eMedicine Specialties > Emergency Medicine > Ophthalmology

Iritis and Uveitis: Treatment & Medication

Author: Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Contributor Information and Disclosures

Updated: Aug 13, 2009

Treatment

Emergency Department Care

  • The main goals in the ED are to correctly diagnose uveitis and to refer the patient to an ophthalmologist.2
  • Although the patient's eye is erythematous and cells are present in the anterior chamber, antibiotics are not indicated.

Consultations

  • Patients with possible uveitis should be examined by an ophthalmologist within 24 hours.

Medication

The goals of pharmacotherapy are to reduce pain and inflammation.

Cycloplegics

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


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.

Adult

1 gtt 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

Exercise caution in patients (eg, elderly) in whom intraocular pressure may be increased; can cause toxic anticholinergic systemic effects (common in children, especially infants) but rare when used sparingly; compressing lacrimal sac by digital pressure for 1-3 min following application may minimize systemic absorption


Homatropine 2-5% (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.

Adult

1 gtt tid

Pediatric

Administer as in adults

Documented hypersensitivity; with 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 in elderly in whom intraocular pressure may be increased; toxic anticholinergic systemic effects can occur, but are rare when used sparingly; adverse effects are more common in children, especially infants; compressing lacrimal sac by digital pressure for 1-3 min following instillation minimizes systemic absorption

Topical steroids

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


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.

Adult

1 gtt q1-6h

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

May cause rise in intraocular pressure; can cause cataract formation with chronic use

More on Iritis and Uveitis

Overview: Iritis and Uveitis
Differential Diagnoses & Workup: Iritis and Uveitis
Treatment & Medication: Iritis and Uveitis
Follow-up: Iritis and Uveitis
References
Further Reading
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References

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

  2. 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].

  3. 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].

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

  5. 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].

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

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

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

  9. 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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Keywords

iritis, uveitis, inflammation of the uveal tract, inflammation of the iris, inflammation of the ciliary body, inflammation of the choroid, iridocyclitis, anterior uveitis, posterior uveitis, choroiditis, chorioretinitis, retinitis

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Contributor Information and Disclosures

Author

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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