Birdshot Retinochoroidopathy. Coccidioidomycosis Valley Fever. Comprehensive Drop Guide. Conjunctival Biopsy in the Diagnosis of Ocular Sarcoidosis. Cryptococcal Choroiditis. Fuchs Heterochromic Iridocyclitis. Glaucomatocyclitic Crisis Posner-Schlossman Syndrome. Idiopathic Multifocal Choroiditis. Christina Y. Juvenile Idiopathic Arthritis Associated Uveitis.
Multiple Evanescent White Dot Syndrome. Necrotizing Herpetic Retinitis. Ocular Cicatricial Pemphigoid. Ocular Manifestations of Sarcoidosis. Uveitis are an important cause of impaired vision and reduced vision-related quality of life in both developed and developing countries.
Understanding their etiology and clinical manifestations is important for establishing the correct anatomical diagnosis, identify underlying etiology, and defining treatment strategies. The following article summarizes the treatment strategies in uveitis.
Appropriate management of a patient with uveitis begins with a careful clinical history collection and comprehensive ophthalmic examination, in order to determine likely etiologies, identify potential prognostic factors, and define the most appropriate therapeutic strategy.
Systemic evaluation is usually indicated for bilateral acute anterior uveitis, recurrent anterior uveitis, granulomatous anterior uveitis, intermediate or posterior uveitis, or any atypical clinical presentation. Treatment strategies for uveitis will depend on the anatomic location of inflammation i. Uveitis-related complications also warrant specific therapeutic approaches.
Finally, patient comorbidities must also be taken into account, considering possible contra-indications for different classes of drugs. The treatment of uveitis is ultimately to achieve the following goals [1] :.
Most patients with acute anterior uveitis AAU benefit from measures to control inflammation and to prevent sequelae from inflammation. In patients with a treatable cause of inflammation, specific treatment is either given instead or in addition to general measures. Cycloplegic agents e. In the acute stage, phenylephrine 2. The clinical usefulness of cycloplegic agents in AAU is due to [2] :. Topical corticosteroids CS penetrate the posterior segment phakic eyes poorly, and their use is thus primarily in the setting of anterior uveitis and for the management of the anterior component of panuveitis.
Posology of eye drop instillation must take into account disease severity and chronicity. Generally, steroid therapy should be given in high doses initially and then slowly tapered according to clinical evolution [3] :. A commonly adopted regimen might consist of [2] :. Several CS exist in topical ocular formulations, and each has unique pharmacologic and pharmacokinetic properties that may provide advantages and disadvantages in specific clinical scenarios.
Relative potencies of CS must also be taken into account, given the safety profile of these drugs and the risks of ocular and systemic complications derived from the use of CS. Relative potencies of CS are established compared to the reference of hydrocortisone; CS are presented in decreasing order of relative potency in the table below:. Side effects from topical CS are the same for any ocular or systemic CS, although the risk of side effects is related to administration route and relative potency of the drugs:.
Risk of steroid-induced glaucoma is related to both patient and drug factors [5] :. Most cases of anterior uveitis are characterized by low IOP secondary to ciliary body hyposecretion.
However, elevated IOP can occur — hypertensive uveitis e. In these cases, AH suppressants e. Although it remains a controversial topic, prostaglandin analogues are not typically prescribed due to potential risk of exacerbating inflammation, reactivation of herpetic keratouveitis, and macular oedema. Pilocarpine should also be avoided due to miosis and increased risk of PS and cataract formation. In cases of severe uveitis, unilateral uveitis, and uveitis not responding to topical CS, periocular repository CS should be considered [3] :.
Below are shown some of the clinical scenarios where periocular steroids might be considered:. It should be noted that periocular use of triamcinolone is off-label, and thus should be discussed with patients [3]. Periocular steroids may be associated with the highest risk for development of steroid-induced glaucoma.
Complications of periocular steroids are related to the procedure itself or related to the drug, and include:. In severe fibrinous anterior uveitis, intracameral tPA may be administered intracamerally In cases of anterior uveitis complicated by CMO, intravitreal steroids may be used, including triamcinolone acetonide IVTA and slow-release intravitreal implants.
However, the main use of IVS for uveitis has been in the treatment of non-infectious posterior uveitis, as discussed below. As a primary treatment modality for ocular inflammatory diseases, NSAIDSs are generally ineffective in both local and systemic formulations; an exception might be some cases of non-necrotizing anterior scleritis [1]. In addition, NSAIDs might provide some utility as an adjunct to other forms of therapy, such as the topical formulation the treatment of macular oedema, as discussed below.
Systemic CS therapy is usually not necessary in AAU, but may be necessary in some clinical scenarios [3] :. Treatment should consist of high dosage initially and then tapering according to clinical effects. Initial dosing can be 1. When the duration of CS therapy exceeds two weeks, then a gradual taper is instructed because of adrenal suppression. Too rapid tapering or early discontinuation of systemic CS may lead to disease recurrence [1]. Recent changes. View form. View source.
Jump to: navigation , search. Enroll in the Residents and Fellows contest. Enroll in the International Ophthalmologists contest. Residents and Fellows contest rules International Ophthalmologists contest rules. Original article contributed by :. Russell W. Read, MD, PhD. All contributors:. Brad H. Feldman, M. Assigned editor:. Marissa Larochelle, MD. Ocul Immunol Inflamm.
Gut inflammation and microbiome in spondyloarthritis. Rheumatol Int. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Learn more Accept. Categories : Articles Uveitis.
What links here. Related changes. Uveitis damages the part of the eye called the uvea — but it often affects other parts of the eye, too.
Sometimes uveitis goes away quickly, but it can come back. It can affect 1 eye or both eyes. The uvea is the middle layer of the eye between the sclera white part of the eye and the retina light-sensitive layer at the back of the eye. It has 3 parts:.
If you notice these symptoms, see your eye doctor right away. Eye doctors can check for uveitis as part of a dilated eye exam. The exam is simple and painless — your doctor will give you some eye drops to dilate widen your pupil and then check your eyes for uveitis and other eye problems. Your doctor will also ask about your medical history — and may recommend some tests to see if you have an infection or another disease that can cause uveitis.
Medicines called steroids can reduce inflammation in your eye. This can ease symptoms and prevent vision loss. Your eye doctor may prescribe steroids in a few different ways:. Steroids can have side effects and can increase your risk for cataracts and glaucoma.
0コメント