Granulomatous Iritis (Anterior Uveitis) Medication

Updated: May 09, 2016
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

Topical corticosteroids and a cycloplegic agent should be started. If the eye does not adequately respond to topical therapy within 1 week or so, or if very severe, oral corticosteroids or a periocular injection of corticosteroids may be added to the treatment regimen.

Oral corticosteroids may be particularly useful in cases of bilateral noninfectious granulomatous iritis. Routine use of depot steroids in infectious uveitis in known steroid responders or in patients with glaucoma or already elevated IOP should be considered carefully because of potential for severe or sight-threatening adverse effects.

In cases of severe granulomatous iritis, the treating clinician may elect to begin therapy with topical and oral corticosteroids. The tapering of steroid therapy is guided by the clinical response on follow-up examination. Topical or systemic nonsteroidal anti-inflammatory drugs (NSAIDs) are of little or no benefit in the treatment of granulomatous iritis.

Immunomodulatory and immunosuppressive medications may be useful in patients who are unresponsive to corticosteroids, in patients with chronic uveitis, or in patients who develop adverse effects of corticosteroid therapy.

A number of other agents have been used, including methotrexate, azathioprine, cyclosporin A, mycophenolate mofetil, cyclophosphamide, and chlorambucil. Myelosuppression and secondary infection are among the most common adverse effects of these agents.

Tumor necrosis factor alpha (TNF-alpha) inhibitors may be useful in some cases of granulomatous anterior uveitis. They are effective in reducing the number of flares of anterior uveitis in patients with sarcoidosis. [7]

An internist or a rheumatologist should be involved in the management of patients treated with immunomodulatory agents.

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Corticosteroids

Class Summary

These agents are the mainstays of therapy for iritis, and they help to stabilize blood-aqueous barrier.

Prednisolone acetate 1% (Pred Forte, Econopred)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and by reversing increased capillary permeability.

Prednisone (Meticorten, Deltasone, Orasone)

Can be used if topical therapy inadequate to treat iritis (especially if bilateral). Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and by reversing increased capillary permeability.

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Cycloplegia

Class Summary

These agents are used to help prevent or break posterior synechiae and to reduce ciliary body–induced pain.

Cyclopentolate hydrochloride 1% (AK-Pentolate, Cyclogyl)

Prevents muscle of ciliary body, and sphincter muscle of iris, from responding to cholinergic stimulation. Induces mydriasis in 15-30 min and cycloplegia in 25-45 min.

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