Iritis and Uveitis Medication

  • Author: Keith Tsang, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 4, 2011
 

Medication Summary

The goals of pharmacotherapy are to reduce pain and inflammation through the use of cycloplegics and corticosteroids. Corticosteroid eye drops have been the standard of care for uveitis since the early 1950s; however, the evidence supporting their use is somewhat sparse.[5] Corticosteroids should only be initiated in conjunction with an ophthalmologist because uveitis is a diagnosis of exclusion, and their side effects include increased IOP, cataract formation, and increased risk of herpes keratitis.

Studies comparing nonsteroidal anti-inflammatory drug (NSAID) eye drops to placebo and corticosteroids have not demonstrated benefit; their use as an alternative to corticosteroids is not supported by evidence.[5]

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Cycloplegics

Class Summary

These agents block nerve impulses to the pupillary sphincter and ciliary muscles, easing pain and photophobia.

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Cyclopentolate 0.5-2% (Cyclogyl)

 

Induces cycloplegia in 25-75 min and mydriasis in 30-60 min. Effects last as long as 1 d; however, duration may be less in setting of severe anterior chamber reaction. For this reason, Cyclogyl less attractive for treating uveitis than homatropine.

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Homatropine (Isopto)

 

Induces cycloplegia in 30-90 min and mydriasis in 10-30 min. Effects last 10-48 h for cycloplegia and 6 h to 4 d for mydriasis, but duration may be less in setting of severe anterior chamber reaction. Homatropine is agent of choice for uveitis.

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Topical steroids

Class Summary

These agents decrease inflammation. Corticosteroid treatment often is initiated only after consultation with an ophthalmologist.

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Prednisolone 1% (Pred Forte)

 

Strongest steroid of its group and best choice for uveitis. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Contributor Information and Disclosures
Author

Keith Tsang, MD  Resident Physician, Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate, Kings County Hospital

Keith Tsang, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP  Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas Lavenburg, MD  Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Kilbourn Gordon III, MD, to the development and writing of this article.

References

  1. Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. Sept 2005;140:509-16. [Medline].

  2. Yanoff and Duker. Uveitis and other intraocular inflammations. In: Ophthalmology. 3rd ed. Mosby; 2008.

  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. Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ, et al. Referral patterns of uveitis in a tertiary eye care center. Arch Ophthalmol. May 1996;114(5):593-9. [Medline].

  5. [Best Evidence] Islam N, Pavesio C. Uveitis (acute anterior). Clin Evid (Online). November 2009;04:705.

  6. Wills Eye Hospital. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 5th ed. Philadelphia, Pa: Lippincott; 2008.

  7. Abad S, Seve P, Dhote R, Brezin AP. [Guidelines for the management of uveitis in internal medicine]. Rev Med Interne. Jun 2009;30(6):492-500. [Medline].

  8. Lyon F, Gale RP, Lightman S. Recent developments in the treatment of uveitis: an update. Expert Opin Investig Drugs. May 2009;18(5):609-16. [Medline].

  9. Lim LL, Smith JR, Rosenbaum JT. Retisert (Bausch & Lomb/Control Delivery Systems). Curr Opin Investig Drugs. Nov 2005;6(11):1159-67. [Medline].

  10. Mohammad DA, Sweet BV, Elner SG. Retisert: is the new advance in treatment of uveitis a good one?. Ann Pharmacother. Mar 2007;41(3):449-54. [Medline].

  11. Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. Apr 2006;119(4):302-6. [Medline].

  12. Dunne JA, Travers JP. Topical steroids in anterior uveitis. Trans Opthalmol soc UK. 1979;99(4):481-4. [Medline].

  13. Foster CS, Alter G, DeBarge LR, Raizman MB, Crabb JL, Santos CI, et al. Efficacy and safety of rimexolone 1% ophthalmic suspension vs 1% prednisolone acetate in the treatment of uveitis. Am J Ophthalmol. Aug 1996;122(2):171-82. [Medline].

  14. Merck Manuals: Uveitis. Available at http://www.merck.com/mmhe/sec20/ch232/ch232a.html.

  15. Nishimoto JY. Iritis. How to recognize and manage a potentially sight-threatening disease. Postgrad Med. Feb 1996;99(2):255-7, 261-2. [Medline].

  16. Nussenblatt R, Whitcup S, Palestine A. Uveitis: Fundamentals and Clinical Practice. 2nd ed. St. Louis, Mo: Mosby; 1996.

  17. Tessler H. Classification and symptoms and signs of uveitis. In: Duane T, ed. Clinical Ophthalmology. New York, NY: Harper and Row; 1987:1-10.

 
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Anatomy of the eye.
Small stellate keratic precipitates with fine filaments in a patient with Fuchs heterochromic iridocyclitis.
Table 1. Classification of Uveitis
TypePrimary Site of InflammationIncludes
Anterior uveitisAnterior chamberIritis/iridocyclitis/anterior cyclitis
Intermediate uveitisVitreousPars planitis/posterior cyclitis/hyalitis
Posterior uveitisChoroidFocal, multifocal, or diffuse choroiditis/chorioretinitis/retinochoroiditis/retinitis/Neuroretinitis
PanuveitisAnterior chamber, vitreous, and/or choroid
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