Treating uveitis

Treatment for uveitis will depend onwhich areas of the eye are affected and what caused the condition.

Medication is the main treatment, but surgery can be used in particularly severe cases.

Steroid medication

Steroid medication (corticosteroids) is used to treat most cases of uveitis.A medicine called prednisolone is usuallyused.

Corticosteroidswork 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 eye drops

Corticosteroid eye drops are usually the first treatment recommended foruveitis affecting the front of the eye (anterior uveitis) thatis not caused by an infection.

Depending on the severity of your symptoms, the recommended dose can range from having to use eye drops every hour to once every two days.

You may experience temporary blurred visionafter using corticosteroid eye drops. If this happens, don't drive or operate machinery until your vision returns to normal.In some people, steroid eye drops can increase pressure in the eye. The ophthalmologist will check for this, and advise you if it occurs.

Don't stop using your eye drops until your GP or ophthalmologist advises that 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 is usually slowly reduced over a matter of weeks.

Corticosteroid injections

If the middle or back of your eye is affected (intermediate or posterior uveitis) or corticosteroid eye drops haven't worked, you may need corticosteroid injections.

The injection can be given to the side of the eye(subconjunctival) or around the eye (periocular). Local anaesthetic eye drops are used to numb your eye so you won't feel any pain or discomfort.

You'll usually onlyrequire 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 ifthis happens.

Oral corticosteroids

Oral corticosteroids (tablets or capsules) are the strongest form of corticosteroids. They are usually used if steroid eye drops and injections haven't worked or areunsuitable, or for posterior uveitis.

Corticosteroids tabletscan cause a wide range of side effects, so theymay only be recommended if it's thought there is a risk of permanent damage to your vision without this treatment. 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 oral corticosteroidscan include weight gain, increased appetite, mood changes such as feeling irritable or anxious, and insomnia. In the long-term they can cause osteoporosis (fragile bones), thinning of the skin, and an increased risk of infection.

To minimise the impact of side effects, you will be prescribed the lowest possible dose that's thought to be effective enough to control your symptoms.

If your GP or ophthalmologist decides to end your treatment, they'll gradually reduce the amount of corticosteroids that you're taking.

Mydriatic eye drops

If you have uveitis affecting the front of your eye (anterior uveitis), you may be given special eye dropscalled mydriatic or dilatingeye drops in addition to steroid medication.

These dropsdilate your pupils and relieve pain by relaxing the muscles in your eye. They can also reduce the risk ofthe iris (the coloured part of the eye) "sticking" to the lens (the transparent section at the front of the eye). This canresult in a condition called glaucoma , whichaffects vision.

However, these drops can cause some temporary blurring of your vision and problems focusing your eyes.

Treating infection

If the cause of your uveitis is known to be an underlying infection, the infectionmay also need to be treated.

Viruses can be treated with antiviral medication, bacterial infections can be treated with antibiotics , and fungal infections can be treated with antifungal medication .

The medicationswill usually be used alongside appropriate steroid medication and cycloplegic or mydriatic eye drops.

Immunosuppressants

A very small number of people with uveitis fail to respond to the above treatments. In such circumstances, a type of medication called an immunosuppressant may be recommended.

Immunosuppressants are a type of medication that suppress (control) the immune system and disrupt the process of inflammation.

If you are having steroid treatment that 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
• headaches
• hair loss

Taking immunosuppressants will make you more vulnerable to infection, soyou should try to avoid close contact with anyone who has a known infection.

You should also report any symptoms of a potential infection, such as a high temperature, coughor inflammation in other parts of your body, to your GP. You should also have the annual flu jab.

However, this is usually only recommended if you have repeated or severe uveitis, or if the condition is caused bycertain infections.

An operation called a vitrectomycan be used to treat uveitis. This involves gently sucking outthe jelly-like substance that fills the inside of the eye (the vitreous humour). It can be carried out either using general anaesthetic or local anaesthetic.

The fluid inside the eye will be temporarily replaced during the operationwith either a bubble of air or gas (or a mixture of the two), or a liquid substitute. Eventually, the eye willnaturally replace the vitreoushumour with a slightly different clear fluid called aqueous humour.

Like all operations, a vitrectomy carries a risk of complications. These include needing further surgery and an increased risk of developing cataracts (cloudy patches in the lens of the eye).

The following may help your symptoms

• wear dark glasses if your eye becomes sensitive to light
• place a warm flannel over the eye to soothe it
• relieve pain by taking painkillers, such as ibuprofen