Uveitis, Anterior, Childhood Medication

Updated: Jun 17, 2016
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

The primary medications used in treating anterior uveitis in children are corticosteroids, topical cycloplegics, and, in certain cases of JIA-associated uveitis, methotrexate. [26, 27] In cases of recalcitrant inflammation, other immunosuppressives and biologic agents have been used with variable success.

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Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Prednisone (Deltasone)

Inhibits phospholipase A and Fc receptor expression, reduces cytokine production, suppresses lymphocyte function, and redistributes circulating leukocytes.

Prednisolone acetate suspension 1% (AK-Pred, Pred Forte)

Potent topical corticosteroid used to treat anterior segment inflammation. Initial dosage is determined by the degree of inflammation.

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Cycloplegics

Class Summary

Instillation of a long-acting cycloplegic agent can relax ciliary muscle spasm that can cause a deep aching pain and photophobia.

Homatropine (Isopto Homatropine)

Useful in treating pain from ciliary spasm and decreasing formation of synechiae.

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Antimetabolites

Class Summary

Decrease inflammation; corticosteroid-sparing effect.

Methotrexate (Folex, Rheumatrex)

Useful in patients with JIA-associated uveitis, where it may reduce inflammation in patients who do not adequately respond to corticosteroid treatment.

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Antineoplastic Agent, Miscellaneous

Class Summary

These agents may be useful as a single agent or in combination with systemic corticosteroids and/or other immunosuppressive agents.

Azathioprine (Azasan, Imuran)

Azathioprine is an imidazolyl derivative of 6-mercaptopurine. Many of its biological effects are similar to those of the parent compound. Both compounds are eliminated rapidly from blood and are oxidized or methylated in erythrocytes and the liver. No azathioprine or mercaptopurine is detectable in urine 8 hours after it is taken.

Azathioprine antagonizes purine metabolism and inhibits the synthesis of DNA, RNA, and proteins. The mechanism whereby azathioprine affects autoimmune diseases is unknown. It works primarily on T cells. It suppresses hypersensitivities of the cell-mediated type and causes variable alterations in antibody production. Immunosuppressive, delayed hypersensitivity, and cellular cytotoxicity tests are suppressed to a greater degree than antibody responses. It works very slowly and may require 6-12 months of trial prior to effect. Up to 10% of patients may have an idiosyncratic reaction disallowing use. Do not allow WBC count to drop below 3000/µL or lymphocyte count to drop below 1000/µL.

Azathioprine is available in tablet form for oral administration or in 100-mg vials for intravenous injection.

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Immunomodulators

Class Summary

May be useful for uveitis associated with inflammatory bowel disease.

Adalimumab (Humira)

Recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF). Reduce inflammation and inhibit progression of structural damage.

Infliximab (Remicade)

Neutralizes cytokine TNF-alpha and inhibits its binding to TNF-alpha receptor. Mix in 250-mL normal saline for infusion over 2 h. Must use with low-protein-binding filter (1.2 µm or less). Several investigational reports have described use in childhood uveitis.

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