Treatment of Uveitis

The goal of treatment is to treat the inflammation and check the eyes regularly to help prevent damage and vision loss.  

Eye doctors treat uveitis to relieve pain, prevent vision loss from inflammation and complications of uveitis, and to treat the cause of the uveitis if known. Treatment of uveitis must continue as long as inflammation is active. It is not possible to know how long uveitis will last.

Treating Anterior Uveitis

Eye doctors typically use topical steroids in the form of eye drops or ointments as the first step except in cases where treatment of the underlying problem is the top priority. The strength of the medicine and how often you need to take it will depend on the level of inflammation in your eye.

Vision loss from iritis can usually be prevented if diagnosed and treated. Eye doctors treat iritis with steroid (corticosteroid) eye drops and eye drops (mydriatic eye drops) that dilate (widen) the pupils. This helps prevent scarring. Mydriatic eye drops can also help prevent the iris from “sticking” to the eye’s lens, a complication of anterior uveitis.

If the uveitis does not respond to drops or ointments, the doctor may inject steroids next to the eye. Rarely, doctors will prescribe steroid pills to treat anterior uveitis.

If anterior uveitis causes increased pressure in the eye, the doctor may prescribe eye drops that help lower eye pressure to prevent damage to the optic nerve.

Doctors will also treat any known condition that is causing the uveitis.

Treating Intermediate and Posterior Uveitis

It is very important for the doctor to try and determine the underlying cause of the inflammation. Infectious causes require the use of an anti-infective agent. For non-infectious causes, the goal of therapy is to get the inflammation under control, quickly. This can be done by the use of corticosteroids. If the inflammation is in one eye only, the eye doctor may first try a steroid injection to the outside of the eyeball. If the eye does not respond or in the cases where both eyes are involved, the doctor will prescribe steroid pills. If inflammation is very severe and/or the patient cannot take pills, the doctor will administer steroids via an IV method.

Medicine from eye drops and ointments will not reach the back of the eye to treat the inflammation of posterior uveitis. Eye doctors must often prescribe steroid pills to treat the inflammation. If the uveitis is caused by an infection (a virus or other infection), then the treatment for that condition will involve anti-infective agents.

Side effects of injections around the outside of the eye include drooping of the lid, fibrous tissue formation, possible perforation of the eyeball. Moreover, since the effects last for only three months, patients may require multiple injections.

Since pills will affect the whole body, and not only the inflammation in the eye, the patient is more likely to experience side effects from the medicine. Side effects of steroid pills can include:

  • nausea
  • heartburn
  • increased appetite, weight gain and fluid retention
  • mood changes/psychosis
  • high blood pressure
  • diabetes
  • thinning of the bones (osteoporosis)
  • bruising
  • impeding growth in children
  • cataracts
  • increased pressure in the eye
  • moonface
  • increased risk of infection, impaired wound healing
  • skin capillary fragility
  • heart problems

Your doctor will look for side effects caused by steroid use. But ask your doctor if you have any questions about side effects.

Eye doctors know that the long-term use of steroids may have serious side effects for patients, so a common goal of uveitis treatment is to slowly lower the dosage of steroids and then stop steroid treatment completely. Doctors work to bring the inflammation under control with the lowest amount of steroids needed. There are also a number of non-steroid anti-inflammatory medicines that are also often used to treat uveitis.

Many patients with chronic noninfectious posterior uveitis may benefit from a new therapy involving a long-acting drug implant. The drug product is surgically implanted into the eye and is designed to release steroids directly into the back of the eye for approximately 2 1/2 years. By delivering the drug directly to the back of the eye, this procedure seeks to reduce or eliminate many of the side effects common to oral steroids. The most common side effects of this treatment are non-systemic and include cataract progression, increased pressure in the eye, and procedural complications and eye pain.

For some patients with chronic uveitis, eye doctors may prescribe nonsteroid anti-inflammatory drugs. These drugs can be an effective way to treat inflammation over a longer period of time. This treatment is not used very much.

Even when the cause of uveitis is unknown, the uveitis may be related to problems with the body’s immune system. Autoimmune diseases are conditions in which parts of the body are attacked by the body’s own immune system.

Treatments that weaken the body’s immune response have been effective in treating some kinds of uveitis. These drugs may be an option for some patients who have flare-ups of uveitis despite treatment with steroids and nonsteroid anti-inflammatory medicine.

Treating Uveitis in Children

Side effects of long-term steroid use may cause special problems for children being treated for chronic uveitis, including slowing down normal growth, so eye doctors are very careful in how they prescribe medicines to treat the inflammation.

If uveitis is diagnosed, different types of eye drops may be prescribed. Mydriatic drops may be prescribed, which dilate the eyes to keep the pupils open and help prevent scarring.

Steroid drops may be prescribed to reduce swelling and inflammation. However, long-term use of steroid eye drops can have significant side effects. Nonsteroid eye drops are also available.

If eye drops are not effective in decreasing the inflammation, oral steroids (taken by mouth) may be prescribed. Other agents which affect the immune system but which are not steroid based include oral or injectable methotrexate. It is now often used to treat significant eye inflammation, so the long-term side effects of steroids can be avoided.

Uveitis and Pregnancy

If you are being treated for uveitis and are thinking about getting pregnant or become pregnant, it is important to discuss the situation with your eye doctor. Your eye doctor will be able to tell you if any of the medicines you are taking have any special risks related to pregnancy.

Uveitis and Breastfeeding

Steroids can be present in breast milk, so it is important to tell your eye doctor if you are breastfeeding.