Uveitis, Anterior, Nongranulomatous Treatment & Management

  • Author: Abdullah Al-Fawaz, MD, FRCS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 24, 2010
 

Medical Care

  • Cycloplegia: 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 not necessary; in fact, letting the pupil move a little may prevent posterior synechiae from forming in the dilated position.
  • Corticosteroids: 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.
    • 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 intraocular pressure 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.
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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.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Specialty Editor Board

Andrew A Dahl, MD  Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine

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.

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.

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

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.

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.

References

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

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