Treatment

Systemic analgesics should be given as necessary to relieve pain, and dark glasses for photophobia. The pupil must be kept dilated unless the iritis is very mild.

Infectious causes of uveitis are treated with appropriate antiviral or antimicrobial agents while in non-infectious causes, corticosteroids are used as the first line agents (1).

Mydriatic/cycloplegic agents can be used to relieve pain and prevent adhesion (1).

• cycloplegics/mydriatics - short acting dilators such as cyclopentolate may be given to
  • keep the pupil dilated, to prevent ciliary spasm and the formation of posterior synechiae - not necessary in Fuch's heterochromic uveitis.
  • stop further protein leakage (flare) (2)
• corticosteroids
  • steroids are usually effective at suppressing inflammation - usually topical eg. prednisolone, dexamethasone. Systemic steroids may be used in severe, and unresponsive cases. Herpes simplex and zoster may flare up when steroids are withdrawn so infrequent dilute steroids may be needed indefinitely

Treatment of uveitis depends on the site of inflammation e.g. - topical corticosteroid eye drops are the treatment of choice in anterior uveitis but are not useful in posterior uveitis due to poor penetration (3).

In people with steroid-dependent or refractory uveitis, systemic (non-corticosteroid) immunosuppressive agents (methotrexate, sulfasalazine, azathioprine, and cyclosporine) may be necessary (1).

It is important to treat the complications. Dilatation of the pupil helps combat glaucoma. Intraocular tension may be reduced by carbonic anhydrase inhibitors. Cataracts and retinal detachment are treated surgically.

Reference:

• (1) Hajj-Ali RA et al. Uveitis in the internist’s office: Are a patient’s eye symptoms serious? Cleve Clin J Med. 2005;72(4):329-39
• (2)American Optometric association 2004. Care of the patients with anterior uveitis
• (3) Smith JR, Rosenbaum JT. Management of uveitis: A rheumatological prospective. Arthritis Rheum. 2002;46(2):309-18