Ocular inflammation and uveitis as a possible sign of another disease

Ocular inflammation is not always an isolated problem. In certain cases, it may be the visible manifestation of a disease affecting other parts of the body. Uveitis is one of the main conditions in which the eye acts as a warning sign from the immune system.

In up to 30–50% of cases, uveitis may be associated with systemic diseases, particularly those of autoimmune or inflammatory origin.

At the Barraquer Ophthalmology Centre, we understand that, when faced with intraocular inflammation, it is essential to look beyond the eye.

What is uveitis and which structures does it affect?

Uveitis is inflammation of the uvea, the middle layer of the eye, which is made up of:

• Iris
• Ciliary body
• Choroid

Depending on its anatomical location, it is classified as:

Anterior uveitis

The most common type. It mainly affects the iris and ciliary body.

Intermediate uveitis

It affects the vitreous and the peripheral area of the retina.

Posterior uveitis

It causes inflammation of the choroid and may affect the retina, the retinal blood vessels and the optic nerve.

Panuveitis

It affects all compartments of the eye.

The problem lies not only in the acute inflammation, but also in the risk of complications such as cataracts, glaucoma, macular oedema or permanent vision loss.

Symptoms of uveitis

Symptoms may vary depending on the type, but the most common include:

Eye pain: More common in anterior uveitis

Redness: Located around the iris

Photophobia: Intense discomfort in response to light

Blurred vision: Due to inflammation or macular oedema

Floaters: Indicate inflammation of the vitreous

When ocular inflammation is a sign of a systemic disease

Uveitis may be the first manifestation of an inflammatory or autoimmune disease. The immune system, which normally protects the body, becomes inappropriately activated and causes inflammation in different organs, including the eye.

The diseases most commonly associated with uveitis include:

• Ankylosing spondylitis: Recurrent unilateral anterior uveitis
• Juvenile idiopathic arthritis: Chronic bilateral uveitis in children
• Behçet’s disease: Severe bilateral ocular inflammation
• Sarcoidosis: Posterior uveitis or panuveitis
• Inflammatory bowel disease: Flare-ups associated with intestinal disease activity
• Multiple sclerosis: Intermediate uveitis

In some cases, ocular inflammation precedes the diagnosis of the systemic disease.

When should uveitis be suspected of not being an isolated problem?

The diagnostic assessment should be extended when:

• The inflammation is bilateral
• It recurs frequently
• It appears in young patients
• It is accompanied by joint pain
• There are skin lesions, oral ulcers, or digestive or respiratory symptoms
• It is intermediate or posterior uveitis, or panuveitis
• It does not respond adequately to initial treatment

In these cases, the approach should be multidisciplinary, coordinating ophthalmology with rheumatology or internal medicine.

Diagnosis of uveitis

Diagnosis is based on a specialised ophthalmological examination that includes:

• Slit-lamp examination
• Fundus examination
• Optical coherence tomography (OCT)
• Blood tests and specific immunological studies according to the clinical suspicion
• Chest X-ray

Not all cases of uveitis require a complete systemic assessment, but it is essential to evaluate each case individually.

Treatment: controlling inflammation and preventing recurrence

Treatment depends on the cause, location and severity:

Local treatment

• Corticosteroid eye drops
• Mydriatic eye drops to relieve pain and prevent synechiae

Systemic treatment

• Oral corticosteroids
• Immunosuppressive drugs and biological therapies

The aim is not only to resolve the current flare-up, but also to prevent recurrences and avoid permanent structural damage that could compromise vision in the long term.

The importance of specialist follow-up

Uveitis is a condition that tends to recur. Regular follow-up makes it possible to:

• Detect complications early
• Adjust treatment according to the response and monitor adverse effects
• Coordinate care with rheumatology or internal medicine when necessary

The eye can act as a window revealing hidden systemic abnormalities.

Uveitis is not always an isolated ocular inflammation. In certain patients, it may be the first sign of an underlying systemic disease.

Detecting it early, investigating its cause and ensuring appropriate follow-up are essential to preserve vision and protect general health.

At the Barraquer Ophthalmology Centre, we approach each case from a comprehensive perspective, because understanding the origin of the inflammation is just as important as treating it.

Dr Maria José Capella, ophthalmologist at the Barraquer Ophthalmology Centre