First Calm the Eye, Then Clear the Vision Understanding Uveitis Cataract, A Guide for Patients and Doctors By Dr. Sonal Hinge

Many patients walk into my clinic saying:
“Doctor, my uveitis is under control… but now my vision is becoming cloudy.”
This moment often brings anxiety for patients and careful decision-making for doctors.
The reason is usually uveitis cataract — a condition that looks like a simple cataract from outside, but behaves very differently on the inside.
This blog is written to bridge the gap between patient understanding and medical clarity.
What Is Uveitis, in Simple Terms?
Uveitis means inflammation inside the eye.
Inflammation is the body’s natural defense, but when it happens repeatedly inside the eye, it can quietly damage delicate structures.
Uveitis can affect:
The front part of the eye
The middle jelly
The retina at the back
Or sometimes the entire eye
In many patients, uveitis comes and goes. Even when symptoms improve, its long-term effects can remain.
What Is a Uveitis Cataract?
A cataract is clouding of the eye’s natural lens, leading to blurred vision and glare.
In uveitis, cataract can:
Develop earlier than normal age-related cataract
Progress faster
Cause vision problems even when cataract looks “mild”
This is because the lens is affected by chronic inflammation and its treatment.
Why Does Cataract Develop in Uveitis?
There are two main reasons:

1. Recurrent Inflammation Inflammatory cells and chemicals inside the eye slowly damage the lens fibers, most commonly causing posterior subcapsular cataract, which affects vision early.
2. Steroid Treatment (Which Is Necessary) Steroids are essential to control uveitis and protect vision. However, long-term steroid use can speed up cataract formation. It’s important for patients to understand: Cataract is not caused by “wrong treatment.” It develops despite correct treatment — because controlling inflammation is more important than avoiding cataract. Symptoms Patients Commonly Notice Gradual blurring of vision Glare or halos around lights Difficulty reading or using mobile phones Vision that worsens during inflammation flare-ups Unlike routine cataract, vision in uveitis cataract can fluctuate, which often worries patients. Why Is Uveitis Cataract Considered Special or High-Risk? Because inflammation changes the eye’s internal environment: The pupil may not open fully The iris may stick to the lens The eye may react strongly after surgery The risk of retinal swelling is higher This is why uveitis cataract surgery is never “routine”, even if the cataract looks small. Why Doctors Often Wait Before Surgery A very common question I hear is: “Doctor, cataract is there — why not operate now?” The answer is simple but critical: The eye must be calm before surgery. Ideally, uveitis should be inactive for at least 3 months before cataract surgery. Operating on an inflamed eye can lead to: Severe post-operative inflammation Raised eye pressure Retinal complications Poor visual outcome Waiting is not delay — it is protection. What Is Checked Before Surgery Before planning surgery, doctors carefully evaluate: Type and severity of uveitis Duration of inflammation control Retina and macula health Eye pressure Any associated systemic disease Sometimes coordination with a physician or rheumatologist is required for overall disease control. How Is Surgery Different from Normal Cataract Surgery ? In uveitis cataract: Surgery is done gently and patiently Extra steps may be needed to manage the pupil Strong anti-inflammatory cover is essential Follow-ups are more frequent Success depends not just on surgery, but on pre- and post-operative care. After Surgery: What Patients Must Remember Eye drops are extremely important Follow-up visits should not be skipped Any pain, redness, or sudden vision drop should be reported immediately Early treatment of inflammation saves vision. Can Vision Become Normal Again? Yes, very good vision is possible if: Uveitis is well controlled The retina is healthy Surgery is timed correctly Post-operative care is followed strictly Vision may be limited only if there is permanent retinal or optic nerve damage. A Message for Patients Your doctor waits before cataract surgery not because the problem is small,