From the Guidelines
In adults with acute iritis, treatment by an ophthalmologist is strongly recommended to decrease the severity, duration, or complications of episodes. This recommendation is based on the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis 1. When it comes to managing iritis, several key points should be considered:
- Treatment typically involves corticosteroid eye drops, such as prednisolone acetate 1%, administered 4-6 times daily initially, then tapered over several weeks as inflammation resolves.
- Cycloplegic drops like cyclopentolate 1% or atropine 1% are also prescribed 2-3 times daily to prevent painful ciliary muscle spasms and reduce the risk of synechiae (adhesions between the iris and lens).
- For patients with recurrent iritis, prescription of topical glucocorticoids for prompt at-home use in the event of eye symptoms is conditionally recommended to decrease the severity or duration of iritis episodes, as stated in the guidelines 1.
- In cases of recurrent iritis, treatment with TNFi monoclonal antibodies is conditionally recommended over treatment with other biologics, according to the guidelines 1. Regular monitoring during treatment is crucial, typically every few days initially, then weekly as improvement occurs. Oral NSAIDs may help manage pain and inflammation, and if iritis is severe or unresponsive to topical therapy, oral corticosteroids like prednisone may be necessary. Underlying causes such as autoimmune disorders, infections, or trauma should be investigated and addressed to prevent complications including glaucoma, cataracts, and permanent vision loss. Symptoms typically improve within days of starting treatment, but complete resolution may take weeks.
From the FDA Drug Label
INDICATIONS AND USAGE Steroid responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitides, when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation; corneal injury from chemical, radiation, or thermal burns, or penetration of foreign bodies.
- Iritis is listed as one of the steroid responsive inflammatory conditions for which prednisolone acetate (TOP) is indicated 2.
- The drug can be used to treat iritis.
From the Research
Definition and Symptoms of Iritis
- Iritis is a form of uveitis, which is an inflammation of the uvea, the middle layer of the eye 3.
- Symptoms of iritis include a red eye, photophobia, pain, and decreased visual acuity 3.
Treatment of Iritis
- Treatment of iritis typically involves the use of topical corticosteroids, which are effective anti-inflammatory drugs [(4,3,5,6)].
- Topical corticosteroids such as prednisolone acetate 1% are often the first choice in the therapy of patients with anterior uveitis 4.
- Cycloplegic agents may also be used in the treatment of iritis to help reduce pain and prevent complications [(3,5)].
Complications and Side Effects of Treatment
- The use of topical corticosteroids can lead to complications such as corticosteroid-induced glaucoma and corticosteroid-induced cataracts 4.
- Steroid dependency is a common complication of iritis treatment, and adjuvant systemic anti-inflammatory therapy may be necessary to obtain remission 6.
- Other complications of iritis include macular edema and glaucoma 6.
Diagnosis and Management of Idiopathic Persistent Iritis
- Idiopathic persistent iritis after cataract surgery (IPICS) is a distinct clinical entity characterized by an unexpected onset of iritis after cataract surgery 6.
- Diagnosis and management of IPICS involve a slow taper of topical steroids, and adjuvant systemic anti-inflammatory therapy may be necessary to obtain remission 6.
- Meloxicam and methotrexate may be used as adjuvant systemic anti-inflammatory medications in the treatment of IPICS 6.