Uveitis medical therapy: Difference between revisions
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{{Uveitis}} | {{Uveitis}} | ||
{{CMG}} {{AE}} {{Faizan}} | {{CMG}} {{AE}} {{Faizan}} | ||
==Overview== | |||
The mainstay of therapy for uveitis is steroids, either as topical eye drops or oral therapy with [[Prednisolone]]. [[Acyclovir]] is the drug of choice for empiric therapy in anterior uveitis. The treatment for intermediate and posterior uveitis generally depends on the underlying disease.<ref name=uveitisbook>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages = }}</ref> | |||
== Medical therapy == | == Medical therapy == | ||
Uveitis is typically treated with [[glucocorticoid | Uveitis is typically treated with [[glucocorticoid]]s, either as topical eye drops (such as [[betamethasone]], [[dexamethasone]] or [[prednisolone]]) or oral therapy with [[Prednisolone]] tablets. In addition topical [[cycloplegic]]s, such as [[atropine]] or [[homatropine]], may be used. If the uveitis is caused by a body-wide infection, treatment may involve [[antibiotics]] and powerful anti-inflammatory medicines [[corticosteroids]]. In some cases an injection of PSTTA can also be given to reduce the swelling of the eye.<ref>[[British National Formulary|BNF]] '''45''' March 2003</ref> | ||
[[Antimetabolite]] medications, such as [[ | [[Antimetabolite]] medications, such as [[Methotrexate]] are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatment with [[Infliximab]] infusions may prove helpful. | ||
More specifically, the treatment regimen differs among the various forms of uveitis: | More specifically, the treatment regimen differs among the various forms of uveitis: | ||
===Anterior Uveitis=== | ===Anterior Uveitis=== | ||
*The mainstay of therapy for anterior uveitis is topical corticosteroid drops combined with cycloplegic drops. | |||
*In the case of infectious anterior uveitis, antimicrobial therapy is recommended.<ref name=uveitisbook>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages = }}</ref> | |||
*In the | |||
====Antimicrobial regimens==== | |||
* '''Infectious uveitis''' | |||
:* '''1. Empiric antimicrobial therapy''' | |||
::* Preferred regimen: [[Acyclovir]] 800 mg PO q5h for 7-10 days | |||
::* Note: Long-term prophylactic [[acyclovir]] 400 mg PO bid may be beneficial in preventing recurrences of herpetic uveitis and development of complications. | |||
:* '''2. Pathogen-directed antimicrobial therapy''' | |||
::* '''2.1 Lyme uveitis''' | |||
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days | |||
===Intermediate and Posterior Uveitis=== | |||
Treatment often depend on the underlying cause of the inflammation. If the cause is infectious, treatment must involve an anti-infective agent. | |||
*Acute retinal necrosis (ARN) due to [[Herpes simplex]] or [[Varicella zoster]] virus: intravenous [[acyclovir]] 10 mg/kg every 8 hours with normal renal function for 1 to 2 weeks followed by [[Valacyclovir]] or [[Famciclovir]] for 6 weeks to several months. In case of ARN due to CMV, IV [[Ganciclovir]] should replace [[Acyclovir]]. | |||
*Progressive outer retinal necrosis: prolonged intravenous antiviral agents, in addition to intravitreal injections with [[Foscarnet]] and [[Ganciclovir]], and the initiation of HAART in HIV-positive patients. | |||
*Acute retinal necrosis (ARN) due to [[Herpes simplex]] or [[ | *Ocular syphilis: intravenous penicillin 4 million U every 4 hours for 10 to 14 days. Corticosteroids are given to decrease intraocular inflammation as a result of [[Jarisch-Herxheimer reaction]] | ||
*Progressive outer retinal necrosis: prolonged intravenous antiviral agents, in addition to intravitreal injections with [[ | |||
*Ocular syphilis: intravenous penicillin 4 million U every 4 hours for 10 to 14 days. | |||
*Ocular TB: treated with the same medications and duration of therapy as TB [[meningitis]] | *Ocular TB: treated with the same medications and duration of therapy as TB [[meningitis]] | ||
*[[Lyme]] uveitis: | *[[Lyme]] uveitis:Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days | ||
If the cause is non-infectious, treatment is administered to reduce inflammation, often through the use of [[corticosteroids]]. | If the cause is non-infectious, treatment is administered to reduce inflammation, often through the use of [[corticosteroids]]. Intermediate uveitis is often treated with [[steroid]] eye drops, whereas posterior uveitis would have to be treated with steroid pills, as eye drops and ointments cannot reach the back of the eye. | ||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Ophthalmology]] | |||
[[Category:FinalQCRequired]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Overview
The mainstay of therapy for uveitis is steroids, either as topical eye drops or oral therapy with Prednisolone. Acyclovir is the drug of choice for empiric therapy in anterior uveitis. The treatment for intermediate and posterior uveitis generally depends on the underlying disease.[1]
Medical therapy
Uveitis is typically treated with glucocorticoids, either as topical eye drops (such as betamethasone, dexamethasone or prednisolone) or oral therapy with Prednisolone tablets. In addition topical cycloplegics, such as atropine or homatropine, may be used. If the uveitis is caused by a body-wide infection, treatment may involve antibiotics and powerful anti-inflammatory medicines corticosteroids. In some cases an injection of PSTTA can also be given to reduce the swelling of the eye.[2]
Antimetabolite medications, such as Methotrexate are often used for recalcitrant or more aggressive cases of uveitis. Experimental treatment with Infliximab infusions may prove helpful.
More specifically, the treatment regimen differs among the various forms of uveitis:
Anterior Uveitis
- The mainstay of therapy for anterior uveitis is topical corticosteroid drops combined with cycloplegic drops.
- In the case of infectious anterior uveitis, antimicrobial therapy is recommended.[1]
Antimicrobial regimens
- Infectious uveitis
- 1. Empiric antimicrobial therapy
- 2. Pathogen-directed antimicrobial therapy
- 2.1 Lyme uveitis
- Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days
Intermediate and Posterior Uveitis
Treatment often depend on the underlying cause of the inflammation. If the cause is infectious, treatment must involve an anti-infective agent.
- Acute retinal necrosis (ARN) due to Herpes simplex or Varicella zoster virus: intravenous acyclovir 10 mg/kg every 8 hours with normal renal function for 1 to 2 weeks followed by Valacyclovir or Famciclovir for 6 weeks to several months. In case of ARN due to CMV, IV Ganciclovir should replace Acyclovir.
- Progressive outer retinal necrosis: prolonged intravenous antiviral agents, in addition to intravitreal injections with Foscarnet and Ganciclovir, and the initiation of HAART in HIV-positive patients.
- Ocular syphilis: intravenous penicillin 4 million U every 4 hours for 10 to 14 days. Corticosteroids are given to decrease intraocular inflammation as a result of Jarisch-Herxheimer reaction
- Ocular TB: treated with the same medications and duration of therapy as TB meningitis
- Lyme uveitis:Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days
If the cause is non-infectious, treatment is administered to reduce inflammation, often through the use of corticosteroids. Intermediate uveitis is often treated with steroid eye drops, whereas posterior uveitis would have to be treated with steroid pills, as eye drops and ointments cannot reach the back of the eye.