From the Guidelines
The treatment for uveitis typically involves medications to reduce inflammation and prevent complications, with corticosteroids as the first-line treatment, and immunosuppressive agents or biologics for chronic or steroid-resistant cases. The goal of treatment is to reduce inflammation, prevent tissue damage, and minimize the risk of complications, with the ultimate goal of maintaining optimal vision and ocular health. Key considerations in the treatment of uveitis include:
- Identifying and treating the underlying cause of uveitis, such as sarcoidosis, tuberculosis, or autoimmune diseases, which often require specific therapies 1
- Using corticosteroids as the first-line treatment, administered as eye drops, periocular or intravitreal injections, or oral prednisone, depending on the severity and location of the uveitis 1
- Adding cycloplegic/mydriatic drops, such as cyclopentolate 1% or atropine 1%, to prevent painful ciliary muscle spasms and reduce the risk of synechiae formation 1
- Considering immunosuppressive agents, such as methotrexate, mycophenolate mofetil, or azathioprine, or biologics, such as adalimumab, for chronic or steroid-resistant cases 1
- Monitoring treatment response and adjusting the treatment plan as needed to minimize the risk of complications and maintain optimal vision and ocular health 1. Regular monitoring for medication side effects and disease progression is essential throughout treatment, with a focus on minimizing the risk of complications, such as cataracts, glaucoma, and vision loss 1.
From the Research
Treatment Options for Uveitis
- The primary goal of treatment for uveitis is to induce and maintain remission while minimizing corticosteroid use to reduce corticosteroid-related adverse effects 2.
- Treatment for uveitis depends on the subtype, with anterior uveitis typically treated with topical corticosteroids, and mild intermediate uveitis may be monitored without initial treatment 2.
- Patients with moderate to severe intermediate uveitis, posterior uveitis, and panuveitis are at high risk of sight-threatening complications and require systemic and/or intravitreal corticosteroids and immunosuppressive agents 2.
Corticosteroid Treatment
- Corticosteroids are a powerful and important class of medications used in the treatment of uveitis, and may be given systemically or locally, in the form of topical drops, periocular injection, intravitreal suspension, or intravitreal implant 3.
- The main advantage of corticosteroids is their ability to quickly and effectively control inflammation early on in the course of uveitis, but they can have serious side effects, whether localized to the eye or systemic 3.
- Topically administered corticosteroids are typically indicated for the treatment of anterior uveitis, whereas periocular or intravitreal agents are employed most often in the management of intermediate or posterior intraocular inflammation 4.
Non-Corticosteroid Immunotherapy
- Noncorticosteroid immunosuppressive agents play an important role in limiting the toxic effects of long-term corticosteroid use 4.
- Disease-modifying antirheumatic drugs such as methotrexate are used as first-line therapy for posterior uveitis, and biologics such as adalimumab are used as second-line treatment for patients with inflammation refractory to treatment 2.
Regional Corticosteroid Delivery
- Intravitreal injection of corticosteroids is more effective, but is associated with more adverse events, than periocular injection 5.
- Some evidence supports the use of subconjunctival triamcinolone acetonide over intravitreal/periocular triamcinolone acetonide, and the overall results of 0.59 mg dosage of the intravitreal fluocinolone acetonide implant were superior to those from the 2.1 mg dose 5.
Recent Advances in Uveitis Management
- Recent advances in the management and understanding of uveitis include treatment with new immunosuppressive therapies that use biological agents, local therapy with steroid implants, and imaging studies for the evaluation of uveitis 6.