Uveitis, Anterior, Childhood Treatment & Management

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

Medical Care

JIA-related uveitis

In these children, the ultimate goal of treatment is to eliminate all anterior chamber cells if possible.

Initial therapy typically includes topical and systemic corticosteroids. Children treated with topical corticosteroids have an increased risk of developing cataracts, especially those treated more than 3 times daily. [14] Short-acting cycloplegic agents often are prescribed to prevent posterior synechiae.

In many patients, corticosteroids alone are not sufficient to control the inflammation, and immunomodulatory therapy will be necessary. Use of immunomodulatory therapy may result in improved outcomes in children with JIA-associated uveitis. [15] Long-term oral methotrexate is often an effective steroid-sparing therapy. Children treated with methotrexate for at least 3 years prior to discontinuation may have a longer relapse-free interval. [16] Cyclosporine, azathioprine, and mycophenolate mofetil have also been useful steroid-sparing therapies. [17, 18]

Biologic response modifiers may be useful for children with persistent inflammation despite standard immunomodulator therapy. Among these agents, etanercept may be less effective in the treatment of uveitis. [19, 20, 21, 22, 23, 24]

HLA-B27 associated uveitis

The severity of uveitis in these conditions ranges widely, necessitating individualized and, in some cases, ongoing care. Milder cases are treated with topical corticosteroids while moderately severe cases are treated with more intensive topical steroid treatment with the addition of cycloplegics. Treatment with sub-Tenon corticosteroids may also be useful for severe flares and/or cystoid macular edema. In recalcitrant cases, immunomodulatory therapy may be necessary to control the inflammation.

Sarcoidosis-associated uveitis

Keep in mind that the particular tissues involved, the severity of the inflammation, and the degree of visual loss drives treatment decisions in most cases. When anterior disease predominates, treatment with topical corticosteroids and cycloplegics usually will suffice. However, severe refractory cases may require systemic immunomodulatory therapy.

Kawasaki disease and uveitis associated with systemic viral illness

Treatment rarely is required in these self-limited conditions; topical steroids may be given in symptomatic cases. More severe cases may be treated with topical corticosteroids and cycloplegics.

Blau syndrome

Topical corticosteroids are the mainstay of therapy for patients with anterior uveitis. Cycloplegics may be used for patients with photophobia and to prevent posterior synechiae formation. Severe exacerbations may require periocular corticosteroids to control the inflammation. Patients with posterior uveitis require systemic corticosteroids and/or immunosuppressive therapy.

Juvenile xanthogranuloma

Topical and systemic corticosteroids are often effective in treating this condition.

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Surgical Care

Surgery is required to treat the complications of severe or chronic inflammation. For example, in JIA-associated uveitis, cataract often develops and the eye should be quiet for at least 3 months prior to surgery. Perioperative systemic corticosteroids have been advocated to reduce postoperative inflammation. Intraocular lens placement is still somewhat controversial; however, intensive medical therapy to control inflammation is essential for patients receiving intraocular lenses. [25]

Severe band keratopathy, as seen in JIA, may require treatment with Ca EDTA chelation. Development of glaucoma may require trabeculectomy or placement of a drainage implant.

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Consultations

Depending on the patient, one or more of the following pediatric subspecialists may assist in the evaluation and treatment of patients:

  • Ocular immunology and uveitis specialist
  • Pediatric rheumatologist
  • Pediatric pulmonologist
  • Pediatric infectious disease specialist
  • Pediatric nephrologist
  • Pediatric cardiologist
  • Pediatric gastroenterologist
  • Pediatric neurologist
  • Pediatric oncologist
  • Child psychiatrist
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