Uveitis

What is Uveitis?

Uveitis is inflammation of the uvea, the middle layer of the eye made up of the iris, the ciliary body and the choroid.^{[1, 2]} It is named by location: anterior (front), intermediate, posterior (back) or panuveitis (all layers).^[1] Untreated uveitis can cause cataract, glaucoma, swelling of the retina, retinal detachment and vision loss.^[2]

Common symptoms

The usual symptoms are eye redness, pain, light sensitivity (photophobia), floaters and blurred vision.^[2] Anterior uveitis tends to cause a red, painful eye, while posterior forms may cause floaters and vision loss with little pain.^{[1, 2]}

Causes and risk factors

Uveitis is classed as non-infectious or infectious. Infections such as toxoplasmosis, herpes, tuberculosis and HIV account for a minority of cases in high-income countries.^[2] In the US and Europe, roughly a quarter to half of cases have no identified cause, and a similar share are linked to a systemic disease such as axial spondyloarthritis. Genetic factors such as HLA-B27 also play a role.^[2] It most often affects adults aged 20 to 50.^[2]

How it is diagnosed and treated conventionally

An ophthalmologist diagnoses uveitis from history, an eye examination and imaging, with blood tests when needed to look for infection or a linked disease.^{[2, 3]}

Treatment depends on the type and cause. For non-infectious anterior uveitis, corticosteroid eye drops are first-line.^[2] Moderate to severe intermediate, posterior and panuveitis carry a high risk of sight-threatening complications and need systemic or injected corticosteroids and immune-suppressing drugs.^[2] Biologic drugs such as adalimumab are used when inflammation does not respond.^{[2, 4]} Infectious uveitis needs antimicrobial medicine.^[2] The goal is to control inflammation while limiting steroid side effects, and a rheumatologist or internist often helps when a systemic disease is involved.^{[2, 3]}

Why Uveitis calls for a whole-person approach

Uveitis is an eye disease, but it often reflects inflammation elsewhere in the body, and its treatment can last a long time. Many cases are linked to a systemic illness, which is why eye and other specialists often work together.^{[2, 3]}

Medical treatment comes first and cannot be replaced. The factors below are areas where supportive care may add comfort.

Linked systemic disease

Between 37% and 49% of cases in the US and Europe are associated with a systemic disease, and that disease should be treated by the right specialist.^[2]

Treatment burden

Chronic non-infectious uveitis can need repeated injections, and systemic immunosuppressive therapy has its own adverse effects through inhibition of immune function.^[4] A main goal of care is to minimize corticosteroid use because of its side effects.^[2]

Recurrence and long follow-up

Chronic or recurrent disease needs long-term monitoring. A Cochrane review found only small trials comparing steroid-sparing drugs, with little data to show which is best.^[5]

Stress and sleep

Worry about vision and ongoing treatment can disturb sleep and mood. Sleep and stress have been studied on their own, as described below.

Acupuncture as supportive care in Uveitis

What the research shows

No clinical trials of acupuncture for uveitis were found in PubMed, so there is no evidence that acupuncture affects eye inflammation or protects vision. Acupuncture should never be used in place of, or to delay, treatment from an eye specialist.

For symptoms that overlap with the experience of living with uveitis, research in other groups exists. A review of 24 trials of acupuncture for insomnia found that in 15 trials comparing it with drug treatment, sleep scores were better after about three weeks, with large differences between trials.^[6] A 2024 review reported better sleep, less fatigue and fewer emotional symptoms, while noting weaknesses in study methods.^[7] These studies did not include people with uveitis.

How acupuncture may work

For sleep, researchers propose effects on brain chemicals, inflammatory signals and the stress hormone axis, mostly from animal studies.^[7] These are proposed explanations. No study has shown that acupuncture changes inflammation inside the eye.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the arms, legs, back and head, usually left in place for about 20 to 40 minutes. A short course of visits is followed by reassessment. Tell the practitioner about your eye condition and treatment so points can be chosen with care.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[8] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Because immune-suppressing drugs raise infection risk, tell us about any recent infection.

Ayurvedic medicine as supportive care in Uveitis

The Ayurvedic view

Ayurveda does not describe uveitis by that name. Painful, red, light-sensitive eyes are traditionally linked to aggravated Pitta, and classical eye disease texts describe inflammatory conditions of the eye under categories such as Abhishyanda. These are traditional categories for choosing care, not biomedical diagnoses.

Therapies that may be used

Ayurvedic support is individualized and may include:

• Cooling, regular meals and steady sleep hours intended to ease stress and fatigue
• Relaxation practices such as breathing exercises and gentle yoga
• Herbs such as turmeric (curcumin) chosen individually, only after review of your medicines and your eye specialist's plan

Do not put oils, drops, washes or herbal preparations in or near the eyes on your own. Panchakarma, the traditional cleansing program, is not appropriate during acute illness, frailty or pregnancy, and needs particular caution for people with active uveitis or those taking high-dose steroids or other immunosuppressants. Any such therapy should be discussed with your eye specialist first.

What the research shows

The evidence for Ayurvedic medicine in uveitis is very limited. No clinical trials of Ayurvedic treatment for uveitis were found.

The nearest research is on curcumin, the active compound of turmeric. A retrospective study of 27 children with juvenile idiopathic arthritis-associated uveitis and mild lingering inflammation in the front of the eye, who took a curcumin-phosphatidylcholine complex alongside immunosuppressive treatment, reported that 22 reached inactive inflammation after a year. There was no control group, so the study cannot show that curcumin caused the change, and it was in children with a specific type of uveitis.^[9] A review describes anti-inflammatory effects of curcumin and notes its poor absorption in the body.^[10]

Ashwagandha has trial evidence for stress and sleep in other adults. A meta-analysis of 12 trials found lower anxiety and stress scores than with placebo, though with low certainty and large differences between trials.^[11] A meta-analysis of 5 trials found a small improvement in sleep, with limited long-term safety data.^[12] Its effect in uveitis or on immunosuppressive drugs has not been established.

Herbal medicine as supportive care in Uveitis

Herbs and formulas that have been studied

Research on herbs for uveitis is mostly laboratory-based. A review of natural product ingredients studied for uveitis described effects on cytokines and T helper cells, from experimental work and not clinical trials.^[13] Curcumin is the best-known example.^[10] Chinese medicine traditionally treats eye inflammation with heat-clearing and liver-calming formulas, but these have not been tested in clinical trials for uveitis in the studies we found.

What the research shows

For uveitis itself the evidence is very limited. The natural product review draws on experimental findings, and its authors call these compounds promising, which is not the same as showing benefit in patients.^[13] The only human data found for a herb are the small uncontrolled curcumin study above.^[9]

A survey of 89 patients at an inflammatory eye disease clinic found that 42% used complementary medicine for their eyes, most often vitamins, herbs, prayer and acupuncture. Its authors warned that such therapies may influence the disease, cause side effects and interact with immunosuppressive drugs, and urged doctors to ask about them.^[14]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines, including the immune-suppressing drugs used for uveitis. A literature review found that St John's wort lowered blood levels of ciclosporin and tacrolimus, with many of the reported herb-drug interactions coming from case reports.^[15] Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[16]

Herbal and dietary supplements account for about 20% of cases of liver toxicity in the United States, which matters if you take drugs such as methotrexate or azathioprine.^[17] About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[18] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding or have liver or kidney disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine might describe the red, painful, light-sensitive eye as liver fire or heat, and Ayurveda as Pitta imbalance. Researchers describe the same picture as immune-mediated inflammation of the uvea, often linked to a systemic disease or infection.^{[2, 4]}

Laboratory work on natural compounds looks at cytokine signaling and T-cell behavior, which loosely parallel the idea of "heat" in the eye.^[13] This is a hypothesis from cell and animal studies, not evidence that a traditional pattern corresponds to a biological process in patients.

How this care fits with your medical care

Complementary care is a supplement to your ophthalmologist's and other physicians' treatment, never a substitute. Do not stop or change eye drops, steroids, immunosuppressants or biologics without your prescriber, and keep every eye examination. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

We do not diagnose or monitor eye disease. Please bring your diagnosis and type of uveitis, your eye specialist's contact details, a full list of medicines, eye drops and supplements, and any report of a linked systemic condition.

When to seek urgent medical care

Uveitis can threaten vision, and new symptoms should be assessed quickly by an eye specialist.^[2]

• Sudden loss of vision or a new dark area in your vision
• A new red, painful eye, especially with light sensitivity or blurred vision
• A sudden shower of floaters or flashes of light
• Severe eye pain, nausea or vomiting with vision changes
• Fever or other signs of infection while taking immune-suppressing medicine

If any of these occur, call 911 or go to the nearest emergency department.