What is the treatment for iridocyclitis?

From the Guidelines

The treatment for iridocyclitis should prioritize a combination of corticosteroids and pupil-dilating medications, with topical corticosteroid eye drops such as prednisolone acetate 1% and cycloplegic/mydriatic drops like cyclopentolate 1% or atropine 1% as the first line of treatment, as recommended by the most recent guidelines 1.

Key Considerations

• The goal of treatment is to reduce inflammation, prevent complications like synechiae and cataracts, and preserve vision.
• Treatment duration varies depending on severity but typically continues until all inflammation resolves, which may take weeks to months.
• Regular follow-up appointments are crucial to monitor intraocular pressure, as corticosteroids can cause pressure elevation.

Medications

• Topical corticosteroid eye drops: prednisolone acetate 1%, starting with frequent dosing (every 1-2 hours while awake) and gradually tapering as inflammation subsides.
• Cycloplegic/mydriatic drops: cyclopentolate 1% or atropine 1%, administered 2-3 times daily to prevent painful ciliary muscle spasm and reduce the risk of synechiae formation.
• Oral corticosteroids (prednisone 1mg/kg/day) or periocular steroid injections may be necessary for severe cases.

Underlying Systemic Conditions

• If the iridocyclitis is associated with an underlying systemic condition like ankylosing spondylitis or juvenile idiopathic arthritis, treating the underlying disease with immunomodulatory medications is essential, as recommended by guidelines 1.

Adjunctive Therapy

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ketorolac eye drops may be used as adjunctive therapy.

Ophthalmological Referral

• Complaints of red, painful, dry or irritated eyes, or visual disturbance in a patient should alert the clinician to the need for immediate ophthalmological referral for diagnosis, classification and management, as recommended by consensus recommendations 1.

From the FDA Drug Label

INDICATIONS AND USAGE Prednisolone acetate ophthalmic suspension 1% is indicated for the treatment of steroid-responsive inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. The treatment for iridocyclitis may include steroid-responsive treatments, such as prednisolone acetate ophthalmic suspension 1% 2.

• The dosage is one to two drops into the conjunctival sac two to four times daily 2.
• Key considerations include not discontinuing therapy prematurely and re-evaluating the patient if signs and symptoms fail to improve after 2 days 2.

From the Research

Treatment Options for Iridocyclitis

The treatment for iridocyclitis depends on the underlying cause of the condition. Some studies suggest the following treatment options:

• Immunomodulatory therapy (IMT) for patients with juvenile idiopathic arthritis-associated chronic iridocyclitis who are unresponsive to conventional therapy 3
• Oral acyclovir for iridocyclitis caused by herpes simplex virus, in conjunction with topical trifluridine and a topical corticosteroid 4
• Chlorambucil for severe, unresponsive iridocyclitis secondary to juvenile rheumatoid arthritis 5
• Systemic antifungal therapy for coccidioidomycosis iridocyclitis, with or without intraocular injections of amphotericin B 6
• Topical nonsteroidal anti-inflammatory drops, such as 0.1% nepafenac, as an alternative to topical corticosteroids, such as 1% prednisolone acetate, for controlling inflammation after laser peripheral iridotomy 7

Considerations for Treatment

When considering treatment options for iridocyclitis, it is essential to take into account the underlying cause of the condition, as well as the potential benefits and risks of each treatment option. For example:

• Early treatment with IMT may be associated with better visual acuity outcomes in patients with juvenile idiopathic arthritis-associated chronic iridocyclitis 3
• The use of oral acyclovir may be beneficial in reducing the risk of treatment failure in patients with iridocyclitis caused by herpes simplex virus 4
• The potential benefits of chlorambucil in treating severe, unresponsive iridocyclitis secondary to juvenile rheumatoid arthritis must be weighed against the potential risks of immunosuppression 5
• Systemic antifungal therapy may be necessary to treat coccidioidomycosis iridocyclitis, but the potential risks of antifungal therapy must be carefully considered 6
• Topical nonsteroidal anti-inflammatory drops, such as 0.1% nepafenac, may be a useful alternative to topical corticosteroids for controlling inflammation after laser peripheral iridotomy, with a lower risk of intraocular pressure elevation 7