What is the treatment for eye inflammation?

Treatment of Eye Inflammation

The treatment of eye inflammation should begin with topical corticosteroids for most cases, with the specific agent and duration determined by the underlying cause and severity of inflammation. 1

Initial Assessment and Treatment Approach

Determining the Type of Eye Inflammation

• Anterior segment inflammation: Conjunctivitis, episcleritis, anterior uveitis
• Posterior segment inflammation: Posterior uveitis, retinal vasculitis
• Lid/adnexal inflammation: Blepharitis, hordeolum, chalazion

First-Line Treatment

• Topical corticosteroids: Prednisolone acetate 1% is indicated for steroid-responsive inflammation of the conjunctiva, cornea, and anterior segment 2
  • Initial dosing: 2-4 times daily to affected eye(s)
  • Duration: Short-term use (1-2 weeks) preferred to minimize side effects
  • Taper: Required to avoid rebound inflammation

Selection of Corticosteroid Based on Condition

1. For severe ocular surface inflammation:

   • Preservative-free dexamethasone 0.1% or prednisolone acetate 0.5-1%
   • Consider ophthalmology referral within 1-4 weeks for cases requiring prolonged therapy

2. For mild-moderate inflammation:

   • Loteprednol etabonate 0.5% (preferred for lower risk of IOP elevation)
   • Fluorometholone (for limited ocular penetration when minimal intraocular effect is desired)

3. For chronic dry eye with inflammatory component:

   • Loteprednol etabonate 0.5% initially, then transition to steroid-sparing agents

Specific Treatment Protocols by Condition

Noninfectious Uveitis

1. Initial therapy:

   • Topical prednisolone acetate 1% every 1-2 hours initially, then taper based on response
   • Goal: Suppress ocular inflammation and achieve inactive disease state 3

2. For inadequate response to topical therapy:

   • Rule out treatment nonadherence, infections, and masquerade syndromes before changing therapy 3
   • Consider periocular or intraocular steroid injections for localized disease
   • Initiate noncorticosteroid systemic immunomodulatory therapy (NCSIT) if topical steroids cannot be tapered below 2 drops/day within 3 months 3

3. Systemic immunomodulatory options (if needed):

   • First-line: Methotrexate, mycophenolate mofetil, azathioprine
   • Second-line: TNF inhibitors (adalimumab, infliximab), other biologics
   • Dose escalation to maximum tolerated therapeutic dose before switching agents 3

Allergic Conjunctivitis

• Topical antihistamines and mast cell stabilizers as first-line
• Short course (7-10 days) of topical corticosteroids for moderate-severe cases
• Loteprednol etabonate 0.2% is effective and well-tolerated 1

Dry Eye Disease with Inflammatory Component

1. Initial therapy:

   • Artificial tears and lubricants
   • Brief course of loteprednol etabonate 0.5% for significant inflammation
   • Address underlying meibomian gland dysfunction if present

2. For chronic cases:

   • Transition to steroid-sparing agents (cyclosporine 0.05% or lifitegrast 5%)
   • Treat blepharitis with lid hygiene and potentially topical antibiotics

Behçet's Disease with Eye Involvement

• Any patient with inflammatory eye disease affecting the posterior segment should receive azathioprine and systemic corticosteroids 3
• For severe eye disease: Add ciclosporine A, infliximab, or interferon-α 3

Monitoring and Follow-up

During Active Treatment

• Monitor for treatment response within 2 days; if no improvement, re-evaluate diagnosis 2
• Check intraocular pressure after 1-2 weeks of topical steroid use
• Assess for steroid-related complications (cataracts, glaucoma)

Long-term Management

• Ophthalmologic monitoring no less frequently than every 3 months for patients on stable therapy 3
• More frequent monitoring (within 1 month) after each change in topical glucocorticoid dosing 3

Important Precautions and Considerations

Contraindications and Cautions

• Avoid topical steroids in suspected infectious keratitis (especially herpes, fungal)
• Limit duration of topical steroids to minimize risk of cataracts and glaucoma
• Remove contact lenses prior to application of steroid drops; may reinsert 15 minutes after administration 2

Special Populations

• Pregnancy: Use only if potential benefit justifies risk to fetus 2
• Pediatric patients: Consider ophthalmology referral for long-term management
• Immunocompromised patients: Rule out infectious causes before initiating steroids

When to Refer to Ophthalmology

• No improvement after 48 hours of appropriate therapy
• Cases requiring more than 8 weeks of topical corticosteroid therapy
• Progressive loss of visual acuity
• Suspected posterior segment involvement
• Recurrent or chronic inflammation

By following this structured approach to eye inflammation treatment, clinicians can effectively manage most cases while minimizing complications and preserving vision.