UVEA

 

Introduction

The UVEA is the middle layer of the wall of the eye. It consists of the iris, ciliary body and choroid.

This guideline summarises the most common conditions affecting the UVEA that may require referral from Primary Care.

 

Red Flags

• Sudden onset reduced visual acuity
   
• Photophobia
   
• Patient describing ‘grey veil’, ‘shadow’ or ‘dark curtain’ in their vision
   
• Papilloedema or other features of raised intracranial pressure
   
• Irregular, dilated or non-reactive pupil
   
• Double vision
   
• Abnormal neurological assessment
   
• Trauma including penetrating injury
   
• Systemically unwell patient
   
• Severe eye pain
   
• Headache with concerning features (see linked page)
   
• Vomiting

This list is not exhaustive

 

Episcleritis

Relatively common, benign and self-limiting.

Acute onset of redness with associated discomfort, often described as a grittiness or an ache.

Visual acuity is not usually affected.

Primary Care Management

• NSAID drops e.g. ketorolac trometamo tds 1-2 weeks
• Review after one week to ensure resolving.

 

Referral Instructions

• Any red flag symptoms, worsening symptoms, or no improvement after 1-2 weeks refer urgently to Eye Casualty

 

Scleritis

Inflammation involving the sclera. It is a severe ocular inflammation, often with ocular complications, which nearly always requires systemic treatment^1,2.

 

Scleritis can present with:

• Painful, red eye. Often described as severe
   
• Commonly associated with other ocular symptoms such as watering and photophobia
   
• Visual acuity may be reduced or normal
   
• Often appears in association with other inflammatory diseases.

 

Referral Instructions

• Urgent referral to Eye Casualty

 

Uveitis

One of the leading causes of preventable severe visual loss in developed countries³.

Clinical features vary depending on the location of the inflammation. Symptoms may develop over hours or days (acute uveitis), or onset may be gradual (chronic uveitis).

Common Symptoms⁴:

 

Acute anterior uveitis

• Usually unilateral.
   
• Pain, redness and photophobia are typical.
   
• Eye pain is often worse when trying to read.
   
• Progressive - occurs over a few hours/days.
   
• Blurred vision.
   
• There may be excess tear production.
   
• Associated headache is common.
   
• Not all symptoms may be present at the start of an attack

 

Chronic anterior uveitis

• Recurrent episodes, with less acute symptoms.
   
• Blurred vision and mild redness are common, often with little pain or photophobia, except during an acute episode.
   
• Patients may find that one symptom predominates (typically this is blurred vision). They tend to become good at spotting this early

The above list of symptoms is not exhaustive.

 

Referral Instructions:

Urgent referral to Eye Casualty

 

Advice and Guidance

Please send advice and guidance requests to Ophthalmology via eRS

 

Useful resources

Professionals

• Scleritis and Episcleritis. About Scleritis and Episcleritis
• Uveitis | Resource for Healthcare Professionals

 

Patients

• Episcleritis_-_Scleritis_050-21.pdf

 

References

• Episcleritis and scleritis: clinical features and treatment results - PubMed
• Clinical features of patients with episcleritis and scleritis in an Italian tertiary care referral center - PubMed
• Current approach in diagnosis and management of anterior uveitis - PMC
• Algorithmic approach in the diagnosis of uveitis - PMC

 

Page review information

Date Reviewed:       02 March 2026

Next review due:     02 March 2028

Sifter name:            Dr Kate Northridge

Contributors:           Mr Ashish Patwardhan, Consultant Ophthalmologist RCHT