Uveitis, Anterior, Childhood Medication

  • Author: R Christopher Walton, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 2, 2012
 

Medication Summary

The primary medications used in treating anterior uveitis in children are corticosteroids, topical cycloplegics, and, in certain cases of JIA-associated uveitis, methotrexate.[23, 24]

Next

Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

View full drug information

Prednisone (Deltasone)

 

Inhibits phospholipase A and Fc receptor expression, reduces cytokine production, suppresses lymphocyte function, and redistributes circulating leukocytes.

View full drug information

Prednisolone acetate suspension 1% (AK-Pred, Pred Forte)

 

Potent topical corticosteroid used to treat anterior segment inflammation. Initial dosage is determined by the degree of inflammation.

Previous
Next

Cycloplegics

Class Summary

Instillation of a long-acting cycloplegic agent can relax ciliary muscle spasm that can cause a deep aching pain and photophobia.

View full drug information

Homatropine (Isopto Homatropine)

 

Useful in treating pain from ciliary spasm and decreasing formation of synechiae.

Previous
Next

Antimetabolites

Class Summary

Decrease inflammation; corticosteroid-sparing effect.

View full drug information

Methotrexate (Folex, Rheumatrex)

 

Useful in patients with JIA-associated uveitis, where it may reduce inflammation in patients who do not adequately respond to corticosteroid treatment.

Previous
Next

Antineoplastic Agent, Miscellaneous

Class Summary

These agents may be useful as a single agent or in combination with systemic corticosteroids and/or other immunosuppressive agents.

View full drug information

Azathioprine (Azasan, Imuran)

 

Azathioprine is an imidazolyl derivative of 6-mercaptopurine. Many of its biological effects are similar to those of the parent compound. Both compounds are eliminated rapidly from blood and are oxidized or methylated in erythrocytes and the liver. No azathioprine or mercaptopurine is detectable in urine 8 hours after it is taken.

Azathioprine antagonizes purine metabolism and inhibits the synthesis of DNA, RNA, and proteins. The mechanism whereby azathioprine affects autoimmune diseases is unknown. It works primarily on T cells. It suppresses hypersensitivities of the cell-mediated type and causes variable alterations in antibody production. Immunosuppressive, delayed hypersensitivity, and cellular cytotoxicity tests are suppressed to a greater degree than antibody responses. It works very slowly and may require 6-12 months of trial prior to effect. Up to 10% of patients may have an idiosyncratic reaction disallowing use. Do not allow WBC count to drop below 3000/µL or lymphocyte count to drop below 1000/µL.

Azathioprine is available in tablet form for oral administration or in 100-mg vials for intravenous injection.

Previous
Next

Immunomodulators

Class Summary

May be useful for uveitis associated with inflammatory bowel disease.

View full drug information

Adalimumab (Humira)

 

Recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF). Reduce inflammation and inhibit progression of structural damage.

View full drug information

Infliximab (Remicade)

 

Neutralizes cytokine TNF-alpha and inhibits its binding to TNF-alpha receptor. Mix in 250-mL normal saline for infusion over 2 h. Must use with low-protein-binding filter (1.2 µm or less). Several investigational reports have described use in childhood uveitis.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, University of Tennessee College of Medicine

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerhard W Cibis, MD  Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas School of Medicine

Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, Peter H Spiegel, MD, to the development and writing of this article.

References

  1. Holland GN, Denove CS, Yu F. Chronic anterior uveitis in children: clinical characteristics and complications. Am J Ophthalmol. Apr 2009;147(4):667-678.e5. [Medline].

  2. Hooper C, McCluskey P. Intraocular inflammation: its causes and investigations. Curr Allergy Asthma Rep. Jul 2008;8(4):331-8. [Medline].

  3. Zaborowski AG, Parbhoo D, Chinniah K, Visser L. Uveitis in children with human immunodeficiency virus-associated arthritis. J AAPOS. Dec 2008;12(6):608-10. [Medline].

  4. Spratt A, Key T, Vivian AJ. Chronic anterior uveitis following bacille Calmette-Guérin vaccination: molecular mimicry in action?. J Pediatr Ophthalmol Strabismus. Jul-Aug 2008;45(4):252-3. [Medline].

  5. Rothova A, Schneider M, de Groot-Mijnes JD. Human immunodeficiency virus-induced uveitis: intraocular and plasma human immunodeficiency virus-1 RNA loads. Ophthalmology. Nov 2008;115(11):2062-4. [Medline].

  6. BenEzra D, Cohen E, Maftzir G. Uveitis in children and adolescents. Br J Ophthalmol. Apr 2005;89(4):444-8. [Medline].

  7. Zierhut M, Michels H, Stubiger N, Besch D, Deuter C, Heiligenhaus A. Uveitis in children. Int Ophthalmol Clin. 2005;45(2):135-56. [Medline].

  8. Monheit BE, Read RW. Optic disk edema associated with sudden-onset anterior uveitis. Am J Ophthalmol. Oct 2005;140(4):733-5. [Medline].

  9. Ayuso VK, Ten Cate HA, van der Does P, Rothova A, de Boer JH. Male gender and poor visual outcome in uveitis associated with juvenile idiopathic arthritis. Am J Ophthalmol. Jun 2010;149(6):987-93. [Medline].

  10. Wensing B, Relvas LM, Caspers LE, Valentincic NV, Stunf S, de Groot-Mijnes JD. Comparison of rubella virus- and herpes virus-associated anterior uveitis: clinical manifestations and visual prognosis. Ophthalmology. Oct 2011;118(10):1905-10. [Medline].

  11. Levinson RD. Tubulointerstitial nephritis and uveitis syndrome. Int Ophthalmol Clin. Summer 2008;48(3):51-9. [Medline].

  12. Ur Rehman S, Anand S, Reddy A, Backhouse OC, Mohamed M, Mahomed I. Poststreptococcal syndrome uveitis: a descriptive case series and literature review. Ophthalmology. Apr 2006;113(4):701-6. [Medline].

  13. Atmaca L, Boyvat A, Yalçindag FN, Atmaca-Sonmez P, Gurler A. Behçet disease in children. Ocul Immunol Inflamm. Apr 2011;19(2):103-7. [Medline].

  14. Thorne JE, Woreta FA, Dunn JP, Jabs DA. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology. Jul 2010;117(7):1436-41. [Medline].

  15. Kalinina Ayuso V, van de Winkel EL, Rothova A, de Boer JH. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis. Am J Ophthalmol. Feb 2011;151(2):217-22. [Medline].

  16. Goebel JC, Roesel M, Heinz C, Michels H, Ganser G, Heiligenhaus A. Azathioprine as a treatment option for uveitis in patients with juvenile idiopathic arthritis. Br J Ophthalmol. Feb 2011;95(2):209-13. [Medline].

  17. Chang PY, Giuliari GP, Shaikh M, Thakuria P, Makhoul D, Foster CS. Mycophenolate mofetil monotherapy in the management of paediatric uveitis. Eye (Lond). Apr 2011;25(4):427-35. [Medline]. [Full Text].

  18. Saurenmann RK, Levin AV, Rose JB, Parker S, Rabinovitch T, Tyrrell PN, et al. Tumour necrosis factor alpha inhibitors in the treatment of childhood uveitis. Rheumatology (Oxford). Aug 2006;45(8):982-9. [Medline].

  19. Gallagher M, Quinones K, Cervantes-Castañeda RA, Yilmaz T, Foster CS. Biological response modifier therapy for refractory childhood uveitis. Br J Ophthalmol. Oct 2007;91(10):1341-4. [Medline].

  20. Zierhut M, Doycheva D, Biester S, Stübiger N, Kümmerle-Deschner J, Deuter C. Therapy of uveitis in children. Int Ophthalmol Clin. Summer 2008;48(3):131-52. [Medline].

  21. Biester S, Deuter C, Michels H, Haefner R, Kuemmerle-Deschner J, Doycheva D. Adalimumab in the therapy of uveitis in childhood. Br J Ophthalmol. Mar 2007;91(3):319-24. [Medline].

  22. Nemet AY, Raz J, Sachs D, Friling R, Neuman R, Kramer M. Primary intraocular lens implantation in pediatric uveitis: a comparison of 2 populations. Arch Ophthalmol. Mar 2007;125(3):354-60. [Medline].

  23. Rajaraman RT, Kimura Y, Li S, Haines K, Chu DS. Retrospective case review of pediatric patients with uveitis treated with infliximab. Ophthalmology. Feb 2006;113(2):308-14. [Medline].

  24. Saurenmann RK, Levin AV, Rose JB, Parker S, Rabinovitch T, Tyrrell PN, et al. Tumour necrosis factor alpha inhibitors in the treatment of childhood uveitis. Rheumatology (Oxford). Aug 2006;45(8):982-9. [Medline].

  25. Banares A, Hernandez-Garcia C, Fernandez-Gutierrez B, Jover JA. Eye involvement in the spondyloarthropathies. Rheum Dis Clin North Am. Nov 1998;24(4):771-84, ix. [Medline].

  26. de Boer J, Wulffraat N, Rothova A. Visual loss in uveitis of childhood. Br J Ophthalmol. Jul 2003;87(7):879-84. [Medline].

  27. Edmunds L, Elswood J, Calin A. New light on uveitis in ankylosing spondylitis. J Rheumatol. Jan 1991;18(1):50-2. [Medline].

  28. Flynn HW Jr, Davis JL, Culbertson WW. Pars plana lensectomy and vitrectomy for complicated cataracts in juvenile rheumatoid arthritis. Ophthalmology. Aug 1988;95(8):1114-9. [Medline].

  29. Foster CS. Diagnosis and treatment of juvenile idiopathic arthritis-associated uveitis. Curr Opin Ophthalmol. Dec 2003;14(6):395-8. [Medline].

  30. Fox GM, Flynn HW Jr, Davis JL, Culbertson W. Causes of reduced visual acuity on long-term follow-up after cataract extraction in patients with uveitis and juvenile rheumatoid arthritis. Am J Ophthalmol. Dec 15 1992;114(6):708-14. [Medline].

  31. Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology (Oxford). Aug 2011;50(8):1390-4. [Medline].

  32. Hemady RK, Baer JC, Foster CS. Immunosuppressive drugs in the management of progressive, corticosteroid-resistant uveitis associated with juvenile rheumatoid arthritis. Int Ophthalmol Clin. 1992;32(1):241-52. [Medline].

  33. Hofley P, Roarty J, McGinnity G, Griffiths AM, Marcon M, Kraft S, et al. Asymptomatic uveitis in children with chronic inflammatory bowel diseases. J Pediatr Gastroenterol Nutr. Nov 1993;17(4):397-400. [Medline].

  34. Kanski JJ, Shun-Shin GA. Systemic uveitis syndromes in childhood: an analysis of 340 cases. Ophthalmology. Oct 1984;91(10):1247-52. [Medline].

  35. Leirisalo-Repo M. Enteropathic arthritis, Whipple's disease, juvenile spondyloarthropathy, and uveitis. Curr Opin Rheumatol. Jul 1994;6(4):385-90. [Medline].

  36. Petty RE, Smith JR, Rosenbaum JT. Arthritis and uveitis in children. A pediatric rheumatology perspective. Am J Ophthalmol. Jun 2003;135(6):879-84. [Medline].

  37. Rennebohm RM, Burke MJ, Crowe W, Levinson JE. Anterior uveitis in Kawasaki's disease. Am J Ophthalmol. Apr 1981;91(4):535-7. [Medline].

  38. Rosenberg KD, Feuer WJ, Davis JL. Ocular complications of pediatric uveitis. Ophthalmology. Dec 2004;111(12):2299-306. [Medline].

  39. Shore A, Ansell BM. Juvenile psoriatic arthritis--an analysis of 60 cases. J Pediatr. Apr 1982;100(4):529-35. [Medline].

  40. Tay-Kearney ML, Schwam BL, Lowder C, Dunn JP, Meisler DM, Vitale S, et al. Clinical features and associated systemic diseases of HLA-B27 uveitis. Am J Ophthalmol. Jan 1996;121(1):47-56. [Medline].

  41. Weinreb RN, Tessler H. Laboratory diagnosis of ophthalmic sarcoidosis. Surv Ophthalmol. May-Jun 1984;28(6):653-64. [Medline].

  42. Wolf MD, Lichter PR, Ragsdale CG. Prognostic factors in the uveitis of juvenile rheumatoid arthritis. Ophthalmology. Oct 1987;94(10):1242-8. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.