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 are [[Glucocorticoids]], 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 depends on the underlying disease. | |||
== 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: | ||
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*Additionally, if the uveitis causes an increase in [[eye pressure]], the doctor may lower the pressure to avoid damage to the [[optic nerve]] by prescribing eye drops | *Additionally, if the uveitis causes an increase in [[eye pressure]], the doctor may lower the pressure to avoid damage to the [[optic nerve]] by prescribing eye drops | ||
In case of herpetic anterior uveitis, topical corticosteroids is used along with oral [[ | In case of herpetic anterior uveitis, topical corticosteroids is used along with oral [[Acyclovir]] 400 mg twice daily to prevent recurrence.<ref>{{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> | ||
Empiric antimicrobial therapy''' | Empiric antimicrobial therapy''' | ||
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===Intermediate and Posterior Uveitis=== | ===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. Additional specialists in infectious disease or autoimmunity may be needed for such diseases as [[syphilis]], [[tuberculosis]], [[AIDS]], [[sarcoidosis]], or [[Behcet's syndrome]].<ref>{{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> | Treatment often depend on the underlying cause of the inflammation. If the cause is infectious, treatment must involve an anti-infective agent. Additional specialists in infectious disease or autoimmunity may be needed for such diseases as [[syphilis]], [[tuberculosis]], [[AIDS]], [[sarcoidosis]], or [[Behcet's syndrome]].<ref>{{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> | ||
*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 [[ | *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 [[ | *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 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]] | *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 | *[[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 [[ | 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 == | ||
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[[Category:Inflammations]] | [[Category:Inflammations]] | ||
[[Category:Primary care]] | [[Category:Primary care]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 19:25, 13 August 2015
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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 are Glucocorticoids, 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 depends on the underlying disease.
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.[1]
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
It is usually mild. Treatment may involve:
- Dark glasses
- Eye drops that dilate the pupil to relieve pain, and steroid eye drops or ointment
- In the event that uveitis is unresponsive to drops and ointments, steroids may be injected next to the eye and rarely, steroid pills may be prescribed
- Additionally, if the uveitis causes an increase in eye pressure, the doctor may lower the pressure to avoid damage to the optic nerve by prescribing eye drops
In case of herpetic anterior uveitis, topical corticosteroids is used along with oral Acyclovir 400 mg twice daily to prevent recurrence.[2]
Empiric antimicrobial therapy
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. Additional specialists in infectious disease or autoimmunity may be needed for such diseases as syphilis, tuberculosis, AIDS, sarcoidosis, or Behcet's syndrome.[3]
- 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.
References
- ↑ BNF 45 March 2003
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.