By: Robert M. Beardsley, M.D.
So, onward with uveitis! So how do we treat uveitis? As I blogged about last time, uveitis is inflammation of the eye, in particular the iris, ciliary body, or choroid, that is caused by a host of etiologies. Infections can cause uveitis (which is why we always test folks for common infections); systemic inflammatory diseases can also cause uveitis; and many times we find no underlying cause.
Sometimes your ophthalmologist will determine that uveitis is caused by infections, such as syphilis, herpes virus, toxoplasmosis, or tuberculosis. There are thousands of organisms that can infect your eye, but certainly these are the most common causes of uveitis. When a bacteria or virus or parasite causes eye inflammation, it is called infectious uveitis and fortunately overall it is not very common. However, as you would expect, in order to treat infections, they must be neutralized with antibiotics specific to the organism. This can be penicillin, anti-TB therapy, anti-virals such as acyclovir, or a whole host of different anti-parasitic drugs if that it was is causing the infection and subsequent inflammation. These medications can be given as a pill, as an intravenous infusion, or as an injection into the eye. Topical antibiotics are generally not useful in the treatment of uveitis; though they might help if the cornea or conjunctiva are infected. Often, I will give people topical steroids and sometimes oral prednisone (another steroid) to help speed resolution of the inflammation but only when they take antibiotics at the same time.
More common than infections are systemic inflammatory diseases as a cause of uveitis. These can be diseases like HLA-B27 disease, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or sarcoidosis. In these cases, since there is no infection, antibiotics serve no role in the treatment. The treatment is reducing inflammation with anti-inflammatory medications. We like to think of them as a ladder corresponding to disease severity. Many cases can be treated with eyedrops of steroids for a few weeks; the lowest and easiest rung on the ladder. While this does not treat the underlying cause (ie. Does not treat Crohns’ disease with an eyedrop), it can make the disease quiet down in the eye and reduce the symptoms of redness and pain. If drops are not effective, then either an injection of steroid next to the eye or in the eye can be given.
While this sounds super scary, the eye is numbed up and the procedure is painless. Just have to not be too stressed out! Injections work quite well when drops fail and if people cannot take the last step up the ladder, pills. Prednisone is a corticosteroid, not a body building anabolic steroid, but a strong anti-inflammatory steroid. It works very well for acute control of inflammation in people with vision threatening uveitis. However, prednisone is not without side effects which is why we endeavor to get people off of the medication as soon as the disease is controlled. Usually, patients are on prednisone for a month or two and tapered slowly to zero milligrams. In very severe cases, we can give steroid through an IV, but this usually has to be done at an infusion center or hospital.
Photo Credit: Mansarovar Eye Hospital