Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

Uveitis 1505

specific therapy

Indications

■Control of inflammation w/in anterior segment to relieve symptoms

Treatment Options

■Topical corticosteroids:

➣Prednisolone acetate suspension 1%, while awake at onset of

treatment; taper frequency to therapeutic response

■Topical mydriatic/cycloplegic: homatropine 5%

■Periocular steroids:

➣Used to supplement nonresponsive anterior segment inflamma-

tion (subconjunctival injection) or posterior segment inflamma-

tion (sub-Tenon injection)

➣Sub-Tenon or subconjunctival injection: triamcinolone

■Systemic anti-inflammatory & immunosuppressive drugs:

➣Systemic therapy w/ corticosteroids usually initiated for pts non-

responsive to topical corticosteroid therapy, severe visual loss, or

inflammation of posterior segment

➣Immunosuppressive medications (methotrexate, cyclosporine,

azathioprine) usually added to therapy to enhance effect of treat-

ment & for steroid sparing

➣Systemic therapy directed at underlying systemic infection; eg,

clindamycin for Lyme disease

Side Effects & Contraindications

■Topical corticosteroids:

➣Side effects: increased IOP (after 2 wks in corticosteroid-

responsive eyes); cataract w/ long-term therapy

➣Contraindications: herpes simplex keratitis requires concomi-

tant antiviral topical therapy

■Topical mydriatic/cycloplegic drugs:

➣Side effects: dilated pupil, inability to accommodate, difficulty

reading

➣Contraindications: angle-closure glaucoma

■Periocular steroids:

➣Side effects & contraindications: as for topical corticosteroids

➣Other contraindications: glaucoma filtering bleb, history of glau-

coma or suspected glaucoma, scleral thinning

Newer treatments: Cytokine inhibitors such as etanercept and inflix-

imab are being studied for treatment of various types of uveitis.