What is the treatment for iritis (inflammation of the iris)?

From the Guidelines

Iritis treatment should involve a combination of topical corticosteroids and cycloplegics, with the strongest recommendation being to start with prednisolone acetate 1% eye drops and add cyclopentolate 1% or atropine 1% eye drops to relieve pain and prevent synechiae formation, as supported by the 2019 American College of Rheumatology guideline 1.

Key Components of Iritis Treatment

• Topical corticosteroids, such as prednisolone acetate 1% eye drops, should be used initially to control inflammation, with a typical dosing regimen of 1 drop every 1-2 hours while awake, tapering as inflammation improves 1.
• Cycloplegics, including cyclopentolate 1% or atropine 1% eye drops, should be added to relieve pain by paralyzing the ciliary muscle and preventing synechiae formation, with a dosing frequency of 1-3 times daily 1.
• For severe cases or those unresponsive to topical therapy, oral corticosteroids (prednisone 1 mg/kg/day) may be necessary, as recommended by the 2019 American College of Rheumatology guideline 1.

Considerations for Recurrent or Chronic Iritis

• Patients with recurrent or chronic iritis should be evaluated for underlying systemic conditions like ankylosing spondylitis, sarcoidosis, or inflammatory bowel disease, as these conditions may require specific treatment approaches 1.
• Treating the underlying disease is essential in cases associated with these conditions, and steroid-sparing immunomodulatory agents may be required for chronic cases, as supported by the 2019 American College of Rheumatology guideline 1.

Monitoring and Follow-up

• Regular follow-up is crucial to monitor intraocular pressure, as steroids can cause pressure elevation, and to adjust treatment as needed to prevent rebound inflammation, as recommended by the 2019 American College of Rheumatology guideline 1.
• Treatment duration varies from weeks to months depending on severity, with gradual tapering to prevent rebound inflammation, and pain management with oral NSAIDs may also be beneficial as an adjunct therapy, as supported by the 2019 American College of Rheumatology guideline 1.

From the FDA Drug Label

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 iritis (inflammation of the iris) is steroid-responsive treatment, such as prednisolone acetate ophthalmic suspension 1%, as it is indicated for the treatment of inflammation of the anterior segment of the globe, which includes the iris [ 2 ].

• Key points:
  • Prednisolone acetate is used to treat iritis
  • Steroid-responsive inflammation is targeted by this treatment

From the Research

Treatment Options for Iritis

The treatment for iritis, which is the inflammation of the iris, can be managed through various methods, including:

• Cycloplegic agents and corticosteroids, which can ameliorate or completely reverse the condition, as stated in 3
• Topical corticosteroids, such as prednisolone acetate 1%, which are effective anti-inflammatory drugs in the treatment of anterior uveitis, as mentioned in 4
• Non-steroidal anti-inflammatory drugs (NSAIDs), which can inhibit the enzyme cyclooxygenase responsible for the formation of pro-inflammatory prostaglandins, as discussed in 4 and 5
• Immunosuppressive drugs, such as cyclosporin A, tacrolimus, and sirolimus, which can be used to treat uveitis, especially in cases where patients are not responsive to steroidal or nonsteroidal therapy, as mentioned in 5 and 6

Specific Treatment Regimens

Some specific treatment regimens for iritis include:

• Combination immunosuppressive therapy, which may be needed to control severe cases of iritis, as described in 6
• Topical nepafenac, which has been shown to be noninferior to prednisolone acetate in controlling inflammation after laser peripheral iridotomy, as stated in 7
• Oral prednisone, which can be used in combination with other medications, such as methotrexate and cyclophosphamide, to treat severe cases of iritis, as mentioned in 6

Considerations for Treatment

When treating iritis, it is essential to consider the potential side effects of the medications used, such as:

• Corticosteroid-induced glaucoma and cataracts, as mentioned in 4
• Increased intraocular pressure, as discussed in 7
• The need for individualized treatment, depending on the clinical course and severity of the uveitis, as stated in 4