Initial Treatment for Anterior Uveitis
Topical corticosteroids, specifically prednisolone acetate 1%, are the first-line treatment for anterior uveitis. 1
Treatment Algorithm
First-Line Treatment
- Topical corticosteroids (preferably prednisolone acetate 1% or dexamethasone) should be initiated immediately for active anterior uveitis 1
- Initial dosing of prednisolone acetate 1% may require frequent administration (1-2 drops/eye/day or more) based on severity of inflammation 1
- Prednisolone acetate 1% is preferred over difluprednate due to better corneal penetration, though difluprednate requires less frequent administration 1
Monitoring and Tapering
- After initiating topical corticosteroids, patients should be monitored within 1 month of any change in topical therapy 1
- Taper topical corticosteroids gradually as the anterior chamber cellular reaction comes under control 1
- Goal is to discontinue topical corticosteroids within 3 months due to risk of complications 1
When to Consider Systemic Therapy
- If inactivity cannot be reached within 3 months or inflammation reactivates during steroid dose reduction, systemic immunosuppression is recommended 1
- For patients still requiring 1-2 drops/day of prednisolone acetate 1% for uveitis control, adding systemic therapy to taper topical glucocorticoids is recommended 1
- Methotrexate is the first choice for systemic immunosuppression when needed 1, 2
Considerations and Complications
Potential Complications of Topical Corticosteroids
- Corticosteroid-induced glaucoma and elevated intraocular pressure 3, 2
- Cataract formation with prolonged use 3, 2
- Risk increases with greater frequency of drops per day and longer duration of therapy 1
Additional Treatment Options
- Topical and systemic NSAIDs have no demonstrable effect as monotherapy but may be used as additional therapy 1
- For patients with poor prognostic factors or refractory disease, systemic immunosuppression should be considered earlier 1
- In cases refractory to methotrexate, biologics (particularly adalimumab or infliximab) are recommended 1, 4
Treatment Goals
- The goal of treating anterior uveitis should be no cells in the anterior chamber 1
- Treatment aims to induce and maintain remission while minimizing corticosteroid use to reduce adverse effects 4
- Rapid control of inflammation is essential to prevent permanent tissue damage and vision loss 5
Special Considerations
- For infectious causes of anterior uveitis, appropriate antimicrobial treatment must be administered in addition to anti-inflammatory therapy 4
- For anterior uveitis associated with systemic inflammatory disorders, coordination with appropriate specialists (e.g., rheumatologists) is recommended 4
- Periocular and intraocular glucocorticoid injections may be considered at the discretion of the treating ophthalmologist for refractory cases 1