eMedicine Specialties > Ophthalmology > Iris & Ciliary Body

Uveitis, Anterior, Nongranulomatous: Treatment & Medication

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

Updated: Sep 5, 2007

Treatment

Medical Care

  • Cycloplegia: A long-acting cycloplegic agent, such as cyclopentolate or homatropine, should be used to help relieve both pain and photophobia and to prevent the formation of posterior synechiae.
  • Corticosteroids: Topical corticosteroids are the mainstays of therapy and should be used aggressively during the initial phases of therapy.
    • 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.
    • In severe cases of iritis, the addition of oral corticosteroids to the treatment regimen may be necessary.
  • Topical aqueous suppressant: If IOP is elevated, a topical aqueous suppressant should be used.

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.

Medication

Topical corticosteroids and a cycloplegic agent should be started immediately, unless an infectious etiology is suspected. If the eye is not adequately responding to topical therapy within a week to 10 days, the addition of either oral corticosteroids or a periocular injection of corticosteroids to the treatment regimen may be necessary. The injection of steroids may be contraindicated in a known steroid responder or in a patient with an already elevated IOP.

Tapering of steroid therapy is guided by the clinical response on follow-up examination. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) tend to be of little or no benefit in the treatment of iritis.

Corticosteroids

These are the mainstays of therapy for iritis and help to stabilize the blood-aqueous barrier.


Prednisolone acetate 1% (Pred Forte, Econopred)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and by reversing increased capillary permeability.

Adult

1 gtt in affected eye; frequency based on severity of iritis but generally used as starting dose q1-2h

Pediatric

Administer as in adults

Documented hypersensitivity; viral, fungal, or tubercular infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Prolonged use may contribute to glaucoma and cataract formation; close monitoring of IOP required


Prednisone (Deltasone)

Can be used if topical therapy inadequate to treat iritis. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and by reversing increased capillary permeability.

Adult

Initially 1 mg/kg/d or 40-80 mg qam depending on severity; taper over 2-4 wk after satisfactory response; tapering based on inflammation present on follow-up

Pediatric

0.5-1 mg/kg PO divided qd/qid

Coadministration with estrogens may decrease clearance; with digoxin, may increase digitalis toxicity due to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; viral infection; peptic ulcer disease; hepatic dysfunction; connective tissue infections; fungal or tubercular skin infections

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use

Cycloplegics

These agents help prevent or break posterior synechiae and reduce ciliary body–induced pain.


Cyclopentolate HCl 1% (Cyclogyl)

Prevents spasm of ciliary muscle and iris sphincter. Induces mydriasis in 30-60 min and cycloplegia in 25-75 min.

Adult

1 gtt qd/tid

Pediatric

Administer as in adults

Decreases effects of carbachol and cholinesterase inhibitors

Documented hypersensitivity; narrow-angle glaucoma

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution if IOP may be increased (eg, elderly persons); can cause toxic anticholinergic systemic adverse effects (common in children, especially infants) but rare when used sparingly; compressing lacrimal sac with digital pressure for 1-3 min after application may minimize systemic absorption

More on Uveitis, Anterior, Nongranulomatous

Overview: Uveitis, Anterior, Nongranulomatous
Differential Diagnoses & Workup: Uveitis, Anterior, Nongranulomatous
Treatment & Medication: Uveitis, Anterior, Nongranulomatous
Follow-up: Uveitis, Anterior, Nongranulomatous
Multimedia: Uveitis, Anterior, Nongranulomatous
References
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References

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

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

  3. 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. Jan 1996;121(1):35-46. [Medline].

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

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

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

  7. Rosenbaum JT, George RK. Uveitis. In: Current Ocular Therapy 5. 2000:519-21.

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Further Reading

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Keywords

iritis, iridocyclitis, iris, ciliary body, iritis flare, cell and flare, anterior uveitis

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Contributor Information and Disclosures

Author

Roger K George, MD, Director of Uveitis Service, Madigan Army Medical Center; Clinical Instructor, Department of Ophthalmology, Oregon Health and Sciences University
Roger K George, MD is a member of the following medical societies: American Uveitis Society
Disclosure: Nothing to disclose.

Medical Editor

Andrew A Dahl, MD, Residency Director, Ophthalmology, Kingston Hospital, Department of Ophthalmology, Assistant Professor of Surgery (Ophthalmology), Mid Hudson Family Practice Institute
Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

R Christopher Walton, MD, Director of Uveitis and Ocular Inflammatory Diseases Service, Associate Professor, 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 and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

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.

 
 
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