From the Guidelines
Uveitis is inflammation of the uvea, which is the middle layer of the eye that includes the iris, ciliary body, and choroid, and its treatment should prioritize corticosteroid eye drops for anterior uveitis and more aggressive therapies like oral prednisone or immunosuppressive medications for more severe or posterior cases, as recommended by the most recent guidelines 1.
Definition and Classification
Uveitis can affect one or both eyes and may develop suddenly or gradually, with symptoms including eye redness, pain, light sensitivity, blurred vision, and floaters. It can be classified based on which part of the uvea is affected: anterior (front), intermediate (middle), posterior (back), or panuveitis (all layers).
Treatment Approach
Treatment usually involves corticosteroid eye drops like prednisolone acetate 1% administered 4-6 times daily for anterior uveitis, while more severe or posterior cases may require:
- Oral prednisone (starting at 1mg/kg/day)
- Periocular injections
- Immunousuppressive medications such as methotrexate, azathioprine, or biologics, as supported by recent guidelines 1.
Importance of Prompt Treatment
Prompt treatment is essential as untreated uveitis can lead to complications including cataracts, glaucoma, retinal damage, and vision loss, highlighting the need for early detection and management, especially in high-risk populations like those with juvenile idiopathic arthritis-associated uveitis 1.
Underlying Cause Identification
The underlying cause should be identified when possible, as uveitis can be associated with autoimmune disorders, infections, or trauma, which may influence the treatment approach and the need for systemic therapy, as discussed in the context of immune checkpoint inhibitors 1 and juvenile idiopathic arthritis-associated uveitis 1.
Regular Follow-Up
Regular follow-up with an ophthalmologist is necessary to monitor response to treatment and adjust medication as needed, ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life for patients with uveitis, as emphasized by the importance of screening, monitoring, and treatment guidelines 1.
From the Research
Definition and Characteristics of Uveitis
- Uveitis is characterized by inflammation of the uvea, the middle portion of the eye composed of the iris, ciliary body, and choroid, causing eye redness, pain, photophobia, floaters, and blurred vision 2.
- It can be classified as noninfectious or infectious, with toxoplasmosis, herpes, tuberculosis, and HIV comprising a significant percentage of infectious cases 2.
- Uveitis predominantly affects individuals aged 20 to 50 years and can be further categorized into anterior, intermediate, posterior, and panuveitis based on the affected uveal layers 2.
Symptoms and Complications
- Untreated uveitis may cause severe complications, including cataracts, glaucoma, macular edema, retinal detachment, optic nerve damage, and vision loss 2.
- The incidence and prevalence of uveitis are influenced by genetic factors, environmental factors, and infection rates 2.
Treatment Options
- Treatment goals for uveitis are to induce and maintain remission while minimizing corticosteroid use to reduce corticosteroid-related adverse effects 2, 3.
- Corticosteroids are a powerful and important class of medications in the treatment of uveitis, but they can have serious side effects, whether localized to the eye or systemic 3, 4.
- Non-corticosteroid immunosuppressive agents play an important role in limiting the toxic effects of long-term corticosteroid use 4, 5.
- Topical corticosteroids are effective anti-inflammatory drugs in the treatment of anterior uveitis, with prednisolone acetate 1% being the first choice in therapy 6.
Treatment Approach
- A stepladder approach is recommended, starting with the least aggressive treatments to induce remission of inflammation 5.
- The treatment for uveitis depends on the subtype, with anterior uveitis being treated with topical corticosteroids and mild intermediate uveitis being 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.