From the Guidelines
Uveitis management requires prompt treatment with topical corticosteroids, such as prednisolone or dexamethasone, as the first-line treatment for anterior uveitis, and systemic immunosuppression, including methotrexate and biologics like adalimumab, for chronic or steroid-resistant cases 1.
Key Considerations
- Active uveitis in juvenile idiopathic arthritis (JIA) usually requires immediate treatment to prevent vision loss and complications 1.
- Topical corticosteroids are the preferred first-line treatment for anterior uveitis, with systemic corticosteroids reserved for intermediate or posterior uveitis 1.
- Systemic immunosuppression, including methotrexate, is recommended for chronic or steroid-resistant cases, with biologics like adalimumab considered for patients refractory to disease-modifying antirheumatic drug (DMARD) therapy 1.
- The use of anti-TNF treatment strategies, such as adalimumab, is recommended in patients with uveitis refractory to DMARD therapy, principally methotrexate 1.
Treatment Approach
- For anterior uveitis, topical prednisolone acetate 1% is typically started at one drop every 1-2 hours while awake, then gradually tapered as inflammation resolves 1.
- Cycloplegic agents like cyclopentolate 1% or atropine 1% are added to prevent synechiae formation and relieve pain 1.
- For intermediate or posterior uveitis, systemic corticosteroids (prednisone 1mg/kg/day, maximum 60-80mg daily) are often necessary, with a slow taper over weeks to months 1.
- Periocular or intravitreal steroid injections (triamcinolone acetonide 40mg/ml) may be used for localized disease 1.
Monitoring and Follow-up
- Regular monitoring for medication side effects and disease activity is essential, with follow-up examinations including visual acuity, intraocular pressure measurement, and slit-lamp examination to assess treatment response 1.
- Underlying systemic diseases must be identified and treated concurrently, as uveitis is often associated with conditions like sarcoidosis, ankylosing spondylitis, or inflammatory bowel disease 1.
From the Research
Uveitis Management Overview
- Uveitis is a form of eye inflammation that can cause vision loss, and its management typically involves the use of corticosteroids as the first line of therapy 2, 3.
- Corticosteroids can be administered topically, periocularly, intravitreally, or systemically, depending on the location and severity of the inflammation 2, 3.
Treatment Options
- Topical corticosteroids, such as prednisolone acetate, are commonly used to treat anterior uveitis 4, 5.
- Difluprednate 0.05% ophthalmic emulsion is a potent topical corticosteroid that has been shown to be effective in treating inflammatory eye disorders, including uveitis 5.
- Periocular or intravitreal corticosteroids may be used to treat intermediate or posterior uveitis 2.
- Systemic corticosteroids, such as oral or intravenous prednisone, may be used to treat vision-threatening uveitis, bilateral inflammation, or uveitis associated with systemic disease 2, 6.
Immunomodulatory Therapy
- Non-corticosteroid immunosuppressive agents, such as methotrexate and azathioprine, may be used to limit the toxic effects of long-term corticosteroid use 2, 6.
- Biologic therapies, such as adalimumab, may be used to treat juvenile idiopathic arthritis-associated uveitis 6.
Practice Patterns
- A survey of uveitis specialists in North America found that topical corticosteroid therapy is the first-line treatment for acute, non-infectious anterior uveitis 4.
- The survey also found that practice patterns vary widely, with different initial medication dosing and follow-up care approaches used by different specialists 4.