This site provides information on iritis and uveitis, and the conditions associated with these eye diseases.  There are message boards where questions may be asked and experiences shared.  It is provided as a service to patients worldwide by an ophthalmologist in England.

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Welcome to iritis .com

iritis (uveitis) is a common eye condition in which the iris is inflamed. This site aims to draw together patients who suffer from iritis (uveitis), and doctors who treat it.

I started this site because many of my iritis (uveitis) patients clearly wanted to know more about their condition. However, in a government hospital setting there is never enough time to explain things as much as one would wish. I also started this site because for many patients, being able to discuss their condition with others is therapeutic in itself.

For those people with iritis (uveitis) associated with medical conditions, links to self-help and advice groups are given.

While all information is given freely and in good faith, I cannot be liable for the information given on this site, as the information is not tailored to your particular condition.

This is not the only iritis (uveitis) site on the net Ė other sites are listed in the directory of external links Ė but it is the only site started and maintained by an ophthalmologist.  I hope you find it helpful.

Dr Victor Chua MA (Cantab), MB BChir (Cantab), MRCSE (Ophth.)
Cambridge, England
16 June 2000

What is iritis (uveitis)?

Your eye doctor may have diagnosed that you have a condition known as iritis (uveitis). This is a condition where a part of the eye, the iris, becomes inflamed. With proper treatment an attack of iritis (uveitis) can be controlled.

What are the signs of iritis (uveitis)?

Eye pain (may be severe)

Blurred or decreased vision

Sensitivity to light (photophobia)

Red eye

Tears

Smaller pupil on affected eye (sometimes)

 

Red right eye in iritis (uveitis)

It is more common for just one eye to be affected during an attack of iritis (uveitis). However both eyes can be affected at the same time.  

Generally, the eye is not sticky, crusty or producing a discharge. These are symptoms more suggestive of conjunctivitis.

What is the iris?

The iris is the structure behind the cornea of the eye which dilates and constricts.  In bright light, the iris constricts (you may have noticed this yourself).  In dim light, it dilates.

What is the difference between the iris and the pupil?

The pupil is defined as the the hole in the middle of the iris.  The iris is the structure which is around the hole and defines the hole. 

Are there different kinds of iritis (uveitis)? What is the difference between iritis (uveitis) and uveitis?

Yes. iritis (uveitis) is the commonest of a family of conditions called uveitis. The uvea extends from the front of the eye to the back of the eye. Where the uvea is inflamed at the front of the eye involving the iris, uveitis is synonymous with iritis (uveitis). Where it inflamed near the middle of the eye involving the ciliary body, it is called cyclitis. When the back of the eye involving the choroid is inflamed, it is called choroiditis.

What are the causes of iritis (uveitis)?

Unknown (this is the most common)

Certain medical conditions such as:

  1. Ankylosing spondylitis

  2. Ulcerative colitis

  3. Crohnís disease

  4. Sarcoidosis

Injury to the eye

Surgery to the eye

Infections such as:

  1. Shingles or chickenpox virus (herpes zoster)

  2. Cold sore virus (herpes simplex)

  3. Parasite, eg toxoplasmosis

Is iritis (uveitis) contagious?

Very few people with iritis (uveitis) have a contagious variety. If you do, your doctor will tell you.

Can attacks of iritis (uveitis) be prevented?

Generally speaking, no. No-one knows why people have recurrent attacks at particular times. There is published evidence that earthquake victims have much higher rates of recurrence so some doctors think stress may be a factor.

How is iritis (uveitis) diagnosed?

When symptoms occur, a prompt examination by an ophthalmologist (medical doctor specializing in the eye) is important. If left untreated, inflammation in the eye can lead to permanent damage or even in extreme cases blindness.

The ophthalmologist will use instruments to examine the inside of the eye and can usually make the diagnosis on that basis. Since uveitis can be associated with disease elsewhere in the body, he will require a thorough understanding of your overall health. This may involve consultation with other medical specialists. He may also request blood tests, X-rays, and other specialized tests to establish a cause of the uveitis.

How is iritis (uveitis) treated?

Eye drops, especially steroids (such as Prednisolone [PredForte]or Dexamethasone [Maxidex]) and pupil dilators, are medications used to reduce inflammation and pain in the front of the eye. The steroid drops may need to be instilled frequently (in severe cases as much as every half an hour). Your ophthalmologist will arrange to see you again to assess the progress of the treatment and will, according to the degree of inflammation, decrease or increase the treatment.

Pupil dilating drops (such as Cyclopentolate [Mydrilate] or Atropine) make you feel more comfortable and prevent certain complications of iritis (uveitis). However you may become more sensitive to bright light, especially during the summer, and you may lose the ability to focus on near objects (accommodation), and your vision may become more blurred.

Arenít steroids harmful?

Steroids taken by mouth have side-effects. However steroid eye drops are absorbed principally by the eye and do not cause the same side-effects as oral steroids. In a small proportion of people steroid eye drops cause the pressure in the eye to rise above normal. Your ophthalmologist will measure the pressure in the eye to discover if you are one of these people and will treat you accordingly.

What are the possible complications of uveitis?

In most cases complications are rare, but they include:

Glaucoma (high pressure in the eye causing damage)

Cataract (clouding of the lens of the eye)

New blood vessel formation (neovascularization)

These complications may themselves need treatment. If complications are advanced, conventional or laser surgery may be required.

What is the probable outcome?

Uveitis arising in the front or middle of the eye (iritis (uveitis) or cyclitis) is commonly more sudden in onset, generally lasting six to eight weeks, and in early stages can usually be controlled by the frequent use of drops. Often, this type of uveitis cannot be given a specific cause.

Uveitis in the back part of the eye (choroiditis) is commonly slower in onset and may last longer, and is often more difficult to treat. Treatment may involve steroid tablets or injections. Often, multiple tests are required to find the cause of this type of uveitis.

With infections, uveitis tends to clear up once the underlying infection is treated.

Are there any restrictions to what I can do?

You should not drive a car if you canít see properly. Dark glasses will make you feel more comfortable. Whether you will need to give up work depends on the severity of the symptoms. There is no special diet required.

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Types of iritis (uveitis)

iritis (uveitis) may be associated with the conditions listed below.  However, it is important to realize that the majority of cases of iritis (uveitis) have no known association

If your ophthalmologist has reason to suspect that you have an associated condition, he may request tests such as blood tests and x-rays to confirm the associated condition.

The information given in the headings below apply only if you have the known associated condition. Some of them are very rare. The more common associations are listed first.

"B27" iritis (uveitis)

50% of iritis (uveitis) sufferers are positive in a blood test that looks for a protein found on cell surfaces called "HLA-B27".  "B27" is also associated with the following conditions:

Ankylosing spondylitis
Psoriasis
Ulcerative colitis
Crohn's disease
Reiter's syndrome

Non-infectious associations

Fuch's heterochromic iridocyclitis
Intermediate uveitis
Sarcoidosis

The following are very rare in the Western world

BehÁet's disease
VKH (Vogt-Koyanagi-Harada) disease

The following association is very rare, full stop

Multiple sclerosis

Infections associated with iritis (uveitis)

Herpes simplex (cold sore)
Varicella zoster (shingles)

The following are very rare

Tuberculosis (TB)
Acquired syphilis
Leprosy
Lyme disease
Toxoplasmosis

iritis (uveitis) due to injury

An impact or penetrating injury to the eye may cause iritis (uveitis).  As an infection may mimic iritis (uveitis), it is vital that an ophthalmologist be consulted if there is any possible doubt about ocular penetration.

iritis (uveitis) due to surgery

Any intra-ocular surgery, such as cataract extraction or trabeculectomy for glaucoma, will cause some degree of iritis (uveitis) for a few weeks after surgery.  To reduce inflammation your eye surgeon will prescribe steroid drops to reduce the inflammation.  Exact regimes differ from surgeon to surgeon.

iritis (uveitis) in children

Juvenile chronic arthritis (in USA, Juvenile rheumatoid arthritis)

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Frequently Asked Questions

What is iritis (uveitis)?

There is a whole page devoted to this.  Click here.

Why is the font size in iritis (uveitis).com so big?

This is because many patients with iritis (uveitis) have poor vision, or are using dilating drops which reduce near visual acuity.  If it is too big (or too small), you can change the text size in your browser.  For example, in Microsoft Internet Explorer select View from the menu and then Text Size.

What is the difference between iritis (uveitis) and uveitis?  Sometimes I am told I have iritis (uveitis), sometimes I am told I have uveitis, but the symptoms are the same to me

iritis (uveitis) is a kind of uveitis, specifically it is the same as "anterior uveitis".  There are three types of uveitis - anterior, intermediate, and posterior. Intermediate and posterior uveitis are rare conditions. iritis (uveitis) (= anterior uveitis) is a common condition.

Isn't iritis (uveitis) due to an infection?  I thought most diseases ending in -itis were caused by infection

Few cases of iritis (uveitis) are caused by infection, although infection is a rare cause. The -itis suffix actually denotes inflammation, which is not the same as infection. Infection is caused by an external organism invading the body. 

Inflammation is one response of the body to infection. Unfortunately, inflammation may occur when the body's immune system targets itself inappropriately. In most cases of iritis (uveitis), it is the inappropriate targeting which occurs.

What are the functions of the drops I have been prescribed?

There are many drops used in the treatment of iritis (uveitis). The two main kinds of drops used in iritis (uveitis) are

  1. Steroid drops
  2. Dilating drops

Steroid drops

Steroid drops (also known as corticosteroid drops) are used to decrease inflammation, which is the cause of pain and redness of the eye. Steroid drops come in different varieties and strengths, and may be taken as often as every half an hour or as infrequently as twice a week.  For most attacks of iritis (uveitis) your ophthalmologist will advise steroid drops every two hours or so for the first few days.

Examples of steroid drops (brand names in [brackets]):

Prednisolone [PredForte; Predsol is a weaker formulation]
Dexamethasone [Maxidex]
Betamethasone [Betnesol]
Fluoromethalone [FML]
Hydrocortisone [Neo-Cortef]
Clobetosone butyrate [Cloburate]
Rimexolone [Vexol]

Dilating drops

Dilating drops are used to relax (ie. make large) the pupil and the ciliary musle. There are two reasons for this: first, relaxing the pupil helps prevent the formation of posterior synechiae, and second, relaxing the pupil and ciliary muscle decreases the pain associated with iritis (uveitis).

Dilating drops have differing duration of action, noted below:

Atropine (1 week)
Homatropine (1 day)
Cyclopentolate 0.5% [Mydrilate] (8 hours)
Tropicamide 1% [Mydriacyl] (6 hours)

The duration of action given is approximate.  For example, the effect of atropine may wear off in a few days in some people, a few weeks in others.

Are there any side effects from steroid drops?

About 5% of the population are "steroid responders", meaning that the intraocular pressure goes up when steroid drops are used. Your ophthalmologist will measure your intraocular pressure on your first two visits to determine whether you fall into this group.  

If you are a steroid responder, your ophthalmologist may prescribe anti-glaucoma medication to bring the pressure down, or he may prescribe a weaker steroid such as FML.  A new steroid drop, Rimexolone, which has high potency but low potential to increase pressure has come on the market. 

If you are a steroid responder, you should remember this fact and mention it to your ophthalmologist on your next visit so that he can take appropriate action to minimise a rise in pressure.

Other side effects are few. The purpose of steroid drops is to decrease inflammation. Therefore, while you are on steroid drops your resistence to external infection will be reduced. Since the wearing of contact lenses may encourage infection, contact lenses should not be worn.

Are there any side effects from dilating drops?

Blurred vision is the main side effect. Some people may notice dry mouth. In some people (especially those given atropine) some slowing of the heart beat may occur.

The last time I had iritis (uveitis) I was given steroid drops. However, for my most recent attack I was given different steroid drops!  Why?

The different steroid drops have differing strengths: PredForte and Maxidex are at the strong end of the scale, Betnesol and Predsol are in the middle, and FML is a weak steroid. They have slightly different penetration characteristics. Your eye doctor will have a preference.

Probably the commonest drops used in the UK for the treatment of iritis (uveitis) are PredForte and Maxidex. There is little to choose between them in strength. Some doctors and hospitals prefer one drop, some another.  When I used to work in East Anglia, I prescribed Maxidex; when I moved to the Midlands I started prescribing PredForte mainly because it was advocated by the local iritis (uveitis) expert.

Many ophthalmologists (including myself) don't think there is very much difference between PredForte and Maxidex. There is little or no convincing research to demonstrate any superiority of one over the other.

The last time I had iritis (uveitis) I was given dilating drops. However, for my most recent attack I was given different dilating drops!  Why?

Again, the preferences of your ophthalmologist will have a large part to play. The main difference between the various kinds of dilating drops lies in their duration of action. There are also significant differences in the severity of their side effects.

When I used to work in East Anglia, I prescribed cyclopentolate 1% to people with simple uncomplicated iritis (uveitis). When I moved to the Midlands, atropine was the standard dilating drop at my new hospital so I started prescribing it instead. The main difference was that people on cyclopentolate recovered sharp vision sooner on discontinuing the drop as it only lasts 8 hours on average. People on atropine had to wait a week. However, there is little or no convincing evidence to demonstrate any long-term advantage of one dilating drop over the others.

If you have had particular preferences for one type of dilating drop in the past, you should mention this to your ophthalmologist.

What about non-steroidal anti-inflammatory drops?

These are sometimes used in place of steroid drops in mild cases of iritis (uveitis).  Examples are Diclofenac (Voltarol ophtha) and ketolorac (Acular).

My vision has not got better despite the treatment

The aim of iritis (uveitis) treatment is not short-term restoration of vision, but rather the long-term preservation of vision. Very often, the vision remains poor because of dilating drops such as atropine, homatropine, cyclopentolate [Mydrilate], and tropicamide. By keeping your pupil dilated, your ophthalmologist aims to minimise the chances of long-term damage to the eye due to posterior synechiae. The drops also have the effect of lessening the pain in the eye.

If rapid restoration of sight is very important to you, let your ophthalmologist know. It is possible to prescribe short-acting dilating drops to be taken before bedtime. However, nobody knows whether this is more or less likely to lead to complications later. Most ophthalmologists would say that after two or three days of steroids and constant dilation, dilation at night only is safe.

If anything, I have become more sensitive to light since treatment commenced

This is probably because you have been given dilating drops, which enlarge the pupil. This allows more light to enter the eye.

Wear dark glasses.

The doctor gave me an injection in the eye!  Why is this necessary?

In severe cases of iritis (uveitis), or when the iris  is persistently stuck to the lens, injections into the conjunctiva (the white part of the eye outside the cornea) are very effective in delivering a constant dose of steroids and dilating drops to the eye. The effect lasts for a day or two, and virtually all of my patients are glad that they opted to have it done, as the relief from pain and discomfort is dramatic.

The procedure sounds much worse than it is. The eye is thoroughly anaesthetized with drops before the procedure.  There may be some dull pain after the procedure and the eye may be difficult to close for an hour or so. Your ophthalmologist may advise padding the eye.

The last time I had iritis (uveitis) my left eye was affected.  This time my right eye is affected.  My iritis (uveitis) must be getting worse as it has spread from one eye to the other

The majority of cases of iritis (uveitis) are relapsing and remitting, or in other words, it comes and goes. There seems to be little in which eye it affects. iritis (uveitis) going from one eye to another, with a quiet period in between, is normal.

I have been given steroid tablets.  What are the side effects?

Steroid tablets (eg. Prednisolone) are given in cases of complicated uveitis, often posterior uveitis. They are used to dampen down the immune system.

The major side effects are

Weight gain in the abdominal area
Purple lines on the abdomen and flanks
Round ("moon") face
Increased susceptibility to infection
Water retention
Osteoporosis resulting in brittle bones
Inappropriate hair growth (eg. facial hair in a woman)
Baldness in men
Acne
Muscle wasting
Hypertension (high blood pressure)
Diabetes mellitus

Steroids are given because your ophthalmologist judges that the risks to the eye outweigh these side effects.  If your side effects are very severe, you should discuss the pros and cons of steroids with your ophthalmologist.

I seem to get an attack of iritis (uveitis) at least once a year.  Is there any way I can prevent the attacks from happening?

I'm afraid not!  There have been a few studies which suggest that stress is a factor. In earthquake victims living in tents in Japan, the rate of iritis (uveitis) tripled. There are scientific papers noting that flare-ups of rare kinds of iritis (uveitis) (JCA, BehÁet, Vogt-Koyanagi-Harada) are less common during pregnancy. This is probably due to the change in hormones during pregnancy.

I get attacks of iritis (uveitis) frequently.  Do I need to see an ophthalmologist at all?  Can't my family physician prescribe the appropriate treatment?

You need to see an ophthalmologist in order to confirm the diagnosis. If you have only had iritis (uveitis) once or twice, you may be confusing the symptoms of some other eye condition with that iritis (uveitis).

In particular, corneal ulcers may be mistaken for iritis (uveitis) by both patients and by non eye-trained doctors. This is an important distinction because corneal ulcers are made worse by steroid drops.

I keep an unopened bottles of steroid drops and dilating drops in the refrigerator at home in case I have flare-ups.  Am I taking any risks self-medicating?

If you have had iritis (uveitis) many times, you may come to recognise the symptoms accurately. In an ideal world you would see an ophthalmologist to confirm the diagnosis as soon as you get the symptoms.  

In the real world, you may live 100 miles from the nearest ophthalmologist, or it may be 10 pm on a Saturday night and you may face a six-hour wait at the nearest hospital's casualty (emergency) department.

If you do self-medicate in these circumstances, the risk you are taking is small as long as you see an ophthalmologist the next day.

I'm off to Antarctica for six months.  I won't be able to consult an ophthalmologist if I get an attack of iritis (uveitis).  What can I do?

This is a difficult question, and you alone must weigh up the benefits and risks. I can only tell you what I would do if it was me myself who had to make the decision.

If I had very frequent attacks of iritis (uveitis) (more than one every six months) over the last few years, and there was a high probability of an attack while I was in Antarctica, I would probably not go.

If attacks were rare (less than one a year), and each attack was not very severe (not needing injections into the eye), and I was confident that I could recognise the symptoms of iritis (uveitis) accurately then I might well pack some unopened steroid and dilating drops. However, I would be aware that iritis (uveitis) is a potentially blinding condition and take that risk accordingly.

What other conditions can cause symptoms of a painful red eye?

  1. Corneal ulcer -- in young people, often associated with contact lens wear. Treated with antibiotics/antiviral drops depending on the cause. Made worse by steroid drops.
  2. Corneal abrasions -- due to superficial scratches of the cornea (from direct trauma or from a foreign body in the eye). Very painful. May lead to corneal ulcers if not treated with antibiotics as a precaution.
  3. Recurrent corneal erosions -- Very painful, recurrent red eyes due to unstable corneal epithelium (the surface covering of the cornea). 
  4. Bacterial conjunctivitis -- causes a sticky red eye which is more uncomfortable than painful. Often starts in one eye then spreads to the other. Treated with antibiotics.
  5. Allergic conjunctivitis -- causes itchy red eyes which are not particularly painful. Usually affects both eyes. More common in people with multiple allergies, with asthma, with hayfever, and with eczema (ie. with an atopic disposition). Treated by drops which reduce the allergic response.
  6. Viral conjunctivitis -- causes a watery eye which is not usually very painful. Often starts in one eye then spreads to the other. No effective treatment. May last for a long time (weeks to months).
  7. Chlamydial conjunctivitis -- causes a slightly sticky discomfort in both one or both eyes which grumbles along for weeks before becoming significant enough to see a doctor for. Usually sexually transmitted. Effectively treated with antibiotic tablets.
  8. Episcleritis -- reddening of part of the eye only. May be accompanied by pain, in which case steroid drops may help. Otherwise goes away by itself after about a month.