Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Uveitis, Anterior, Nongranulomatous Treatment & Management

  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Feb 03, 2015
 

Medical Care

A long-acting cycloplegic agent, such as cyclopentolate, homatropine, scopolamine, or even atropine, should be used to help relieve both pain and photophobia and to prevent the formation of posterior synechiae in acute symptomatic anterior uveitis. However, prolonged use of strong cycloplegic drops is often unnecessary; in fact, letting the pupil move a little may prevent posterior synechiae from forming in the dilated position.

Topical corticosteroids are the mainstays of therapy and should be used aggressively during the initial phases of therapy. For the most common acute anterior uveitis (eg, associated with HLA-B27), topical corticosteroids such as prednisolone acetate 1% are usually started at every hour initially, rarely more frequently for very severe episodes.

Difluprednate (Durezol) can be used at a less-frequent dose schedule than prednisolone acetate 1% and may be useful when increased effect or improved compliance is needed.

A subconjunctival injection of depot-steroids (eg, Celestone) may be used if the patient poorly complies with topical therapy or if the iritis is not responding to topical corticosteroids alone. A sub-tenon injection with a longer-acting corticosteroid, such as triamcinolone acetate, is reserved for more prolonged episodes, especially if there is cystoid macular edema that is not resolving with topical therapy.

In severe cases of acute anterior uveitis, the addition of oral corticosteroids to the treatment regimen may be necessary.

Therapy for increased IOP is as indicated.

In viral anterior uveitis, antiviral therapy (including valganciclovir for CMV) may be useful, but this is not well established.

Fuchs heterochromic anterior uveitis does not usually require corticosteroid treatment.

In chronic cases, such as in the anterior uveitis associated with juvenile rheumatoid arthritis, systemic immunomodulatory corticosteroid-sparing agents may be required. If cystoid macular edema is unresponsive to corticosteroid therapy, treatment with methotrexate and anti–tumor necrosis factor alpha (TNF-alpha) agents should be considered.[11]

Next

Consultations

Consultations with other subspecialists should be arranged, as warranted by the patient's history or based on the results of laboratory or radiographic investigations.

Previous
 
 
Contributor Information and Disclosures
Author

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

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, Association for Research in Vision and Ophthalmology, Retina Society, American College of Healthcare Executives, American Uveitis Society

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Acknowledgements

Abdullah Al-Fawaz, MD, FRCS Assistant Professor, Cornea and Uveitis Department, King Abdulaziz University Hospital, Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia

Abdullah Al-Fawaz, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology and Royal College of Physicians and Surgeons of Glasgow

Disclosure: Nothing to disclose.

Roger K George, MD, Director of Uveitis Service, Madigan Army Medical Center; Clinical Instructor, Department of Ophthalmology, Oregon Health and Sciences University

Disclosure: Nothing to disclose.

Ralph D Levinson, MD Associate Professor of Ophthalmology, Jules Stein Eye Institute at the David Geffen School of Medicine at UCLA

Ralph D Levinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Uveitis Society, Association for Research in Vision and Ophthalmology, and International Ocular Inflammation Society

Disclosure: Nothing to disclose.

References
  1. Smith JR. HLA-B27--associated uveitis. Ophthalmol Clin North Am. 2002 Sep. 15(3):297-307. [Medline].

  2. Ali A, Samson CM. Seronegative spondyloarthropathies and the eye. Curr Opin Ophthalmol. 2007 Nov. 18(6):476-80. [Medline].

  3. Pleyer U, Forrester JV. Uveitis and Immunological Disorders. Essentials in Ophthalmology. Springer; 2009.

  4. McCannel CA, Holland GN, Helm CJ, Cornell PJ, Winston JV, Rimmer TG. Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group. Am J Ophthalmol. 1996 Jan. 121(1):35-46. [Medline].

  5. Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007 Apr 21. 369(9570):1379-90. [Medline].

  6. Wakefield D, Chang JH, Amjadi S, Maconochie Z, Abu El-Asrar A, McCluskey P. What is new HLA-B27 acute anterior uveitis?. Ocul Immunol Inflamm. 2011 Apr. 19(2):139-44. [Medline].

  7. Suzuki T, Ohashi Y. Corneal endotheliitis. Semin Ophthalmol. 2008 Jul-Aug. 23(4):235-40. [Medline].

  8. Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005 Sep. 140(3):509-16. [Medline].

  9. Birnbaum AD, Jiang Y, Vasaiwala R, Tessler HH, Goldstein DA. Bilateral simultaneous-onset nongranulomatous acute anterior uveitis: clinical presentation and etiology. Arch Ophthalmol. 2012 Nov. 130(11):1389-94. [Medline].

  10. Vitale AT, Graham E, de Boer JH. Juvenile idiopathic arthritis-associated uveitis: clinical features and complications, risk factors for severe course, and visual outcome. Ocul Immunol Inflamm. 2013 Dec. 21(6):478-85. [Medline].

  11. Kruh JN, Yang P, Suelves AM, Foster CS. Infliximab for the treatment of refractory noninfectious Uveitis: a study of 88 patients with long-term follow-up. Ophthalmology. 2014 Jan. 121(1):358-64. [Medline].

  12. Rosenbaum JT, Smith JR. Anti-TNF therapy for eye involvement in spondyloarthropathy. Clin Exp Rheumatol. 2002 Nov-Dec. 20(6 Suppl 28):S143-5. [Medline].

  13. Braakenburg AM, de Valk HW, de Boer J, Rothova A. Human leukocyte antigen-B27-associated uveitis: long-term follow-up and gender differences. Am J Ophthalmol. 2008 Mar. 145(3):472-9. [Medline].

  14. Jabs DA, Busingye J. Approach to the diagnosis of the uveitides. Am J Ophthalmol. 2013 Aug. 156(2):228-36. [Medline]. [Full Text].

  15. [Guideline] Jabs DA, Rosenbaum JT, Foster CS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol. 2000 Oct. 130(4):492-513. [Medline].

  16. Jap A, Chee SP. Immunosuppressive therapy for ocular diseases. Curr Opin Ophthalmol. 2008 Nov. 19(6):535-40. [Medline].

  17. Kump LI, Cervantes-Castaneda RA, Androudi SN, Foster CS. Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology. 2005 Jul. 112(7):1287-92. [Medline].

  18. Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology. 2014 Mar. 121(3):785-96.e3. [Medline].

  19. Mackensen F, Smith JR, Rosenbaum JT. Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome. Ophthalmology. 2007 May. 114(5):995-9. [Medline].

  20. Menezo V, Lightman S. The development of complications in patients with chronic anterior uveitis. Am J Ophthalmol. 2005 Jun. 139(6):988-92. [Medline].

  21. Nussenblatt RB, Whitcup SM. Uveitis. Fundamentals and Clinical Practice. 3rd ed. 2003.

  22. Pepose JS, Holland GN, Wilhelmus KR. Ocular Infection and Immunity. 1996.

  23. Rodrigues EB, Farah ME, Maia M, et al. Therapeutic monoclonal antibodies in ophthalmology. Prog Retin Eye Res. 2009 Mar. 28(2):117-44. [Medline].

  24. Rosenbaum JT, George RK. Uveitis. Current Ocular Therapy 5. 2000. 519-21.

 
Previous
Next
 
Fine keratic precipitates in a patient with ankylosing spondylitis–associated acute anterior uveitis.
Small stellate keratic precipitates with fine filaments in a patient with Fuchs heterochromic iridocyclitis.
Acute anterior uveitis with plasmoid aqueous and hypopyon in a patient with ulcerative colitis.
Fuchs heterochromic iridocyclitis with cataract and iris heterochromia.
Iris atrophy in a patient with herpes simplex virus–associated anterior uveitis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.