Nongranulomatous Iritis (Anterior Uveitis) Treatment & Management

Updated: Aug 04, 2017
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Medical Care

A long-acting cycloplegic agent, such as cyclopentolate, homatropine, scopolamine, or even atropine, should be used to help relieve both pain and photophobia and to prevent the formation of posterior synechiae in acute symptomatic anterior uveitis. However, prolonged use of strong cycloplegic drops is often unnecessary; in fact, letting the pupil move a little may prevent posterior synechiae from forming in the dilated position.

Topical corticosteroids are the mainstays of therapy and should be used aggressively during the initial phases of therapy. For the most common acute anterior uveitis (eg, associated with HLA-B27), topical corticosteroids such as prednisolone acetate 1% are usually started at every hour initially, rarely more frequently for very severe episodes.

Difluprednate (Durezol) can be used at a less-frequent dose schedule than prednisolone acetate 1% and may be useful when increased effect or improved compliance is needed.

A subconjunctival injection of depot-steroids (eg, Celestone) may be used if the patient poorly complies with topical therapy or if the iritis is not responding to topical corticosteroids alone. A sub-tenon injection with a longer-acting corticosteroid, such as triamcinolone acetate, is reserved for more prolonged episodes, especially if there is cystoid macular edema that is not resolving with topical therapy.

In severe cases of acute anterior uveitis, the addition of oral corticosteroids to the treatment regimen may be necessary.

Therapy for increased IOP is as indicated.

In viral anterior uveitis, antiviral therapy (including valganciclovir for CMV) may be useful, but this is not well established.

Fuchs heterochromic anterior uveitis does not usually require corticosteroid treatment.

In chronic cases, such as in the anterior uveitis associated with juvenile rheumatoid arthritis, systemic immunomodulatory corticosteroid-sparing agents may be required. If cystoid macular edema is unresponsive to corticosteroid therapy, treatment with methotrexate and anti–tumor necrosis factor alpha (TNF-alpha) agents should be considered. [11]

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Consultations

Consultations with other subspecialists should be arranged, as warranted by the patient's history or based on the results of laboratory or radiographic investigations.

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