Topical corticosteroids
A common treatment for uveitis is topical steroid drops. These steroids are different from the steroids that some athletes take to build muscle mass. The accompanying table lists examples of topical steroids. Prednisolone acetate is one of the most common topic steroids. Although generic version of prednisolone acetate is available, many physicians prefer to recommend a brand name such as pred forte.

Doctors usually prescribe topical corticosteroids if your inflammation includes swelling toward the front of the eye. Topical corticosteroids have limited benefit for forms of uveitis that are more posterior (toward the back of the eye), because they fail to reach that portion of the eye.

In general, topical corticosteroids are extremely safe and well tolerated. About one person in twenty will experience a rise in eye pressure from the topical corticosteroids. This is known as glaucoma. If the pressure rise is longstanding or severe, the optic nerve at the back of the eye is irreversibly damaged. Doctors closely monitor the pressure in the eye when patients use corticosteroids drops. However, it is critical to remember that the inflammation itself can sometimes raise the pressure in the eye. Often times the physician may have difficulty determining whether the steroid drop or the disease is causing the pressure elevation. Drops can lower the pressure in the eye and your physician may recommend these as well as a part of the uveitis treatment.

The chronic use of a topical steroid may lead to a cataract. A lens is present within the eye. As part of the normal aging process, this lens becomes cloudy. This cloudiness is known as a cataract. Frequent chronic use of topical steroid drops will accelerate cataract development. However, untreated inflammation will also cause a cataract. Consequently, the steroid drops inhibit cataract formation by reducing inflammation while promoting cataract formation as a side effect of the drops. By frequently examining your eyes, your physician will advise you on an amount of topical medication appropriate for the intensity of your inflammation.

Steroid drops may interfere with your body's ability to heal a scratched cornea. The steroid drops also interfere with your body's ability to resolve an infection such a herpes infection on the surface of the eye. Although, it is important to start steroid drop at the earliest evidence of iritis, it is also important that infection or damage to the cornea are not present. An allergic reaction to a steroid drops is rare, but allergies can develop to some of the preservatives present in the drops.

Contact lens wearers can use steroid drops. However, the material in the drops may require frequent cleaning of the lens.

Eye drops can drain through the corner of the eye into the nose and the back of the throat. You can minimize this by using gentle pressure at the inside corner of the eye for about two minutes after putting in the drop. Alternatively, squeezing the eye and holding it gently shut after placing the drop in the eye accomplishes a similar result.

Oral Corticosteroids
Another treatment uses a hormone known as corticosteroid. This is usually in the form of a pill known as prednisone. Normally the body produces the equivalent of about 7.5 mg of prednisone per day. Variable amounts of prednisone can reduce inflammation. The side effects of prednisone depend upon the individual, the dosage of therapy, and the duration of therapy. The accompanying table lists some of the side effects associated with prednisone therapy.

Prednisone works quickly to reduce the inflammatory response. It is one of the most potent anti-inflammatory medications known. However, doctors prescribe it cautiously because of numerous side effects. In addition, the benefits from prednisone may diminish with long standing use, as the body seems to adjust to chronic dosage.

Prednisone is usually taken in the morning since the body tends to produce its own cortisone in the early morning. People tolerate prednisone better with food since this drug can increase acid production, and lead to heartburn or ulcers at higher dosages. The body can become dependent upon prednisone. Consequently patients who use prednisone for longer periods of time need to reduce prednisone dosage gradually. Patients on prednisone therapy should carry a card listing this medication.

Patients who have surgery or who are in an emergency situation such as a serious motor vehicle accident will need to receive extra amounts of prednisone temporarily since the body normally responds to stress by producing its own cortisone and its ability to respond to stress disappears when one is taking prednisone by mouth.

Corticosteroid side effects include:

• Weight gain
• Facial puffiness
• Fluid retention
• Mood change
• Sleep disturbance
• Acne
• Lowered resistance to infection
• Diabetes
• Easy bruising
• Osteoporosis
• Glaucoma
• Cataracts
• Adrenal suppression
• Ulcers

Periocular Corticosteroids
You may receive an injection of a corticosteroid medication if the inflammation didn’t respond to cortisone drops. For most patients, a local injection of a cortisone-like medication is safer than the options for treatment with oral therapy. However, cortisone injections usually need repeating and may not be as effective as oral medications for some individuals.

Injections around the eye of cortisone-like medications are usually very safe. If an infectious process is present in the eye, the body's response to the infection is reduced by the injection and the infection can progress. Although infections are usually easy to recognize within the eye, this isn’t always the case. Your physician will ordinarily take precautions to be sure that the medication is not being used to treat an infectious cause of uveitis.

In some people the cortisone medication elevates the pressure within the eye. This is rarely a problem, but because the medication may last for several months, the pressure rise can be serious in a rare individual. Occasionally it is even necessary to remove the injected material, but the frequency of this problem is probably less than one injection per 1000. Your doctor will probably check you several weeks after the cortisone injection to make sure that the pressure hasn’t risen excessively and to assess the benefit from the medication.

Other potential problems from the injection include developing a cataract. Steroid drops, steroid pills, or the inflammation itself can also cause cataracts. The injection rarely affects the eyelid, but could cause some droopiness of the upper lid. It can also cause skin atrophy or loss of some of the fat that surrounds the eyeball, though these are rare occurrences.

If the needle from the injection enters the eye itself, complications such as a retinal detachment could occur. Physicians take great care to try to avoid this unusual complication. Local discomfort or bleeding can occur with any injection. The injection can be repeated as often as monthly. Different forms of medication have different potencies and different duration of action. While potential complications are associated with any approach to therapy, in general, corticosteroid injections are safer than many of the other approaches to uveitis therapy.

Methotrexate
Methotrexate is one of the most popular medications for treating moderately severe autoimmune diseases in which white blood cells primarily attack the joints. Methotrexate was originally developed as a cancer chemotherapy drug. Treatment doses for autoimmune diseases are approximately 1/100 to 1/1000 of the doses for treating cancer. Methotrexate in general is a safe medication. Methotrexate is taken by mouth or by injection. Most patients prefer to use a pill, although the shot is often better absorbed and may reduce the nausea that patients occasionally experience.

Patients usually take methotrexate just once a week or on one day of the week. It may produce some intestinal upset, nausea, or diarrhea on the day of its use. It occasionally causes mouth sores, hair loss, and fatigue. Women who are pregnant or are trying to become pregnant shouldn’t use this medication. Methotrexate causes miscarriages. Methotrexate doesn’t, however, alter a woman’s ability to become pregnant after the medication is discontinued.

Methotrexate can cause cirrhosis or chronic liver damage. Methotrexate isn’t usually the treatment of choice for patients with a history of previous hepatitis or heavy alcohol use. It’s important for patients to limit alcohol intake while on methotrexate therapy. They should also receive periodic laboratory tests to assure normal blood counts and healthy livers. On rare occasions, it is necessary to perform a liver biopsy to insure the safety of methotrexate.

Some physicians order blood tests to be sure that patients haven’t had exposure to viruses that cause hepatitis prior to starting methotrexate therapy.

A very rare but serious side effect from methotrexate is lung inflammation. This may require hospitalization and oxygen therapy for a few days.

Although methotrexate suppresses the immune system, in general colds and flu do not occur more frequently among patients taking methotrexate. Patients on methotrexate are probably more predisposed to develop shingles, a painful infection due to the virus that causes chicken pox. However, this infection remains rare even among patients on methotrexate therapy.

The immune system is probably important in eliminating cancers from the body as they develop. Methotrexate may interfere with the body's ability to perform this so-called immune surveillance. However, if cancers are more common among patients who take methotrexate, the increase is very slight and may even be non-existent.

Call your doctor if you develop a temperature greater than 101 while on methotrexate or if you are considering elective surgery while on methotrexate. The treatment can impair wound healing or increase the likelihood of developing an infection at the time of the surgery.

Azathioprine (Imuran)
Azathioprine is a drug that is similar in potency to methotrexate in treating uveitis and other autoimmune diseases. Like methotrexate, it was originally a treatment for cancer. The dosages to treat autoimmune disease are lower than the dosages used in cancer treatment. Imuran is taken as a pill, usually once per day. Side effects of imuran include nausea and, occasionally, hair loss. Allergic reactions to imuran can occur including flu-like symptoms with fever, and abnormal laboratory tests sometimes develop several days after imuran therapy is begun. When you stop taking the medication the problem resolves itself.

Women should not become pregnant while taking imuran therapy. Imuran lowers the sperm count of a male. Imuran may lower one's white cell count and it is important that periodic laboratory tests insure that the blood counts are normal while on this therapy.

Call your doctor if you develop a fever greater than 101 while on imuran therapy.

Imuran interacts with a drug that treats gout called allopurinol. You doctor will need to adjust your dosage if you are taking this medication.

Cyclophosphamide (Cytoxan)
Cytoxan is an alkylating drug. It is one of the most potent immunosuppressive medications known. It works by poisoning cells in the immune system, the cells that cause autoimmune damage as well as cells that protect against developing infection. Cytoxan therapy can cause lower white count that leads to infection, hair loss, sterility, bladder inflammation, and increased risk of cancer. Bladder and skin cancers are especially common. Cytoxan therapy can be given by vein. In this situation it causes fewer side effects but on the day that it’s given, it generally causes nausea and fatigue. If cytoxan is taken by mouth daily, take it in the morning with additional fluids throughout the day to minimize bladder irritation. Cytoxan requires careful monitoring of white blood cell counts. Women who are pregnant should not take this drug. This drug can damage the ovaries in women of childbearing age.

Cyclosporine
Cyclosporine is an effective medication for treating uveitis in many instances. Cyclosporine helps suppress the function of cells in the immune system without killing those cells. This distinguishes cyclosporine from other medications such as imuran, methotrexate, or cytoxan.

Cyclosporine is a popular medication in treating people with organ transplants. Patients who receive a donated organ such as a kidney will experience their immune system trying to reject this donated tissue. Cyclosporine helps prevent this from occurring.

Cyclosporine is generally taken as a capsule every 12 hours. The dosage depends upon a person’s weight. Side effects can include flu-like symptoms, muscle cramps, tingling, sore gums, and hair growth. The chronic use of cyclosporine can cause kidney damage. Cyclosporine often elevates blood pressure. Patients with high blood pressure (hypertension) usually receive a different type of medication. Periodic laboratory tests and blood pressure determinations are important for patients who are receiving cyclosporine therapy.

Patients on cyclosporine therapy may be more likely to develop infections because a lower immune system. Patients with diabetes may experience a worsening of that disease because of cyclosporine. People should avoid or reduce use of nonsteroid anti-inflammatory drugs such as ibuprofen, motrin, advil, aleve, naprosyn, aspirin, voltaren, or orudis. In addition, cyclosporine interacts with many different medications. Check with your doctor about potential interactions. Other names for cyclosporine include sandimmune or neoral.

Dilating drops
Dilating drops help relieve pain that is sometimes associated with uveitis. This drop also helps to prevent or minimize a complication of uveitis known as synechiae. This complication involves the pupil getting stuck to the lens.

Dilating drops are very safe. The accompanying table shows some examples of dilating drops and how long the drop lasts for most people. Dilating drop can interfere with reading since the pupil is normally small when performing visual tasks close to the eye. Dilating drops can also make one sensitive to light. Consequently if the inflammation is not too severe, your doctor may recommend using the drops only at night to avoid problems with light sensitivity and reading difficulty.

BACK TO TOP