patients only find the floaters a problem and the eye does not develop long-term complications. As a result, after a period of observation, patients may be discharged to return only if there is a new problem. As the condition can fluctuate, many patients notice that their problems may go away for perhaps months, or even years, before returning again. Many patients learn that their mild inflammation causes irritating symptoms, but nothing more severe.

Some patients have more problems with their inflammation, which can be more severe and persistent. These will need to attend the clinic regularly, may need to use treatment for years, and may have significant visual problems.

1. Anterior uveitis:
Some eyes become inflamed at the front of the eye (anterior uveitis). In this case the eyes may become red and sore, and bright lights may cause discomfort. This will need to be treated with steroid / anti-inflammation eye drops, and some patients will need these long-term in order to control the inflammation.

2. Cataract:
Many different forms of uveitis, particularly those that go on for long periods of time, can lead to a cataract (a clouding of the lens off the eye). Long-term steroid use can do the same. Cataract is not uncommon in those patients with more severe forms of intermediate uveitis, and an operation may be needed to remove it.

3. Macular Oedema:
The macular is the part of the back of the eye that is used for seeing fine detail such as reading. In Intermediate uveitis the macula may become ‘waterlogged’ – this is referred to as macular oedema. This is often the greatest problem. If left untreated, or is resistant to treatment, it can cause scarring which will permanently reduce the sharpness of vision. Therefore, if it occurs, it needs treating with steroids by mouth or by a local injection.

4. Floaters:
Sometimes, especially in young people, the black floaters become so dense that they actually begin to obstruct vision. This is often associated with macular oedema and treatment with steroids may be recommended. For those with very severe problems, it is sometimes necessary to remove the debris with an operation called a vitrectomy.

5. Glaucoma:
Any type of uveitis can cause the pressure inside the eye to be too high which can damage vision (glaucoma). This is not a common concern in Intermediate uveitis.

Intermediate uveitis and general health.

The great majority of patients with Intermediate uveitis are otherwise well and no cause is found for the eye problem. A few patients will have inflammation elsewhere in their body - the most common of these is a condition called Sarcoidosis which accounts for approximately 5% of Intermediate uveitis.

Every patient with Intermediate uveitis who attends the Uveitis Clinic will be asked about general health. A chest X-ray and blood tests will be ordered to help find out other problems should they exist. It must be stressed that in the majority of cases no cause will be found.

Disclaimer: Adapted from Manchester uveitis patient leaflet.