Uveitis and Ocular Inflammatory Disease

Uveitis and Ocular Inflammation in Melbourne's Northern Suburbs

Uveitis — inflammation within the eye — is one of the more complex conditions seen in ophthalmology. It encompasses a broad spectrum of disease, from self-limiting acute episodes to chronic, sight-threatening inflammatory disorders requiring long-term specialist care. Northern Eye Consultants provides specialist assessment and management of uveitis and ocular inflammatory disease from our consulting rooms at Northpark Hospital, Bundoora, serving patients across Melbourne's northern suburbs including Epping, Mill Park, Greensborough, Eltham, Thomastown, Preston, and Reservoir.

Dr Xavier Fagan — our subspecialist in medical retina and ocular inflammatory disorders — completed 18 months of fellowship training in uveitis at the Royal Victorian Eye and Ear Hospital following his ophthalmology training. He was awarded the K G Howsam Medal for the best performing ophthalmology candidate across Australia and New Zealand, and holds a public hospital appointment at the Royal Victorian Eye and Ear Hospital.

What is Uveitis?

The uvea is the middle layer of the eye, comprising three anatomically distinct structures: the iris (the coloured ring that controls the pupil), the ciliary body (which produces aqueous fluid and controls lens focus), and the choroid (a vascular layer lying between the retina and the sclera that supplies blood to the outer retina).

Uveitis is classified by anatomical location:

• Anterior uveitis (iritis / iridocyclitis) — Inflammation of the iris and/or ciliary body. The most common form. Presents with a red eye, pain, photophobia, and blurred vision. Cells and flare are visible in the anterior chamber on slit lamp examination.
• Intermediate uveitis — Inflammation centred in the vitreous body and peripheral retina. Typically causes floaters and blurred vision. Often associated with conditions such as multiple sclerosis or sarcoidosis.
• Posterior uveitis — Inflammation of the choroid (choroiditis), retina (retinitis), or both (chorioretinitis). Can cause severe floaters, visual field loss, and central vision loss. More likely to cause permanent damage than anterior disease.
• Panuveitis — Inflammation involving all layers of the uveal tract simultaneously. The most severe form, often associated with systemic inflammatory conditions such as Behçet's disease or sarcoidosis.

Symptoms — Why Prompt Assessment Matters

Anterior uveitis typically presents with:

• Red eye — often diffuse, or most prominent around the cornea (ciliary flush)
• Eye pain — often described as a deep ache, worsened by light
• Photophobia — marked light sensitivity, often severe
• Blurred vision — from inflammatory cells in the anterior chamber and aqueous
• Small or irregular pupil — from posterior synechiae (adhesions between iris and lens)

Posterior and intermediate uveitis may present more insidiously, with floaters (often dense or sudden-onset), blurred or reduced vision, and visual field defects — sometimes without significant pain or redness. This can delay presentation and allow more extensive damage to accumulate before diagnosis.

Any sudden red eye with pain or photophobia, or new-onset floaters with visual disturbance, warrants urgent ophthalmological review. Contact our rooms on 03 9466 8822 if you have concerns.

Causes of Uveitis

Uveitis may be infectious or non-infectious. Identifying the underlying cause — through history, examination, and targeted investigation — is important because it determines the most appropriate treatment.

Non-infectious causes account for the majority of uveitis in Australia. Many cases are idiopathic (no identifiable cause). Known systemic associations include:

• HLA-B27-associated disorders — ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease (Crohn's and ulcerative colitis)
• Sarcoidosis — a multisystem granulomatous disease that can cause uveitis at any level
• Behçet's disease — a vasculitis causing recurrent panuveitis with a risk of severe visual loss
• Juvenile idiopathic arthritis (JIA) — often causes a quiet, insidious chronic anterior uveitis in children
• Multiple sclerosis — associated with intermediate uveitis

Infectious causes include herpes simplex virus (HSV), herpes zoster virus (HZV), cytomegalovirus (CMV), toxoplasmosis (a common cause of posterior uveitis), and syphilis. Identifying an infectious cause is important because treatment requires antimicrobial therapy, not just immune suppression.

Diagnosis

Assessment of uveitis at Northern Eye Consultants includes a detailed history (including systemic symptoms, joint disease, skin rashes, previous episodes), comprehensive slit lamp examination to assess the extent and character of anterior and posterior inflammation, and advanced imaging where indicated.

Optical Coherence Tomography (OCT) detects and quantifies macular oedema — one of the most important complications of posterior and intermediate uveitis.

Fluorescein angiography maps areas of vascular leakage and retinal inflammation, helping to characterise the extent and nature of posterior uveitis.

Systemic workup is tailored to the clinical presentation and may include blood tests (HLA-B27, FBC, ESR, CRP, ACE, syphilis serology, Toxoplasma serology), chest X-ray or CT, and referral to rheumatology, gastroenterology, or infectious diseases as appropriate.

Treatment

Treatment is directed at controlling active inflammation, preventing recurrence, and managing complications. The approach depends on the type, severity, and underlying cause of uveitis.

Anterior uveitis is typically treated with topical steroid drops (prednisolone acetate or dexamethasone) to suppress inflammation, and cycloplegic drops (atropine or cyclopentolate) to relieve ciliary spasm and prevent posterior synechiae. Most acute anterior uveitis resolves within four to six weeks with appropriate treatment.

Posterior and intermediate uveitis, and uveitis causing macular oedema, may require periocular steroid injections (around the eye) or intravitreal steroid implants (injected into the vitreous). Ozurdex (dexamethasone intravitreal implant) provides a sustained steroid release over several months and is an effective treatment for uveitic macular oedema.

Chronic or bilateral uveitis, or uveitis associated with systemic inflammatory disease, often requires systemic immunosuppression. First-line agents include oral prednisolone (for acute control) followed by steroid-sparing agents such as methotrexate, mycophenolate mofetil, or azathioprine. For refractory uveitis — particularly in Behçet's disease and JIA — biologic therapy (such as adalimumab, an anti-TNF agent) has demonstrated significant benefit.

For patients requiring systemic immunosuppression, shared care with a rheumatologist or physician is essential. Infectious causes require specific antimicrobial therapy alongside or instead of immune suppression.

Complications and Why Specialist Follow-Up is Essential

Uveitis — particularly when inadequately treated — can lead to a range of serious ocular complications:

• Cataract — Chronic inflammation and prolonged corticosteroid use both accelerate lens opacification. Uveitic cataract surgery is technically more challenging than routine cataract surgery and requires specialist experience.
• Uveitic glaucoma — Elevated intraocular pressure can result from inflammatory cells blocking the trabecular meshwork, posterior synechiae causing pupil block, or steroid-induced pressure rise. Management may require anti-glaucoma drops, laser, or glaucoma surgery. For more information, see our glaucoma page.
• Macular oedema — The most common cause of visual impairment in uveitis. Fluid accumulation in the macula causes distortion and central vision loss. Treatment with intravitreal or periocular steroids can resolve the oedema.
• Band keratopathy — Calcium deposits in the cornea from chronic anterior inflammation, causing a white band across the visual axis. Can be treated with chelation (EDTA) when visually significant.
• Retinal detachment and scarring — Posterior uveitis can cause retinal scarring, epiretinal membrane formation, and traction — potentially leading to retinal detachment in severe cases.

Multidisciplinary Care

Uveitis associated with systemic inflammatory disease is best managed collaboratively. Ocular inflammation and systemic disease activity often — but not always — run in parallel. Effective management may require coordination between your ophthalmologist and a rheumatologist (for joint disease), gastroenterologist (for IBD), infectious diseases physician (for infectious uveitis), and your GP.

Dr Fagan works closely with physicians across Melbourne's northern suburbs to deliver coordinated care for patients with systemic inflammatory disease affecting the eye. Detailed reports are provided after each consultation to support shared management.

For a broader overview of retinal conditions managed at Northern Eye Consultants, visit our Medical Retina page. To arrange a referral, contact our rooms on (03) 9466 8822 or use HealthLink EDI nthneyec.