Uveitis medical therapy
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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]
Medical therapy
Uveitis is typically treated with glucocorticoid steroids, 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.