Uveitis Treatment Strategies - What Works and What Doesn't (2022)


WHAT IS UVEITIS?

Uveitis is the inflammation of the uveal tract, with different approaches available for uveitis treatment. As the underlying issue is inflammation, uveitis treatment is primarily aimed at stopping the biochemical processes that cause and sustain inflammation. There will also be other considerations such as whether the uveitis is caused by infection or autoimmune disease. Various investigations will need to be conducted particularly for recurring or bilateral uveitis. Also important is whether the uveitis has resulted in complications such as cataract and glaucoma.

Uveitis Treatment Strategies - What Works and What Doesn't (1)

(Image adapted from the internet)

(Video) Lecture: Uveitis Therapeutics: Noninfectious Uveitis

Diagram demonstrating the anatomy of the eye. The uveal tract, comprising the iris, ciliary body and choroid, is highlighted in red boxes.

UVEITIS TREATMENT: CORTICOSTEROIDS

Corticosteroids (often just called steroids for short) are the mainstay of treatment for uveitis. By dampening the immune and inflammatory response, steroids help to limit the tissue damage caused by the uveitis.

Steroid eye drops, such as prednisolone and dexamethasone, are usually sufficient for anterior uveitis treatment. This is because the inflammation is at the front of the eye at the level of the iris and ciliary body. The steroid from the eye drops can be absorbed into the eyeball via the cornea to directly act on the inflamed iris. Steroid eye drops are usually given as a course over a few weeks. A typical steroid regime would be 4 times daily for 1 week, 3 times daily for 1 week, twice daily for 1 week, once daily for 1 week and then stop. The treatment regime is altered according to response to treatment. It is not uncommon for those with difficult chronic uveitis to be on one drop of steroid a day on a long-term basis to keep the inflammation at bay.

Steroid injections can also be given for more severe cases of anterior uveitis or uveitis that has affected the back portions of the eye (posterior uveitis). The injections can be given either around the eye (periocular) or into the vitreous cavity in the eyeball itself (intravitreal). Common steroids used for injections include triamcinolone and dexamethasone. The main reason for injections is because the injections will deliver the steroid to where it is required - the back of the eye. The steroid also lasts longer when injected. Hence, the injected steroid will have a stronger and longer effect on the back of the eye than eye drops. Depending on the clinical response, steroid injections may need to be repeated every few months or so. The risk of severe infection of the eyeball following intravitreal steroid injections is around 1 in 1000.

Uveitis Treatment Strategies - What Works and What Doesn't (2)

(Video) Uveitis Therapeutics

To reduce the risk of infection, your ophthalmologist will perform the intravitreal steroid injection under aseptic conditions. You will be awake, but don't worry - your eye will be sufficiently numbed with anesthetic eye drops during the 10-minute procedure.

(Image adapted from the internet)


Systemic steroids are also given for posterior uveitis and sometimes for severe cases of anterior uveitis. Uveitis treatment with steroid tablets involves taking a course of typically prednisone or prednisolone, over a period of several months. Often the dose starts at a high level, such as 60 mg daily, and this is then reduced over the next few weeks. The ideal scenario would be to control your uveitis with a prednisolone dose of less than 10 mg daily. Very occasionally, you may need an infusion of steroid into your veins for very severe inflammation. The main advantage of systemic steroids is that the anti-inflammatory effect covers the entire eye. Systemic administration is therefore very effective for widespread ocular inflammation. However, it is also associated with systemic side effects of steroids.

The problem with steroids is that they will cause wide-ranging side effects. In the eye, steroids can cause the lens to become opaque and form a cataract. They can also elevate the eye pressure sufficiently to cause damage to the optic nerve, thus leading to glaucoma. Elsewhere in the body, steroids can weaken your bones and cause osteoporosis. They reduce the ability of the body's immune system to fight against infection. They can significantly affect blood sugar control for those with diabetes mellitus. They can also cause high blood pressure and gastric ulcers. Steroids will also likely affect your sleep and mood.

Hence, steroids should not be used on a long-term basis if at all possible. However, sometimes the uveitis recurs as soon as the steroids are discontinued. If long-term use is unavoidable, then your ophthalmologist will strive to get you on the minimum possible dose required to control the inflammation. If you are on systemic steroids, it is important that you have regular monitoring of your eye and general health. You may also need to take tablets to strenghten your bones and to protect your stomach from gastric ulceration.

You must not take steroids if you have an active infection. Make sure you discuss your health condition with your ophthalmologist before you start on oral steroid medications.

(Video) Teaming Up to Overcome Challenges in the Diagnosis and Management of Noninfectious Uveitis

UVEITIS TREATMENT: IMMUNOSUPPRESSIVE & BIOLOGIC AGENTS

In severe cases of inflammation, the inflammation does not settle despite prolonged uveitis treatment with systemic steroids. When this happens, additional treatment is required to control the uveitis.

Immunosuppresive agents work by suppressing your body's immune cells, thereby giving additional anti-inflammatory action. Examples of these drugs include Azathioprine, Methotrexate, Mycophenolate mofetil, Cyclosporin A, Cyclophosphamide and Tacrolimus.

Biologic agents are antibodies that can manipulate the inflammatory response in uveitis to achieve control. Examples of biologic agents include Infliximab, Etanercept and Adalimumab.

When used in conjunction with steroids, both immunosuppressive and biologic agents can be very effective uveitis treatment modalities. They are either taken orally or injected, and therefore like steroids, they are also associated with significant side effects. They should only be used under close supervision with specialists experienced in the use of these medications. Side effects include liver failure, kidney failure, reduced immunity against infection and potential increased risk of blood cancers. If you are on immunosuppressive or biologic agents, you will need to undergo regular blood tests.

UVEITIS TREATMENT: OTHER CONSIDERATIONS

(Video) Treating uveitis - clinical challenges in ophthalmology

Mydriatics: These are medications that dilate the pupil. By dilating your pupil, you relax the muscles in the iris and relieve the muscle spasm caused by the uveitis. This makes the eye feel more comfortable and less light sensitive. Mydriatics are also important to break any adhesions between the iris and the lens (posterior synechiae). Mydriatic medications can either be applied as eye drops or given as injections around the eyeball. Examples include: Cyclopentolate, Tropicamide, Phenylephrine and Atropine.

Uveitis Treatment Strategies - What Works and What Doesn't (3)


This is an eye with uveitis that had 360 degrees of posterior synechiae, where the whole pupil was stuck down to the lens surface. Treatment with mydriatic eye drops has successfully broken most of the adhesions, and has allowed the pupil to dilate normally again.

(Image adapted from the internet)


Non-steroidal anti-inflammatory drugs (NSAIDs): These are also anti-inflammatory medications, but work on a biochemical pathway that is different to steroids, hence the term 'non-steroidal'. They are not as strong as steroids, but can be useful against mild forms of uveitis. NSAIDs are taken either as tablets or as eye drops. They have a lower side effect profile and are somewhat safer to take compared to steroids. That said, NSAIDs are known to cause kidney failure and stomach ulcers. Oral NSAIDs that you can buy over the counter include ibuprofen, flurbiprofen, naproxen and diclofenac. Ketorolac and diclofenac are 2 examples of NSAID eye drops.

Intraocular surgery: Sometimes with uveitis, intraocular surgery becomes unavoidable. Vitrectomy surgery to remove the vitreous may be required if there is too much inflammatory debris in the eye or if there is a retinal detachment (retinal detachment surgery). If the uveitis causes a cataract that is impairing vision, then cataract surgery will be required. Having had cataract surgery also helps improve the visualization when your eye is being examined. The uveitis (or the steroid treatment) may cause your eye pressure to become elevated. This may necessitate treatment with pressure-lowering eye drops or even glaucoma surgery if the eye pressure remains uncontrolled.

(Video) Cole Eye Institute Uveitis Symposium

FAQs

What is the best treatment for uveitis? ›

Most cases of uveitis can be treated with steroid medicine. A medicine called prednisolone is usually used. Steroids work by disrupting the normal function of the immune system so it no longer releases the chemicals that cause inflammation.

Which food is not good for uveitis? ›

All of these foods are natural antioxidants and deliver anti-inflammatory effects. Meanwhile, patients should be aware of any processed food, high salt, oils, butter, sugar, and animal products.

How do you treat uveitis without steroids? ›

Adalimumab is a biologic, which controls inflammation by blocking specific proteins in the body. It is also used to treat arthritis, Crohn's disease and several other autoimmune conditions. Humira became the first and only FDA-approved non-steroid treatment for noninfectious uveitis in June 2016.

Does sleep help uveitis? ›

Repetitive episodes of intraocular inflammation pose the risk of tissue damage, glaucoma, cystoid macular edema, cataract and permanent visual disability. Inform your patients that keeping stress levels low and getting adequate sleep each night (seven to nine hours) may help offset the frequency of uveitis episodes.

How do you stop a uveitis flare up? ›

Avoid exotic infections, especially when travelling

Infections are well-recognized as important causes of uveitis. Many infections can cause uveitis, and these include tuberculosis, malaria, Lyme disease, toxoplasmosis, syphilis and herpes (both herpes simplex and herpes zoster).

What herbs are good for uveitis? ›

If you are being treated for uveitis, tell all of your providers about any herbs you are considering taking. Turmeric ( Curcuma longa ): Has antioxidant properties and may help boost the immune system. One small study suggested turmeric may help reduce symptoms of chronic uveitis, but the study was not well designed.

How do I get rid of inflammation in my eye naturally? ›

Aloe vera. Because of aloe vera's anti-inflammatory and antibacterial properties, some natural healers recommend using it to alleviate sore eyes. Mix 1 teaspoon of fresh aloe vera gel into 2 tablespoons of cold water, and then soak cotton rounds in the mixture.

What triggers uveitis? ›

Uveitis can also be caused by an infection, such as: toxoplasmosis – an infection caused by a parasite. herpes simplex virus – the virus responsible for cold sores. varicella-zoster virus – the virus that causes chickenpox and shingles.

Can taking turmeric help uveitis? ›

Turmeric (Curcuma longa): Has antioxidant properties and may help boost the immune system. One small study suggested turmeric may help reduce symptoms of chronic uveitis, but the study was not well designed. Turmeric may increase the risk of bleeding.

Does exercise help with uveitis? ›

(d) Physical activity: physical activity reduces the level of reactive oxygen species to ameliorate the symptom of uveitis.

What foods cause eye inflammation? ›

Artificial trans and saturated fats (found in margarine and processed foods) Vegetable Oils High in Omega-6 Fatty Acids (soybean, grape seed, corn, sunflower, peanut, sesame oils) Refined Carbohydrates (bread, pasta, candy some cereals, cookies, cake, processed food, sugary soft drinks) Excessive Alcohol consumption.

How can I reduce inflammation in my eye? ›

Medicines called steroids can reduce inflammation in your eye. This can ease symptoms and prevent vision loss. Your eye doctor may prescribe steroids in a few different ways: Eye drops.

Can uveitis be cured permanently? ›

Even if a specific cause is not identified, uveitis can still be treated successfully. In the majority of cases, identifying a cause for the uveitis does not lead to a cure. It is still necessary to use some form of treatment to control the inflammation.

What happens if uveitis doesn't go away? ›

Uveitis is a general term used to describe a group of diseases that cause red eyes, eye pain and inflammation. These diseases typically affect the uvea, the eye's middle layer. They can also affect other parts of the eye. If not treated, uveitis can cause permanent blindness or vision loss.

Can stress make uveitis worse? ›

Uveitis is an inflammatory eye condition often related with an autoimmune disease. Although stress as such does not cause uveitis, it can worsen an attack or cause the relapse of the disease.

Can stress bring on uveitis? ›

Therefore stress could be a trigger factor for recurrence, and at such times, patients should be alert to the early signs of uveitis and seek prompt examination by an ophthalmologist. This study tests the hypothesis that stressful life events are associated with the onset of RAAU.

Can stress and anxiety cause uveitis? ›

There are at least two possible causal interactions between stress and uveitis: stress may be a risk factor for inducing the onset of uveitis; or a reaction to the symptoms and limitations imposed by uveitis itself, such as decreased visual acuity.

Why is my uveitis keep coming back? ›

Chronic uveitis is commonly related to an underlying condition or disease, such as an inflammatory disease or autoimmune disorder. Acute uveitis is often the result of an infection or eye injury. Chronic uveitis can lead to complications, such as glaucoma, cataracts, and macular edema.

How long does uveitis take to get better? ›

acute uveitis – uveitis that develops quickly and improves within 3 months. recurrent uveitis – where there are repeated episodes of inflammation separated by gaps of several months. chronic uveitis – where the inflammation lasts longer and returns within 3 months of stopping treatment.

How long does it take for uveitis to clear up? ›

You may be given drops that dilate your pupil to prevent eye spasms and other problems. Dark glasses can help with light sensitivity caused by the uveitis. With treatment, uveitis may clear up in as little as 2-5 weeks although depending on the severity, it may take several months to resolve.

Is warm compress good for uveitis? ›

It is best treated with warm compresses placed on the affected eye(s) several times a day for at least 10 minutes. Your doctor may prescribe pain relievers that can be taken by mouth and/or eye drops that are placed directly in the eye.

Can CBD help uveitis? ›

Retinal inflammation and degeneration in uveitis are caused by oxidative stress. CBD exerts anti-inflammatory and neuroprotective effects by a mechanism that involves blocking oxidative stress and activation of p38 MAPK and microglia.

Can Ayurveda cure uveitis? ›

By getting Ayurvedic treatment, Uveitis is cured permanently. This treatment is preferred over allopathic steroid treatment as there is no side effect involved. Allopathic treatment for uveitis aimed at reducing inflammation and relieving pain in the eye.

How is uveitis prevented? ›

How can uveitis be prevented? Seeking proper treatment for an autoimmune disease or infection can help to prevent uveitis. Uveitis in otherwise healthy people is difficult to prevent since the cause isn't known. Early detection and treatment are important to reduce the risk of vision loss, which can be permanent.

Why is my immune system attacking my eyes? ›

Neuromyelitis optica is an autoimmune disorder that affects the nerves of the eyes and the central nervous system, which includes the brain and spinal cord. Autoimmune disorders occur when the immune system malfunctions and attacks the body's own tissues and organs.

Can Covid trigger uveitis? ›

Few papers reported conjunctivitis and uveitis in COVID-19 patients, but no cases were reported with findings suggesting that the patient could have been infected with COVID-19 and his eye condition lead to the diagnosis of COVID-19.

What medications can cause uveitis? ›

These medications include cidofovir, cobalt, diethylcarbamazepine, pamidronic acid (disodium pamidronate), interleukin-3 and interleukin-6, oral contraceptives, quinidine, rifabutin, streptokinase and sulfonamides. Other systemic medications may cause uveitis.

Can uveitis be cured permanently? ›

Even if a specific cause is not identified, uveitis can still be treated successfully. In the majority of cases, identifying a cause for the uveitis does not lead to a cure. It is still necessary to use some form of treatment to control the inflammation.

How do I get rid of uveitis? ›

What's the treatment for uveitis?
  1. Eye drops. Prescription eye drops are the most common treatment.
  2. Pills. Your eye doctor may also prescribe steroids as a pill.
  3. Injections. In some cases, your eye doctor might put the steroid in or around your eye with a small needle.
  4. Implants.
Nov 16, 2021

How long does it take for uveitis to clear up? ›

You may be given drops that dilate your pupil to prevent eye spasms and other problems. Dark glasses can help with light sensitivity caused by the uveitis. With treatment, uveitis may clear up in as little as 2-5 weeks although depending on the severity, it may take several months to resolve.

What triggers uveitis? ›

Uveitis can also be caused by an infection, such as: toxoplasmosis – an infection caused by a parasite. herpes simplex virus – the virus responsible for cold sores. varicella-zoster virus – the virus that causes chickenpox and shingles.

Videos

1. Non-Antibiotic Strategies for Control of Necrotic Enteritis | Dr. Lisa Bielke
(BIOMIN)
2. Uveitis webinar 2 - Basic Uveitis 2 - February 6, 2021
(Uveitis Webinar)
3. BASIC UVEITIS COURSE Webinar 5
(Uveitis Webinar)
4. Uveitis Webinar 11 (6-11-2021)
(Uveitis Webinar)
5. OCL Webinar - Uveitis
(OCL Vision)
6. Management of Uveaitis
(Kanal Pengetahuan FKKMK UGM)

Top Articles

Latest Posts

Article information

Author: Lilliana Bartoletti

Last Updated: 12/26/2022

Views: 5585

Rating: 4.2 / 5 (53 voted)

Reviews: 84% of readers found this page helpful

Author information

Name: Lilliana Bartoletti

Birthday: 1999-11-18

Address: 58866 Tricia Spurs, North Melvinberg, HI 91346-3774

Phone: +50616620367928

Job: Real-Estate Liaison

Hobby: Graffiti, Astronomy, Handball, Magic, Origami, Fashion, Foreign language learning

Introduction: My name is Lilliana Bartoletti, I am a adventurous, pleasant, shiny, beautiful, handsome, zealous, tasty person who loves writing and wants to share my knowledge and understanding with you.