Changes

March 2025 — reviewed. A literature search was conducted in February 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to clinical recommendations have been made.

Update

Goals

To support primary healthcare professionals to:

• Recognize the symptoms and signs of uveitis.
• Refer people with suspected uveitis for same-day ophthalmology assessment.
• Provide appropriate information and advice to people diagnosed with uveitis.

Outcome measures

Audit criteria

QOF indicators

QIPP - Options for local implementation

NICE quality standards

Serious eye disorders

• Adults with signs of possible glaucoma or related conditions on a routine sight test have additional tests before they are referred for a diagnosis.
• Adults with chronic open angle glaucoma or related conditions have reassessment at specific intervals. 
• Adults with serious eye disorders are given a certificate of vision impairment as soon as they are eligible.

[NICE, 2019]

What is it?

• Uveitis is an inflammatory condition affecting the uveal tract (pigmented portion) of the eye, which includes the iris, ciliary body, and choroid. Inflammation of nearby tissues, such as the retina, the optic nerve, and the vitreous humour, may also occur. 
• The anatomical classification of uveitis is based on the part of the eye affected. 
  • Anterior uveitis (the most common type) affects the front of the eye, primarily involving the iris and the anterior ciliary body. It is also referred to as:
    • Iritis — if inflammation predominantly affects the iris.
    • Iridocyclitis — if inflammation involves the iris and anterior part of the ciliary body (pars plicata).
    • Anterior cyclitis — if inflammation is limited to the anterior part of the ciliary body.
  • Intermediate uveitis affects the middle part of the eye, primarily involving the anterior vitreous, ciliary body, and peripheral retina. It is also referred to as:
    • Pars planitis — if inflammation predominantly affects the pars plana and peripheral retina.
    • Hyalitis — if inflammation primarily involves the vitreous humor.
    • Posterior cyclitis — if inflammation affects any part of the posterior ciliary body.
  • Posterior uveitis (the least common type) affects the back of the eye, primarily involving the choroid, but can also involve the retina and optic nerve. It is also referred to as:
    • Choroiditis — if inflammation predominantly affects the choroid.
    • Retinitis — if inflammation primarily involves the retina.
    • Chorioretinitis — if the choroid and retina are inflamed.
    • Retinochoroiditis — if inflammation starts in the retina and secondarily involves the choroid.
    • Neuroretinitis — if inflammation affects the optic nerve and retina.
  • Panuveitis affects all parts of the eye (anterior, intermediate, and posterior).
• The Standardisation of Uveitis Nomenclature (SUN) working group also classifies uveitis by [Jabs, 2005]:
  • Onset — sudden or insidious.
  • Duration — limited (3 months or less) or persistent (over 3 months).
  • Course — acute (sudden onset of inflammation which resolves within 3 months), recurrent (repeated episodes, separated by periods of inactivity without treatment for 3 months or more), or chronic (persistent uveitis characterized by prompt relapse, within 3 months, after discontinuation of treatment).

[Jun, 2021; BMJ, 2023; The College of Optometrists, 2023]

What are the causes and risk factors?

• Uveitis may be idiopathic (more than 50% of cases) or caused by:
  • Systemic autoimmune disorders, such as:
    • HLA (Human Leukocyte Antigen)-B27- associated disorders, including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and inflammatory bowel disease (Crohn’s disease and ulcerative colitis). 
    • Behçet's disease. 
    • Sarcoidosis. 
    • Multiple sclerosis.
    • Vogt-Koyanagi-Harada syndrome.
  • Infectious causes, such as:
    • Viral — herpes simplex, varicella-zoster (shingles), cytomegalovirus, and HIV.
    • Bacterial — tuberculosis, syphilis, and Lyme disease
    • Parasitic — toxoplasmosis (most common cause of posterior uveitis)
    • Fungal — histoplasmosis and candidiasis.
  • Other causes, such as:
    
    • Use of certain medications, such as rifabutin and bisphosphonates.
    • Eye trauma or surgery (can trigger inflammatory responses).
    • Neoplasia (rare). 
• Risk factors for uveitis include:
  • Previous episode of uveitis.
  • Personal or family history of autoimmune disorders.
  • Use of certain medications, such as immunotherapy drugs.
  • Smoking [AAO, 2025].
  • Age over 20 years — around 90% of cases of anterior uveitis, with a mean onset of 40 years [Islam, 2015]. 
  • HLA-B27 positivity — about 50% of people with acute anterior uveitis are HLA-B27-positive (compared with 8% of the general population). However, the lifetime risk of developing acute anterior uveitis in people who are HLA-B27-positive is only 1% [The College of Optometrists, 2023]. 

[Yanoff and Duker, 2013; Jun, 2021; Hwang, 2022; BMJ, 2023; The College of Optometrists, 2023]

How common is it?

• Uveitis is relatively uncommon. 
  • In developed countries, the incidence ranges from approximately 17–52 cases per 100,000 per year, while the prevalence ranges from 38–714 cases per 100,000 [BMJ, 2023].
  • Anterior uveitis is the most common type, accounting for 75% of all uveitis cases, with an annual incidence of 15–52 per 100,000 population [The College of Optometrists, 2023]. 
  • Posterior uveitis is less common (15–30% of cases), followed by intermediate uveitis (around 15%) [Miserocchi, 2013; Bro, 2020].
  • Idiopathic anterior uveitis is the most common form of anterior uveitis (38–88% of cases) [Regenold, 2021].
  • Infectious uveitis is common in developing countries, whereas non-infectious uveitis is more common in developed countries.
• Uveitis can occur at any age, but it is most common in people aged 20–50 years [Tsirouki, 2018; BMJ, 2023; The College of Optometrists, 2023]. 
  • The peak age of presentation is between 30–40 years.
  • Primary uveitis is rare in older adults, possibly due to age-related immune decline.

What are the complications of uveitis?

• Complications of uveitis include:
  • Visual impairment — uveitis accounts for approximately 5–10% of visual impairment worldwide, and up to 35% of all people with uveitis suffer from between significant visual loss to legal blindness. 
  • Permanent vision loss — uveitis is implicated in up to 25% of cases of legal blindness in the developing world. The major causes of vision loss in people with uveitis are cystoid macular oedema, secondary cataracts, and secondary glaucoma.
• Other possible complications include: 
  • Band keratopathy (calcium deposits in the cornea). 
  • Cataract (secondary to the disease process or corticosteroid treatment). 
  • Glaucoma (secondary to the disease process or corticosteroid treatment). 
  • Cystoid macular oedema (the most common cause of visual impairment in people with uveitis). 
  • Posterior synechiae (adhesions between the posterior iris and the anterior lens surface). 
  • Hypotony (low intraocular pressure). 
  • Macular cyst/hole, macular puckering or macular ischaemia. 
  • Retinal detachment (exudative and tractional) or retinal scars.
  • Choroidal and retinal neovascularization. 
  • Optic neuropathy or optic atrophy. 
  • Vitreous opacities and vitreous haemorrhage.
  • Phthisis (shrinkage of the globe). 
• Paediatric uveitis is associated with a tendency for chronicity, high complication rates, and severe visual impairment. About one-third of children with uveitis suffer severe visual loss.

[Guly, 2010; Tomkins-Netzer, 2014; Dick, 2016; Constantin, 2018; Tsirouki, 2018; BMJ, 2023]

What is the prognosis?

• The prognosis of uveitis depends on factors such as the age of the person, the location, cause, course (acute, recurrent, or chronic; the severity of uveitis; and the speed of treatment.
  
  • Uveitis usually resolves rapidly with treatment; however, many people may develop chronic uveitis.
  • Acute anterior uveitis has the best visual outcome, whereas chronic inflammation is a major cause of visual disability, ocular complications, and potential blindness. 
  • Non-infectious intermediate, posterior, and panuveitis have a poorer prognosis with greater morbidity and a higher prevalence of irreversible sight-threatening pathologic features. The excess morbidity results from the often underlying autoimmune disorders as well as the systemic treatment required.
  • Bilateral uveitis is associated with chronic, systemic conditions, whereas unilateral conditions tend to be acute and idiopathic, or infectious.  
  • Paediatric uveitis is associated with a tendency for chronicity, high complication rates, and severe visual impairment. About one-third of children with uveitis suffer severe visual loss. 
  • Late detection, delayed treatment, poor inflammation control, and recurrent attacks increase the risk of complications.

[Gupta, 2006; Gutteridge, 2007; Yanoff and Duker, 2013; Dick, 2016; Harthan, 2016; Tsirouki, 2018; BMJ, 2023]

How should I assess a person with suspected uveitis?

• Take a history.
  • Ask about the presenting symptoms, including the severity, onset, duration, course, and laterality (unilateral or bilateral).
    
    • Acute anterior uveitis presents with pain (dull/ache) exacerbated on induced pupillary constriction (direct, near or consensual), redness, photophobia, blurred vision, and epiphora (watery eyes).
    • Chronic anterior uveitis presents with blurred vision and mild redness. Pain and photophobia may occur, but they are usually mild.
    • Intermediate and posterior uveitis present with blurred vision and floaters. Pain is absent, and redness is not prominent.  
    • Panuveitis may cause any combination of the above symptoms.
    • Uveitis may be unilateral or bilateral. Unilateral uveitis is more commonly acute and can be infectious; bilateral uveitis is usually due to a chronic, systemic condition.
  • Ask about:
    • Causes and risk factors for uveitis, such as autoimmune disease and previous history of uveitis. 
    • Use of contact lenses (and hygiene routine) — keratitis is associated with inappropriate contact lens use and care. 
• Examine the person. If perforation of the globe is suspected (for example, in ocular trauma or as a complication of scleritis), do not palpate the eye — arrange for urgent ophthalmology assessment.
  • Look for evidence of facial trauma.
  • Perform a general eye examination.
    • Examine the eyelids and surrounding area.
    • Check for any discharge from the eye(s).
    • Examine the conjunctiva, including the tarsal surface. If a foreign body is possible, invert the upper lid to check for a sub-tarsal foreign body. Check the pattern of redness (if present). 
    • Perform fluorescein examination — a stained cornea indicates a corneal abrasion or ulcer.
    • Check visual acuity (using a Snellen chart).
    • Check extraocular movement.
    • Check pupil reactions (using a pen torch or equivalent) and for photophobia.
    • Observe pupil size and shape, and check direct and consensual pupillary reflexes.
    • Check intraocular pressure (depending on local resources).
  • In uveitis:
    • Lids, lashes, and lacrimal ducts are normal.
    • Conjunctival examination reveals 360° perilimbal injection, which increases near the limbus (in anterior uveitis).
    • Visual acuity may be decreased in the affected eye.
    • Extraocular movements are normal.
    • Pupillary miosis is common.
    • There is direct and consensual photophobia (in anterior uveitis).
    • Intraocular pressure may be normal or slightly decreased in the acute phase; however, pressure may become elevated as the inflammation subsides.
    • Opacities of the lens (cataracts) may be present but are not specific for uveitis.
  • Look for signs of systemic, immune-mediated diseases, such as chronic back pain, enthesitis, joint swelling, or arthritis.
• The diagnosis of uveitis must be confirmed by slit-lamp examination of the anterior segment and a dilated fundus examination. 

What else might it be?

• Differential diagnoses of uveitis include:
  • Other serious sight-threatening conditions, such as:
    • Acute glaucoma. For more information, see the CKS topic on Glaucoma.
    • Endophthalmitis.
    • Keratitis — inflammation of the cornea, causing pain, redness, blurred vision, and photophobia.
    • Scleritis — inflammation of the sclera, causing severe pain that is worse with eye movement, often associated with headache.
    • Ocular trauma — for example, penetrating eye injury, embedded foreign body, or acid or alkali burns to the eye.
    • Ocular ischaemia syndrome — results from reduced blood flow to the eye and is often linked to poorly controlled diabetes, severe cardiovascular disease, and/or symptoms of transient ischaemic attack or stroke. 
  • Non-sight-threatening causes, such as:
    • Dry eye syndrome. For more information, see the CKS topic on Dry eye syndrome. 
    • Episcleritis — benign, self-limiting inflammation of the episclera, causing redness and mild discomfort without significant pain or vision loss.
    • Infective conjunctivitis. For more information, see the CKS topic on Conjunctivitis - infective. 
    • Irritant conjunctivitis — associated with an identifiable mechanical or irritant cause, such as a displaced contact lens, a foreign body or eyelashes rubbing against the eye's surface, or a chemical splashing into the eye.
    • Allergic conjunctivitis. For more information, see the CKS topic on Conjunctivitis - allergic. 
    • Superficial corneal injury. For more information, see the CKS topic on Corneal superficial injury. 
    • Photokeratitis — occurs after exposure to ultraviolet light, for example, from the sun, welding arcs, or tanning lamps. There is usually a delay of 6–12 hours between exposure and onset of symptoms, but symptom onset can occur after 1 hour.
    • Subconjunctival haemorrhage. For more information, see the CKS topic on Red eye. 
  • Rare neoplastic syndromes that mimic intraocular inflammation (masquerade syndromes), such as:
    • Lymphoma. 
    • Leukaemia.
    • Ocular melanoma.
    • Metastases.

Scenario: Management

From birth onwards.

Search strategy

Scope of search

A literature search was conducted for guidelines and systematic reviews on the primary care management of uveitis.

Search dates

October 2019 - February 2025

Key search terms

The terms listed below are the core search terms that were used for EBSCOhost MEDLINE (searched 21st October 2019). These were combined with filters to identify guidelines, systematic reviews and primary care relevant literature in EBSCOhost MEDLINE. The strategy was adapted for The Cochrane Library databases. 

S9    S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 
S8    AB papillitis OR TI papillitis 
S7    AB choroiditis OR TI choroiditis 
S6    AB cyclitis OR TI cyclitis 
S5    AB iridocyclitis OR TI iridocyclitis 
S4    TI iritis OR AB iritis 
S3    AB panuveitis OR TI panuveitis 
S2    AB ( uveitis or uveitides ) OR TI ( uveitis or uveitides ) 
S1    (MH "Uveitis+") 

Sources of guidelines

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Royal College of Physicians
• Royal College of General Practitioners
• Royal College of Nursing
• NICE Evidence
• World Health Organization
• Guidelines International Network
• TRIP database
• Agency for Healthcare Research and Quality
• Institute for Clinical Systems Improvement
• National Health and Medical Research Council (Australia)
• Royal Australian College of General Practitioners
• British Columbia Medical Association
• Canadian Medical Association
• Alberta Medical Association
• Michigan Quality Improvement Consortium
• Singapore Ministry of Health
• National Resource for Infection Control
• RefHELP NHS Lothian Referral Guidelines
• Medline (with guideline filter)
• Driver and Vehicle Licensing Agency
• NHS Health at Work (occupational health practice)

Sources of systematic reviews and meta-analyses

• The Cochrane Library:
  • Systematic reviews
  • Protocols
  • Database of Abstracts of Reviews of Effects
• Medline (with systematic review filter)
• EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

• NIHR Health Technology Assessment programme
• The Cochrane Library:
  • NHS Economic Evaluations
  • Health Technology Assessments
• Canadian Agency for Drugs and Technologies in Health
• International Network of Agencies for Health Technology Assessment

Sources of randomized controlled trials

• The Cochrane Library:
  • Central Register of Controlled Trials
• Medline (with randomized controlled trial filter)
• EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

• Bandolier
• Drug and Therapeutics Bulletin
• TRIP database
• Central Services Agency COMPASS Therapeutic Notes

Sources of national policy

• Department of Health
• Health Management Information Consortium (HMIC)

Patient experiences

• Healthtalk
• BMJ - Patient Journeys

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

• British National Formulary (BNF)
• electronic Medicines Compendium (eMC)
• European Medicines Agency (EMEA)
• LactMed
• Medicines and Healthcare products Regulatory Agency (MHRA)
• REPROTOX
• Scottish Medicines Consortium
• Stockley's Drug Interactions
• TERIS
• TOXBASE
• Micromedex
• UK Medicines Information

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

• Clinical accuracy.
• Consistency with other providers of clinical knowledge for primary care.
• Accuracy of implementation of national guidance (in particular NICE guidelines).
• Usability.

Principles of the consultation process

• The process is inclusive and any individual may participate.
• To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
• Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
• Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
• External reviewers are not paid for commenting on the draft topics.
• Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
• All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
• All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

• Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
• Stakeholders identified from the following groups are invited to review draft topics:
  • Experts in the topic area.
  • Professional organizations and societies (for example, Royal Colleges).
  • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
  • Guideline development groups where the topic is an implementation of a guideline.
  • The British National Formulary team.
  • The editorial team that develop MeReC Publications.
• Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

• Topic selection
• Scoping of topic
• Selection of clinical scenarios
• First draft internal review
• Second draft internal review
• External review
• Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

• Animal studies
• Original research is not written in English

Possible exclusions for reviewed literature:

• Sample size too small or study underpowered
• Bias evident or promotional literature
• Population not relevant
• Intervention/treatment not relevant
• Outcomes not relevant
• Outcomes have no clear evidence of clinical effectiveness
• Setting not relevant
• Not relevant to UK
• Incorrect study type
• Review article
• Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

• Feasibility
  • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
• Organizational and Financial Impact Analysis
• Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
  • Eligible population
  • Current interventions
  • Likely uptake of new intervention or recommendation
  • Cost of the current or new intervention mix
  • Impact on other costs
  • Condition-related costs
  • In-direct costs and service impacts
  • Time dependencies
• Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

• Personal financial interests
• Personal family interest
• Personal non-financial interest
• Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.