From the Guidelines
Iritis treatment should always be initiated under the guidance of an ophthalmologist to decrease the severity, duration, or complications of episodes. The primary goal of treatment is to reduce inflammation and prevent complications. For acute iritis, treatment typically involves corticosteroid eye drops, such as prednisolone acetate 1%, starting with one drop every 1-2 hours while awake, then gradually tapering as symptoms improve 1. Cycloplegic drops like cyclopentolate 1% or atropine 1% are added to reduce pain and prevent complications by paralyzing the ciliary muscle and dilating the pupil, typically used 2-3 times daily.
Treatment Considerations
- For severe cases, oral corticosteroids such as prednisone 40-60mg daily may be necessary, with a gradual taper over several weeks.
- If iritis is associated with underlying conditions like autoimmune disorders, treating the primary condition is essential.
- Non-steroidal anti-inflammatory drugs like ketorolac eye drops may supplement treatment.
- Patients should be monitored regularly during treatment to assess response and adjust medication accordingly.
- Prompt treatment is crucial to prevent complications like synechiae (adhesions), cataracts, and glaucoma.
- Recurrent iritis may require maintenance therapy or immunomodulatory drugs to prevent future episodes, with treatment with TNFi monoclonal antibodies conditionally recommended over treatment with other biologics 1.
Recurrent Iritis Management
- Prescription of topical glucocorticoids for at-home use is conditionally recommended for prompt treatment at the onset of symptoms 1, but this should be done under the guidance of an ophthalmologist and as part of a care plan that includes regular monitoring.
- The choice of treatment should be individualized based on the patient's specific condition, medical history, and response to previous treatments.
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. Iritis and iridocyclitis
The treatment for iritis includes the use of prednisolone acetate ophthalmic suspension 1% 2 and prednisone 3.
- Prednisolone acetate ophthalmic suspension 1% is used for the treatment of steroid-responsive inflammation of the anterior segment of the globe 2.
- Prednisone is used for the treatment of iritis and iridocyclitis 3.
From the Research
Iritis Treatment Options
- Topical corticosteroids are a common treatment for iritis, with prednisolone acetate 1% being a frequently used option 4
- Nonsteroidal anti-inflammatory drops, such as 0.1% nepafenac, may also be effective in controlling inflammation after laser peripheral iridotomy (LPI) 5
- Mydriatic and cycloplegic agents may be used in conjunction with corticosteroids to manage iritis symptoms 6
Comparison of Topical Steroids
- A study comparing the efficacy of different topical steroids for acute anterior uveitis found that loteprednol etabonate 0.5% (Lotemax) and prednisolone acetate 1% (Pred Forte) were consistently effective in reducing inflammation 7
- Dexamethasone Na phosphate 0.1%, fluorometholone 0.1% (FML), and generic prednisolone acetate 1% (PRED A) were also found to improve clinical signs, but to a lesser extent 7
Corticosteroid-Sparing Agents
- Conventional systemic immunosuppressants, such as alkylating agents (cyclophosphamide and chlorambucil), antimetabolite agents (methotrexate, mycophenolate mofetil, and azathioprine), and antibiotic/calcineurin inhibitors (cyclosporine, tacrolimus, and sirolimus), may be used as corticosteroid-sparing agents in the treatment of iritis 8
- These agents can help minimize the side effects of long-term corticosteroid use and are often indicated as first-line therapy for systemic inflammatory diseases with destructive ocular sequela 8