Treatment of Uveitis
The goal of treatment is to treat the inflammation and check the eyes regularly to help prevent damage and vision loss. Eye doctors treat uveitis to relieve pain, prevent vision loss from inflammation and complications of uveitis, and to treat the cause of the uveitis if known. It is important to follow the eye doctor’s instructions for treatment carefully throughout the duration of treatment as prescribed. Treatment of uveitis must continue as long as inflammation is active. It is not possible to know how long uveitis will last. Possible treatments are:
Treating Anterior Uveitis
Topical corticosteroids [kawr-tuh-koh-ster-oid]: Eye doctors typically use topical corticosteroids in the form of eye drops or ointments to decrease inflammation as the first step except in cases where treatment of the underlying problem is the top priority. The strength of the medicine and how often it is needed will depend on the level of inflammation in the eye. If the uveitis does not respond to drops or ointments, the doctor may inject steroids next to the eye. Doctors will rarely prescribe steroid pills to treat anterior uveitis.
Eye drops to widen pupil: Vision loss from iritis can usually be prevented if diagnosed and treated. Eye doctors treat iritis with corticosteroid eye drops and eye drops that dilate (widen) the pupils. These eye drops can also help prevent the iris from “sticking” to the eye’s lens, a complication of anterior uveitis.
Topical drop for elevated eye pressure: If anterior uveitis causes increased pressure in the eye, the doctor may prescribe eye drops that help lower eye pressure to prevent damage to the optic nerve.
Treating Intermediate and Posterior Uveitis
Antibiotics, antivirals, or other medications: If the uveitis is caused by a bacterial, viral or fungal infection, then the treatment for that condition will involve anti-infective agents. It may be treated with or without corticosteroids.
Corticosteroids – periocular injection, oral, intravenous (IV): For non-infectious causes, the goal of therapy is to get the inflammation under control, quickly. This can be done by the use of corticosteroids. If the inflammation is in one eye only, the eye doctor may first try a steroid injection to the outside of the eyeball. If the eye does not respond or in the cases where both eyes are involved, the doctor will prescribe corticosteroid pills. If inflammation is very severe and/or the patient cannot take pills, the doctor will administer steroids through an IV route of administration. Side effects of corticosteroid use should be discussed with your eye care professional. Eye doctors know that the long-term use of corticosteroids may have serious side effects for patients (especially children), so a common goal of uveitis treatment is to slowly lower the dosage of steroids and then stop steroid treatment completely. Doctors work to bring the inflammation under control with the lowest amount of steroids needed.
Corticosteroids – implant: Many patients with chronic noninfectious posterior uveitis may benefit from a therapy involving a long-acting drug implant. The drug product is surgically implanted into the eye and is designed to release steroids directly into the back of the eye. This procedure seeks to reduce or eliminate many of the side effects common to oral corticosteroids.
Nonsteroid anti-inflammatory drugs: For some patients with chronic uveitis, eye doctors may prescribe nonsteroid anti-inflammatory drugs. These drugs can be an effective way to treat inflammation over a longer period of time. This treatment is not used very much.
Immunosuppressive and biologic agents: Even when the cause of uveitis is unknown, the uveitis may be related to problems with the body’s immune system. Autoimmune diseases are conditions in which parts of the body are attacked by the body’s own immune system. Immunosuppressive or cytotoxic drugs that weaken the body’s immune response have been effective in treating some kinds of uveitis. These drugs may be an option for some patients who have flare-ups of uveitis that affects both eyes, doesn’t respond well to corticosteroids or nonsteroidal anti-inflammatory drugs, or becomes severe enough to threaten vision. They can be swallowed as a pill, injected subcutaneously (under the skin), or infused into the blood within a vein. Taking immunosuppressant agents can make a person more vulnerable to infection. A small number of people with uveitis can benefit from treatment with a type of immunosuppressants known as biologics.
New treatments: A new treatment, corticotropin, is being examined. It is injected subcutaneously to reduce inflammation with less systemic side effects than steroids.