How is uveitis treated. What are the main types of medication used for uveitis. Why are steroid eye drops the primary treatment for iritis. What are the potential side effects of steroid treatments for uveitis.

Understanding Uveitis and Its Treatment Options

Uveitis is an inflammatory condition affecting the uvea, the middle layer of the eye. The treatment approach for uveitis varies depending on its cause and the specific area of the eye affected. While medication is the primary form of treatment, severe cases may occasionally require surgical intervention.

Primary Treatment: Steroid Medications

Steroids are the cornerstone of uveitis treatment, with prednisolone being the most commonly prescribed medication. These drugs work by suppressing the immune system’s inflammatory response, thereby reducing the symptoms of uveitis.

Forms of Steroid Treatment

• Steroid eye drops
• Steroid injections
• Oral steroid tablets or capsules

The choice of steroid formulation depends on the location and severity of the uveitis.

Steroid Eye Drops: First-Line Treatment for Anterior Uveitis

Steroid eye drops are typically the initial treatment for uveitis affecting the front of the eye, particularly when not caused by an infection. The dosage can range from hourly application to once every two days, depending on the severity of symptoms.

Important Considerations for Steroid Eye Drops

• Temporary blurred vision may occur after application
• Avoid driving or operating machinery until vision normalizes
• Some individuals may experience increased intraocular pressure
• Continue treatment as prescribed, even if symptoms improve

Can steroid eye drops cause complications? While generally safe, some patients may experience increased eye pressure. Regular monitoring by an ophthalmologist is crucial to manage this potential side effect.

Steroid Injections: A Targeted Approach for Persistent Uveitis

When uveitis affects the middle or back of the eye, or if eye drops prove ineffective, steroid injections may be necessary. These injections are typically administered with local anesthesia to ensure patient comfort.

Key Points About Steroid Injections

• Usually require only one injection during peak symptoms
• Rarely cause significant side effects
• May increase intraocular pressure in some individuals

How frequently are steroid injections needed for uveitis? In most cases, a single injection is sufficient to manage symptoms during their most severe phase. However, the ophthalmologist will determine the need for any follow-up treatments based on the patient’s response.

Oral Steroid Therapy: A Powerful Option for Severe Uveitis

Steroid tablets or capsules represent the most potent form of steroid treatment. They are typically reserved for cases where eye drops and injections have been ineffective or unsuitable, or when uveitis affects the back of the eye.

Duration and Side Effects of Oral Steroid Therapy

The length of oral steroid treatment can vary significantly, ranging from a few weeks to several months or even years, depending on the patient’s response and underlying conditions.

• Short-term side effects: weight gain, increased appetite, insomnia, mood changes
• Long-term side effects: osteoporosis, skin thinning, increased infection risk

How can the side effects of oral steroids be minimized? To reduce the risk of side effects, doctors prescribe the lowest effective dose possible. Additionally, gradual dose reduction is essential when discontinuing treatment to avoid withdrawal effects.

Mydriatic Eye Drops: Complementary Treatment for Anterior Uveitis

In cases of anterior uveitis, mydriatic eye drops may be prescribed alongside steroid treatments. These drops dilate the pupils, alleviating pain by relaxing eye muscles and reducing the risk of glaucoma development.

Effects of Mydriatic Eye Drops

• Temporary blurring of vision
• Potential focusing difficulties

Why are mydriatic drops important in uveitis treatment? These drops play a crucial role in managing pain and preventing complications like glaucoma, which can significantly impact vision if left untreated.

Treating Underlying Infections in Uveitis

When an infection is the root cause of uveitis, addressing this underlying condition becomes a critical part of the treatment plan. The approach varies depending on the type of infectious agent involved.

Infection-Specific Treatments

• Viral infections: antiviral medications
• Bacterial infections: antibiotics
• Fungal infections: antifungal drugs

How does treating the underlying infection help manage uveitis? By eliminating the infectious trigger, the body’s inflammatory response can be reduced, leading to an improvement in uveitis symptoms and potentially preventing recurrence.

Immunosuppressants: Advanced Treatment for Refractory Uveitis

For patients who don’t respond adequately to standard treatments, immunosuppressant medications may be recommended. These drugs work by modulating the immune system and interrupting the inflammatory process.

Potential Side Effects of Immunosuppressants

• Skin rashes
• Numbness or tingling sensations
• Gastrointestinal issues (loss of appetite, nausea, vomiting)
• Hypertension
• Headaches
• Hair loss
• Respiratory problems

What precautions should patients on immunosuppressants take? Due to the increased vulnerability to infections, patients should avoid close contact with individuals known to have active infections. It’s crucial to report any signs of potential infection, such as fever or unusual symptoms, to healthcare providers promptly.

Monitoring and Follow-up Care in Uveitis Treatment

Regular monitoring is essential throughout the course of uveitis treatment to ensure its effectiveness and to manage any potential side effects. This typically involves frequent check-ups with an ophthalmologist.

Key Aspects of Uveitis Monitoring

• Regular eye examinations
• Intraocular pressure checks
• Assessment of treatment response
• Adjustment of medication dosages as needed

How often should patients with uveitis have follow-up appointments? The frequency of follow-up visits depends on the severity of the condition and the type of treatment being used. Initially, appointments may be as frequent as weekly, gradually decreasing as the condition stabilizes.

Living with Uveitis: Lifestyle Considerations and Long-term Management

While medical treatment is crucial, patients with uveitis can also take steps in their daily lives to manage their condition and improve their overall eye health.

Lifestyle Tips for Uveitis Patients

• Protect eyes from UV radiation with sunglasses
• Maintain a healthy diet rich in anti-inflammatory foods
• Manage stress through relaxation techniques
• Avoid smoking and limit alcohol consumption
• Get adequate sleep to support immune function

Can lifestyle changes impact the course of uveitis? While not a substitute for medical treatment, healthy lifestyle choices can support overall eye health and potentially help manage inflammation, complementing prescribed therapies.

Emerging Treatments and Research in Uveitis Management

The field of uveitis treatment is continuously evolving, with researchers exploring new therapeutic approaches to improve outcomes and reduce side effects associated with current treatments.

Promising Areas of Uveitis Research

• Targeted biologic therapies
• Novel drug delivery systems
• Gene therapy approaches
• Personalized medicine strategies

What potential benefits do emerging treatments offer for uveitis patients? These new approaches aim to provide more targeted therapies with fewer systemic side effects, potentially improving treatment efficacy and quality of life for individuals with uveitis.

Uveitis treatment requires a multifaceted approach, often combining different medications and regular monitoring to achieve optimal outcomes. While steroid eye drops remain the cornerstone of treatment for many forms of uveitis, particularly anterior uveitis, the management plan may need to be tailored to each individual’s specific condition and response to therapy. As research continues to advance our understanding of uveitis and its treatment, patients can look forward to potentially more effective and less invasive management options in the future. Regular communication with healthcare providers and adherence to prescribed treatments are crucial for successfully managing this complex eye condition and preserving vision in the long term.

Uveitis – Treatment – NHS

Treatment for uveitis depends on what’s causing it and which area of the eye is affected.

Medicine is the main treatment, but in rare cases, surgery may be recommended to treat particularly severe uveitis.

Steroid medicine

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.

Steroid medicines come in different forms, and the type used will often depend on the areas of your eye affected by uveitis.

Steroid eyedrops

Steroid eyedrops are usually the first treatment used for uveitis that affects the front of the eye and is not caused by an infection.

Depending on your symptoms, the recommended dose can range from having to use eyedrops every hour to once every 2 days.

You may have temporary blurred vision after using the drops. Do not drive or operate machinery until your vision returns to normal.

In some people, steroid eyedrops can increase pressure in the eye. The eye specialist (ophthalmologist) will check for this and advise you if this happens.

Do not stop using your eyedrops until a GP or ophthalmologist tells you it’s safe to do stop, even if your symptoms disappear. Stopping treatment too soon could lead to your symptoms returning. The frequency of drops will usually be slowly reduced over a number of weeks.

Steroid injections

If the middle or back of your eye is affected or steroid eyedrops have not worked, you may need steroid injections.

Local anaesthetic eyedrops are used to numb your eye so you will not feel any pain or discomfort.

You’ll usually only require 1 injection while your symptoms are at their worst.

Steroid injections rarely cause significant side effects, but in some people they can make the pressure in the eye increase. The ophthalmologist will check for this and advise you if this happens.

Steroids tablets or capsules

Steroids tablets or capsules are the strongest form of steroids. They’re usually used if steroid eyedrops and injections have not worked or are unsuitable, or for uveitis affecting the back of the eye.

Steroids tablets can cause a wide range of side effects, so will only be recommended if it’s thought there’s a risk of permanent damage to your vision.

How long you’ll have to take steroid tablets for depends on how well you respond to treatment and whether you have an underlying autoimmune condition.

Some people only need to take them for 3 to 6 weeks, while others need to take them for months or possibly years.

Short-term side effects of steroids tablets or capsules can include weight gain, increased appetite, insomnia and mood changes such as feeling irritable or anxious.

In the long term they can cause osteoporosis, thinning of the skin, and an increased risk of infection.

To minimise any side effects, you’ll be prescribed the lowest possible dose to control your symptoms.

Read more about steroids.

Do not stop taking steroids until a doctor says it’s safe to do so. Suddenly stopping your medicine can cause unpleasant withdrawal effects.

When a GP or ophthalmologist thinks you can stop the treatment, they’ll advise you about how to gradually reduce the amount of steroids you’re taking.

Mydriatic eyedrops

If you have uveitis that affects the front of your eye (anterior uveitis), you may be given mydriatic eyedrops as well as steroid medicine.

These eyedrops enlarge (dilate) your pupils and relieve pain by relaxing the muscles in your eye. They can also reduce your risk of developing glaucoma, which affects vision.

However, mydriatic eyedrops can cause some temporary blurring of your vision and problems focusing your eyes.

Treating infection

If an underlying infection is causing uveitis, the infection may also need to be treated.

Viruses can be treated with antiviral medicine. Bacterial infections can be treated with antibiotics. Fungal infections can be treated with antifungal medicine.

Immunosuppressants

Immunosuppressant may be recommended if you’re among the few people who do not respond to the treatments described above.

Immunosuppressants work by controlling the immune system and disrupting the process of inflammation.

If steroid treatment is causing significant side effects, immunosuppressants can also be used to allow your dose of steroids to be reduced.

Possible side effects of immunosuppressants include:

• skin rash
• numbness or tingling in different parts of your body
• loss of appetite
• nausea and vomiting
• high blood pressure
• headaches
• hair loss
• breathlessness

Taking immunosuppressants will make you more vulnerable to infection, so you should try to avoid close contact with anyone who has a known infection.

Report any symptoms of a potential infection, such as a high temperature, cough, or inflammation in other parts of your body, to a GP. You should also have the annual flu vaccine.

Immunosuppressants can also affect the functioning of some of your organs and systems in your body, such as your lungs, liver, kidneys and bone marrow. Regular blood tests are needed to check these systems remain healthy.

A small number of people with uveitis can benefit from treatment with immunosuppressants known as biologics.

Surgery

Rarely, an operation called a vitrectomy may be needed to treat uveitis. It’s usually only recommended if you have repeated or severe uveitis, or if the condition is caused by certain infections.

A vitrectomy involves gently sucking out the jelly-like substance that fills the inside of the eye (vitreous humour). It can be done using either a general anaesthetic or a local anaesthetic.

During the operation, the fluid inside your eye will be temporarily replaced with either a bubble of air or gas (or a mixture of the 2), or a liquid substitute. Eventually, the vitreous humour will naturally replace itself.

Like all operations, a vitrectomy carries a risk of complications. These include needing further surgery and an increased risk of developing cataracts.

Symptom relief

The following measures may help relieve your symptoms:

• wearing dark glasses if your eye becomes sensitive to light
• placing a warm flannel over your eye to soothe it
• taking painkillers, such as ibuprofen, to relieve pain

Page last reviewed: 03 January 2020
Next review due: 03 January 2023

Iritis – Diagnosis and treatment

Diagnosis

Your eye doctor will conduct a complete eye exam, including:

• External examination. Your doctor might use a penlight to look at your pupils, observe the pattern of redness in one or both eyes, and check for signs of discharge.
• Visual acuity. Your doctor tests how sharp your vision is using an eye chart and other standard tests.
• Slit-lamp examination. Using a special microscope with a light on it, your doctor views the inside of your eye looking for signs of iritis. Dilating your pupil with eyedrops enables your doctor to see the inside of your eye better.

If your eye doctor suspects that a disease or condition is causing your iritis, he or she may work with your primary care doctor to pinpoint the underlying cause. In that case, further testing might include blood tests or X-rays to identify or rule out specific causes.

Treatment

Iritis treatment is designed to preserve vision and relieve pain and inflammation. For iritis associated with an underlying condition, treating that condition also is necessary.

Most often, treatment for iritis involves:

• Steroid eyedrops. Glucocorticoid medications, given as eyedrops, reduce inflammation.
• Dilating eyedrops. Eyedrops used to dilate your pupil can reduce the pain of iritis. Dilating eyedrops also protect you from developing complications that interfere with your pupil’s function.

If your symptoms don’t clear up, or seem to worsen, your eye doctor might prescribe oral medications that include steroids or other anti-inflammatory agents, depending on your overall condition.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Preparing for your appointment

Make an appointment with a doctor who specializes in eye care — an optometrist or an ophthalmologist — who can evaluate iritis and perform a complete eye exam.

Here’s some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms, including any that may seem unrelated to your vision problem and when they began
• All medications, vitamins or supplements you take, including doses
• Key personal information, including recent trauma or injury and your family medical history, including whether any family member has an autoimmune disorder
• Questions to ask your eye doctor

Take a family member or friend to your appointment, if possible, to help you remember information you’re given. Also, having your pupils dilated for the eye exam will affect your vision for a time afterward, so it might be helpful to have someone drive you home.

For iritis, some questions to ask your doctor include:

• Can iritis permanently affect my vision?
• Do I need to come back for follow-up exams? When?
• What should I do if my symptoms don’t go away or seem to worsen?
• I have other health conditions. How can I best manage them together?
• Do you have brochures or other printed material I can have? What websites do you recommend?

What to expect from your eye doctor

Your doctor is likely to ask you several questions, such as:

• Do you have symptoms in one or both eyes?
• Do you feel pain in your eye after touching your eyelid?
• Do you have headaches?
• Does bright light worsen your eye pain?
• Is your vision blurred?
• Do you have symptoms of arthritis, such as joint pain?
• Do you have sores in your mouth or on your genitals?
• Have you been diagnosed with iritis before?
• Have you been diagnosed with other eye conditions?
• How are you feeling overall?

Nov. 13, 2019

How do Eye Doctors Treat Uveitis?

Antibiotics, antivirals, or other medications: If the uveitis is caused by a bacterial, viral or fungal infection, then the treatment for that condition will involve anti-infective agents. It may be treated with or without corticosteroids.

Corticosteroids – periocular injection, oral, intravenous (IV): 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 corticosteroid pills. If inflammation is very severe and/or the patient cannot take pills, the doctor will administer steroids through an IV route of administration. Side effects of corticosteroid use should be discussed with your eye care professional. Eye doctors know that the long-term use of corticosteroids may have serious side effects for patients (especially children), 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.

Corticosteroids – implant: Many patients with chronic noninfectious posterior uveitis may benefit from a 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. This procedure seeks to reduce or eliminate many of the side effects common to oral corticosteroids.

Nonsteroid anti-inflammatory drugs: 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.

Immunosuppressive and biologic agents: 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. Immunosuppressive or cytotoxic drugs 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 that affects both eyes, doesn’t respond well to corticosteroids or nonsteroidal anti-inflammatory drugs, or becomes severe enough to threaten vision. They can be swallowed as a pill, injected subcutaneously (under the skin), or infused into the blood within a vein. Taking immunosuppressant agents can make a person more vulnerable to infection. A small number of people with uveitis can benefit from treatment with a type of immunosuppressants known as biologics.

New treatments: A new treatment, corticotropin, is being examined. It is injected subcutaneously to reduce inflammation with less systemic side effects than steroids.

Anticholinergic Agents, Ophthalmic, Corticosteroids, Ophthalmic, Corticosteroid Ophthalmic Implants, Tumor Necrosis Factor Blockers

Author

Monalisa N Muchatuta , MD, MS Resident Physician, Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Monalisa N Muchatuta , MD, MS is a member of the following medical societies: African Federation for Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Society for Clinical Pathology, Emergency Medicine Residents’ Association, Global Humanitarian Health Association, International Federation for Emergency Medicine, National Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Additional Contributors

Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.

Robert E O’Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O’Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Heart Association, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Keith Tsang, MD Resident Physician, Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate, Kings County Hospital

Keith Tsang, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Emergency Medicine Residents’ Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Kilbourn Gordon III, MD, to the development and writing of this article.

How to Treat Your Uveitis

It’s important to get the right treatment for your uveitis as soon as you can. If it’s not taken care of, uveitis can lead to serious eye problems, including blindness.

Your treatment plan should include things to control your inflammation. Treatment can also:

• Ease eye pain
• Prevent the damage to your eyes from getting worse
• Help get back eyesight you’ve lost

What your doctor will prescribe depends on what kind of uveitis you have, where it is in your eye, and if you have it in both eyes. If your first course doesn’t work well, your doctor can switch you to something else.

Corticosteroids

You may know these as steroids. They’re probably the first treatment you’ll try. They block a chemical that causes inflammation.

They can be given in a few different forms.

Eye drops. If your uveitis is at the front of your eye and isn’t caused by an infection, steroid drops probably will be your first treatment.

How often you’ll put these drops in will depend on how much your eyes are inflamed. Use them until your doctor tells you it’s OK to stop.

You may have short-term blurred vision.

Your doctor also may give you mydriatic eye drops to take with your steroids. These drops dilate your pupil, relax your eye muscles, and ease pain. They can lower your risk of glaucoma, too.

Shots. You may need these if your uveitis is in the middle or back of your eye, or if your eye drops don’t work.

The good news is that you may only need one shot. The bad news is that you’ll get it in your eye, usually on the side. Your eye doctor can give you drops to numb the area so you don’t feel the shot.

Pills. If your uveitis doesn’t respond to drops or shots, oral steroids are an option. They can also work if you have disease in the back of your eye. They’re much stronger than other forms of steroids.

Take your steroid pills for as long as your doctor says. Your dose will get smaller toward the end of your treatment. If the pills don’t work, you’ll probably try something else.

If you take steroid pills for a short time, you may have side effects. They can include:

• Weight gain
• Acne
• Anxiety
• Mood changes
• Sleeplessness

In the long term, they can cause more serious problems like:

• Osteoporosis
• Cataracts
• Glaucoma
• Diabetes

Because of all this, you’ll take the lowest dose you need, and only for as long as you have to.

Drugs to Treat Infection

If your uveitis is caused by a viral or bacterial infection, you may need to take an antibiotic or another medication used to fight that type of infection. Once the infection clears, your uveitis should, too.

Immunotherapy

It’s not likely, but uveitis can happen when your immune system attacks your body by mistake. That’s also known as autoimmunity. In that case, you might need to take a drug that powers down your immune system to stop the inflammation.

The drugs you’d take are called immunosuppressants. They include:

• Azathioprine
• Cyclosporine
• Methotrexate
• Mycophenolate

You may need to have blood tests regularly while you take these. This would be to watch for serious side effects, like liver damage.

Targeted Therapies

Biologic drugs target certain parts of your immune system to stop inflammation. You may need these if other uveitis treatments don’t work well enough.
Biologics your doctor may prescribe include:

• Abatacept (Orencia)
• Adalimumab (Humira)
• Daclizumab (Zinbryta)
• Infliximab (Remicade)
• Rituximab (Rituxan)

These drugs can make it harder for you to fight off infections. They also may raise your chance of having certain types of cancer.

Surgery

If your uveitis is severe, if it keeps coming back after treatment, or if it’s caused by some infections, surgeries like these may help:

Vitrectomy. Your eye surgeon can take out part of the gel inside your eye, known as your vitreous humor. Air, gas, or liquid is pumped in to replace what your surgeon takes out, but your eye will eventually fill up the space with its own fluid.

You can have this under either local or general anesthesia.

Implant surgery. A tiny capsule is put into your eye that slowly releases steroids to treat your inflammation. It’s used on uveitis in the back of the eye that’s harder to treat. The implant stays in for roughly 2 to 3 years.

For Symptoms Only

You might also try these therapies to ease symptoms. They won’t treat the cause of your uveitis:

• Drugs for mild pain, like ibuprofen
• A warm towel over your eye to ease aches
• Sunglasses in bright or harsh light to cut glare

The diagnosis and treatment of iritis

Iritis means inflammation of the iris. The term is synonymous with anterior uveitis, when used to encompass inflammation of the iris root and ciliary body, but does not include more posterior inflammation.

It is uncommon, with an estimated annual incidence of 12-15 per 100,000 population. Every age may be affected, although it occurs most commonly between the third and fifth decades. Racial and genetic factors predispose susceptibility.

A triggering stimulus activates the inflammatory cascade that breaks down the blood – ocular barrier and releases white cells and fibrin into the anterior chamber.

The majority of episodes of acute iritis have no identifiable trigger, yet paradoxically it is a feature of many systemic and ocular diseases, especially those with infectious, traumatic and immune aetiology.

Associated conditions
Ocular associations include trauma and infection. Trauma may be surgical, for example cataract surgery, or misadventure causing blunt or penetrating injury.

An especially fierce iritis is produced by retained organic ocular foreign body. Corneal infections cause iritis. Some medications, for example latanoprost drops, are also rarely associated.

Numerous systemic conditions are associated with iritis. Frequent culprits are sarcoidosis, HLA B27 spondyloarthropathies and autoimmune diseases in which altered immunity provokes inflammation of the iris.

Iritis is seen in conditions associated with lowered resistance to infection, as in systemic steroid use, AIDS and herpes zoster, and in infections such as TB, syphilis and other STIs.

Juvenile rheumatoid arthritis is the most common association with iritis in childhood, although granulomatous iritis is often due to sarcoidosis. Typically, iritis associated with active systemic disease responds poorly to standard treatment and may recur frequently.

Diagnosis
Iritis is one of three main intraocular causes of acute red eye (the other two being acute glaucoma and scleritis).

All three are distinguished from external red eye by the symptom triad of reduced vision, pain and photophobia.

In iritis, vision loss and pain are usually less severe, with photophobia being the prominent symptom.

Pen torch examination reveals conjunctival redness most marked around the periphery of the iris and a constricted pupil. If there have been previous episodes, the pupil may appear distorted because of fibrinous adhesions to the anterior lens surface. Commonly, ocular and systemic review is normal.

With slit lamp magnification, white cells can be seen floating in the anterior chamber and adhering to the internal corneal surface (keratic precipitates), sometimes with fibrin strands sticking the pupil to the anterior lens (posterior synecheae).

Severe cases may show clumps of white cells on the anterior iris or posterior cornea (granulomatous uveitis) or a fluid level in the inferior aspect of the anterior chamber (hypopyon).

Systemic investigation is not indicated for the first episode, unless it is unusually prolonged or robust inflammation is present. However, subsequent flare-ups should be worked up fully with immune profile serum ACE, ESR, tests for syphilis and radiology as indicated in the ocular and systemic review.

Treatment
The principles of treatment are to reduce the inflammatory response with topical steroids, such as dexamethasone 0.1% drops 2-4 hourly; to prevent iris adhesion to anterior lens with cycloplegics such as cyclopentolate 1% drops once daily; and to treat the underlying cause if known.

Periocular steroid injection and systemic anti-inflammatory or immunosuppressive treatments may be indicated for very active iritis, although are usually reserved for inflammation involving posterior ocular tissue (pan-uveitis).

Once inflammation is under control, drops are gradually tapered in frequency and/or strength over several weeks as indicated by the response to treatment.

Very mild iritis is probably self-limiting and may not even present.

Complications
Promptly treated, even recurrent iritis has a good visual prognosis. However, if inflammation is not controlled cataract, glaucoma and degenerative corneal change (band keratopathy) occur as a complication of prolonged intraocular inflammation.

Long-term topical steroid use alone may cause cataract and glaucoma, in addition to making the cornea more vulnerable to infection, such as herpes simplex keratitis.

Therefore it is unwise to treat iritis with topical steroids without initial slit lamp examination and subsequent follow up of the treatment response and possible co-morbidities.

Idiosyncratic elevation of intraocular pressure can occur with topical steroids (steroid responder) and may need long-term glaucoma care even though the drops are stopped.

Conclusion
Iritis may present at any age, occurring in genetically-predisposed individuals, often with no apparent systemic association, a good response to topical steroids and no long-term sequelae.

However, iritis may also occur as a manifestation of other systemic or ocular disease and can cause permanent eye damage with consequent loss of sight, especially when managed sub-optimally.

Ms Vafidis is consultant ophthalmic surgeon at Central Middlesex Hospital, London Further reading

• Nussenblatt R, Whitcup S. Uveitis: Fundamentals and Clinical Practice, 3rd ed

• Philadelphia: Mosby/Elsevier Science, 2003.

Causes, Symptoms, Tests and Treatment

What Is Iritis?

Iritis is inflammation of your iris, the colored part of your eye. It’s also called anterior uveitis.

Your iris is made up of muscular fibers that control how much light enters your pupil, the opening in the center, so you can see clearly. It makes your pupil smaller in bright light and larger in dim light.

Iritis can cause serious problems, including vision loss. See your doctor as soon as possible if you have eye pain, redness, or blurry vision.

Iritis Symptoms

Iritis usually comes on quickly and most often affects only one eye. Signs and symptoms may include:

• Pain in your eye or brow area
• Severe eye pain in bright light
• Redness, especially around your iris
• An unusually small or strangely shaped pupil
• Blurry vision or vision loss
• Headache

When to get medical care

Call your eye doctor as soon as possible if you have symptoms of iritis. If you can’t reach them, go to an emergency room.

Iritis Causes and Risk Factors

In most cases, doctors don’t know what causes iritis. Sometimes, it’s tied to eye trauma or other health conditions. Causes of iritis may include:

• Injury from burns, punctures, or strikes with a blunt object
• Conditions such as ankylosing spondylitis, Reiter syndrome, sarcoidosis, inflammatory bowel disease, Behcet’s disease, juvenile rheumatoid arthritis, and psoriasis
• Infections from bacteria and viruses, including Lyme disease, tuberculosis, toxoplasmosis, syphilis, herpes simplex, and herpes zoster
• Infections with parasites, such as toxoplasmosis
• Infections from a fungus, such as histoplasmosis
• Reactions to medications

You might be more likely to get iritis if you smoke tobacco or if you have certain genetic disorders.

Iritis Exams and Diagnosis

Your doctor will ask about your symptoms and your medical history, including whether you have a condition that can cause iritis. They’ll also do exams including:

• A visual acuity test. You might read an eye chart to check your vision.
• Pressure readings. Your doctor will measure the pressure inside your eye with a special device.
• Penlight and slit lamp exams. A small beam of light can give your doctor a good look at your eye. A slit lamp uses a magnifying lens to show more detail. You might get drops to dilate (widen) your pupil first.

If your doctor suspects that another health problem is causing your iritis, they might order blood tests, imaging tests, or tests of the fluid inside your eye.

Iritis Treatment

It’s crucial to start treatment for iritis right away. You’ll probably get medicine and have follow-up visits with your doctor.

Medical treatment of Iritis

Your doctor will prescribe medication to help your eye heal and make you feel better. You might have surgery if your case is severe or if you have complications.

Drugs to treat iritis

Your doctor may prescribe one or more of these medications:

• Eye drops to dilate your pupil and prevent muscle spasms
• Steroids to lessen inflammation. You’ll probably use eye drops first. If your eye isn’t better after a week, your doctor might give you pills or shots around your eye.
• Antibiotics or antivirals to fight infection
• Anticholinergic drugs to block nerve signals for pain and light sensitivity
• Medicines to slow your immune system, if the cause of your iritis is autoimmune.

Iritis treatment at home

Take these steps while you recover:

• Follow the directions on your prescription medications.
• Wear dark glasses if light makes your eye pain worse.
• Take over-the-counter painkillers such as acetaminophen or ibuprofen if necessary.

Follow-up care for iritis

Your doctor might want to check your eye a few days after you start treatment and then see you over the next few weeks to be sure it’s healing the way it should.

Iritis Complications

Without treatment, iritis may cause complications that can lead to permanent vision loss or blindness. These include:

• Clouded lens (cataract)
• High pressure in your eye (glaucoma)
• Scar tissue causing your iris to stick to your lens or cornea (synechiae)
• Inflammation of the vitreous gel inside your eye (vitritis) or of your retina (retinitis)
• Swelling in the back of your eye (macular edema)
• Optic nerve damage
• Calcium buildup on your cornea (band keratopathy)

Outlook for Iritis

Iritis that’s caused by an injury usually goes away within 1 or 2 weeks. Other cases may take weeks or months to clear up. If a bacteria or virus causes your iritis, it will go away after you treat the infection.

Iritis might last a long time or come back if it’s linked to a disease such as sarcoidosis or ankylosing spondylitis. Your eye doctor might tell you to keep steroid eye drops on hand so you can use them at the first sign of inflammation.

90,000 Uveitis, iritis, eye inflammation: causes, symptoms, treatment.

Uveitis is an inflammation of the middle layer of the eyeball, which consists of the iris, ciliary body and choroid. Together they are called the choroid.

Uveitis can occur for a variety of reasons, such as eye trauma and inflammatory diseases.Exposure to toxic chemicals such as pesticides and acids used in manufacturing processes can also cause uveitis.

Uveitis is divided into types depending on the area of ​​inflammation:

• Anterior uveitis – is an inflammation of the iris (iritis) or iris and ciliary body.

• Medium uveitis – is an inflammation of the ciliary body.

• Posterior uveitis – is an inflammation of the choroid.

• Diffuse uveitis (also known as panuveitis) is an inflammation of all areas of the choroid.

This tiny medicinal implant (Retisert, Bausch + Lomb) is surgically implanted into the back of the eye, where it provides a stable supply of the required amount of anti-inflammatory drugs for the treatment of uveitis.

Many cases of uveitis are chronic and can lead to numerous complications such as corneal opacities, cataracts , increased intraocular pressure (IOP), glaucoma , retinal edema or retinal detachment .These complications can lead to permanent loss of vision.

Statistics on the prevalence of uveitis vary by geographic region. However, as a result of a study, based on 522 international articles on the causes and patterns of uveitis, as well as 22 large epidemiological reviews, the researchers concluded that its prevalence is 52.4 cases per 100,000 people.

Symptoms of uveitis

Symptoms of anterior uveitis include:

Middle and posterior uveitis usually goes away without pain.Symptoms of these types of uveitis include blurry vision and floating “flies”, usually in both eyes. Most patients with moderate uveitis are adolescents and people between 20 and 40 years of age.

Diffuse uveitis combines the symptoms of all types of the disease.

What causes uveitis?

Uveitis has dozens of causes, including viral, fungal and bacterial infections. But in many cases, the cause of its occurrence is unknown.

Your optometrist can often determine the cause of uveitis if you have had an eye injury or have an infectious or immunological systemic disorder.

Here are just a few of the diseases that can lead to uveitis:

• ankylosing spondylitis

• herpes simplex

• shingles

• inflammatory bowel disease 9002

• inflammatory bowel disease

• arthritis

  leptospirosis

• lupus

• Lyme disease

• multiple sclerosis

• psoriatic arthritis

• sarcoidosis

• syphilis1111

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In addition, smoking has been shown to be a risk factor for the development of uveitis.

Treating uveitis and iritis

If your ophthalmologist determines that you have uveitis, they will likely prescribe a steroid to help reduce eye inflammation.

The use of steroids as eye drops, tablets or injections depends on the type of uveitis diagnosed. Because iritis affects the front of the eye, it is usually treated with eye drops.

Pills or injections are usually given to treat posterior uveitis. Depending on the symptoms, any of the above methods can be used to treat moderate uveitis.

Steroids and other immunosuppressive drugs can cause many serious side effects such as kidney damage, high blood sugar, high blood pressure, osteoporosis, and glaucoma.

This is especially the case for steroids in pill form, as they require a high dosage in order for a sufficient amount of the drug to reach the back of the eye. Therefore, it is very important to carefully follow the dosage recommendations of the attending physician and have regular check-ups to monitor the progress of treatment.

If you have anterior uveitis, your ophthalmologist will likely prescribe pupil dilator eye drops in addition to steroids to relieve pain. You may also need eye drops to lower intraocular pressure if you have increased intraocular pressure due to uveitis.

If you have a diagnosed systemic disease that may contribute to uveitis, your doctor will treat that too.

If you suffer from light sensitivity (photophobia) with chronic iritis or uveitis, ask your optometrist to prescribe photochromic lenses.These spectacle lenses automatically darken in sunlight, reducing photophobia-related discomfort when going outside.

Page published in November 2020

Page updated April 2021

Irit – Medical center “Liko-Med”

What is iritis?

Iritis is an inflammation of the iris (colored) membrane of the eyeball. The disease causes redness and pain in the eyes, discoloration of the iris, hypersensitivity to light, and blurred vision.The inflammation usually resolves quickly and usually affects only one eye. If left untreated, iritis can cause cataracts, glaucoma, and permanent vision loss. In most cases, surgical treatment removes the symptoms and prevents the disease from affecting the quality of vision.

Ambulance.

If you have any symptoms of iritis, especially severe eye pain, blurred vision, or redness around the iris, see your doctor or hospital emergency department immediately.

What to expect?

With the right treatment, even the most acute iritis attacks disappear in one to two weeks. Sometimes treatment takes much longer: chronic iritis can take several months to heal. To exclude a relapse, the doctor recommends that you carefully monitor your condition. After the inflammation has passed, it is worth being examined by a doctor regularly. If you are at risk of developing chronic iritis, you may be prescribed steroid eye drops to use at the first sign of a relapse.Chronic iritis can cause permanent damage to the eyes and impairment of vision.

Treatment .

The goal of iritis treatment is to prevent eye damage, relieve pain and reduce inflammation. Possible applications:

– Steroid eye drops, which reduce inflammation – in case of moderate iritis.

– Drops in the eyes that dilate the pupil – relaxes the eyes and accelerates the recovery process.

– Antibiotics – for iritis caused by infection.

– Systemic steroid drugs – for the elimination of chronic iritis.

What to do yourself?

Iritis requires medical attention. To relieve symptoms yourself, follow these guidelines:

– Wear dark glasses if light is painful.

– Take pain reliever when there is pain or discomfort in the eyes.

When to see a doctor?

See your optometrist for any visual impairment or unusual changes in the iris.

What to ask a doctor?

1. Are my symptoms related to an underlying medical condition?

2. Do I have any signs of permanent damage to my eyes?

3. What treatment do you recommend?

4. How often should I come for a check-up?

5. When will the symptoms go away?

6. Is there a risk of relapse?

7. What are the warning signs of relapse?

8. What to do if the symptoms of the disease return?

Making a diagnosis.

The doctor checks your eyes and asks questions about your medical history and recent events. The symptoms of inflammation of the iris are very similar to other eye conditions, so a doctor recommends laboratory tests to rule out an infection or autoimmune disease.

Steroid ointments in modern ophthalmic practice | Loskutov I.A.

It is generally accepted that P.Hench et al. [1], who used the drug in patients with rheumatoid arthritis. Since then, steroid hormones have become widespread as powerful anti-inflammatory drugs. Glucocorticoids are adrenocorticoid steroid hormones. In practical medical practice, both naturally occurring hormones (for example, hydrocortisone) and synthetic analogs (for example, dexamethasone) can be used.

The classic signs of inflammation – redness, swelling, fever, pain and loss of function – are determined by changes in vascular permeability, tissue infiltration with leukocytes.Several types of cells are involved in the process at once; the fundamental importance of a number of specific inflammatory mediators has been proven. Glucocorticoids realize their anti-inflammatory effect in several ways at once. They are able to suppress the formation and, to some extent, the activity of inflammatory mediators, the migration of leukocytes, as well as the functioning of immunocompetent cells in the area of ​​inflammation.
The appointment of steroid eye ointments, as well as steroid ointments in general, has quite clear grounds.So, on the one hand, the inclusion of any drug in the ointment base effectively provides a gradual and prolonged release of the active principle, the preservation of the agent on the surface. On the other hand, the disadvantages of ointment preparations are also obvious, especially in ophthalmic practice, expressed, for example, in less ease of use.
Indications for the appointment of steroid ointments are determined as follows. The drugs are proven to be effective in inflammatory lesions of the conjunctiva of the eyelids and eyeball, cornea.They are also used for inflammatory lesions of the anterior segment of the eyeball, for example, with allergic conjunctivitis, acne rosacea, superficial punctate keratitis, iritis, iridocyclitis, corneal lesions with chemical or thermal burns.
The problem of using steroid ointments for infectious conjunctivitis remains to a certain extent open. So, if the risk of worsening the condition of the eyeball due to, for example, a sharp edema, is obvious, then with some infectious lesions of the conjunctiva, the use of steroid ointments is indicated.
Separately, there is the question of the appointment of steroid ointments after surgical interventions on the eyeball and its appendages. After a number of interventions, it is advisable to prescribe steroid drugs, including in the form of ointments.
Under the influence of various factors, the development of newly formed vessels in the corneal tissue is possible. The neovascularization process can be very intense and pose a serious threat to vision. Steroid drugs have the ability to act as highly effective inhibitors of vascular proliferation [2].
Unfortunately, one cannot but dwell on those conditions in which the appointment of steroid ointments is contraindicated. This is, first of all, epithelial treelike keratitis, an acute infectious stage of almost all viral diseases of the cornea and conjunctiva, as well as fungal infection of the eye tissues.
It should always be remembered that long-term use of steroid ointments, as well as steroid drugs in general, suppresses the local immune response. This can lead to the addition of a secondary infection.Another danger of long-term use of steroid ointments is the possibility of developing secondary ocular hypertension or the so-called steroid glaucoma. Such glaucoma, in the absence of compensation for intraocular pressure, leads to the appearance of defects in the visual field and atrophy of the optic nerve. Therefore, if it is necessary to use steroid ointments for a long time, it is necessary to control the level of intraocular pressure at least once every 2 weeks, regardless of whether it is an adult or a child. You should be especially careful when prescribing steroids for conditions accompanied by thinning of the corneal tissue, since steroids can cause perforation.The development of posterior capsular cataracts after prolonged administration of steroids is described.
So, let’s consider some conditions in which the use of, for example, the most common ophthalmic ointment hydrocortisone 0.5% seems appropriate.
A very common pathological condition is blepharitis – inflammation of the edges of the eyelids caused by dysfunction of the meibomian glands, damage to the edges of the eyelids by the parasite Demodex folliculorm and a number of other reasons. Depending on the causative factor, the main therapy is carried out, but for more effective relief of such unpleasant symptoms as edema and hyperemia of the eyelid edges, burning sensation and itching, the appointment of 0.5% hydrocortisone ointment is effective [3, 4, 5].
Atopic keratoconjunctivitis is often diagnosed in patients with atopic dermatitis or eczema. Symptoms consist of a burning sensation, the appearance of mucous discharge, conjunctival hyperemia and photophobia. Small papillae on the conjunctiva differ from those in spring conjunctivitis primarily in size and location. So, papillae with atopic conjunctivitis are smaller and are located more often on the conjunctiva of the lower eyelid. Development of superficial peripheral keratitis with subsequent neovascularization is possible.A short course of application of hydrocortisone ointment relieves clinical symptoms [6, 7].
In fair-skinned people with acne rosacea, it is possible to develop ocular complications in the form of blepharoconjunctivitis. Sometimes the cornea is affected. There is a moderate injection of the eyeball, gray nodules on the bulbar conjunctiva near the limbus, which may ulcerate.
The peripheral cornea can also ulcerate with the development of neovascularization. The disease is chronic with frequent relapses.
An inflammatory lesion of episclera develops, as a rule, in only one eye. The etiology of episcleritis remains unclear, although it is legitimate to associate the development of this disease with such systemic diseases as rheumatoid arthritis and tuberculosis. It is possible to develop episcleritis in Sjogren’s syndrome [8].
Symptoms of episcleritis are hyperemia, pain, photophobia, lacrimation. On examination, local hyperemia, infiltration, edema of the episclera, the adjacent conjunctiva are revealed.As a rule, the disease progresses favorably, although relapses may develop.
Much more dangerous is the appearance of scleritis – a granulomatous lesion of the white membrane of the eye with the development of collagen destruction, cell infiltration and vascular changes. In such cases, topical use of steroid ointments is advisable, but only as an adjunct to the systemic administration of corticosteroids.
An important problem in ophthalmology has been and remains the problem of treating uveitis.According to the location of the affected uveal tissue, in particular, anterior uveitis or iridocyclitis is isolated. Depending on the severity of the lesion, the disease is characterized by pain syndrome, photophobia and decreased vision. There is edema and hyperemia of the iris, a cellular reaction in the moisture of the anterior chamber, precipitates on the corneal endothelium. Along with mydriatics, in almost all cases of iridocyclitis, steroid drops or ointments are required.
One of the forms of damage to the uveal tissue is the so-called chronic cyclitis or pars planites.In this case, the inflammation covers the zone of the conditional border of the anterior and posterior part of the uveal tissue. Most often, the disease occurs in young people with complaints of the presence of floating points in the field of vision. In most cases, both eyes are affected. Typical absence of complaints of pain, photophobia, redness of the eyes. The patient may not even be aware of the presence of an inflammatory lesion in the eye. Pathology can only be detected by a specialist with a detailed examination of the periphery of the fundus.
Steroid ointments may be prescribed in the first phase of therapy.In mild cases, this may be sufficient, although, as a rule, topical steroid injections are more effective [9].
Thus, it is obvious that the spectrum of effective use of ophthalmic steroid ointments, in particular 0.5% hydrocortisone ointment, is very wide.

Literature:

1. Hench PS, Kendall EC, Slocumb CH, Polley HS. Effect of hormone of adrenal cortex on rheumatoid arthritis. Preliminary report. Mayo Clinic Proc. 1949; 24: 181-97.
2. Leopold I. Nonsteroidal and steroidal anti-inflammatory agents. In Surgical Pharmacology of the Eye. 1985; 83-133.
3. Shimazaki J, Goto E, Masafumi O, et al Meibomian gland disfunction in patients with Sjogrens Syndrome. Ophthalmology 1998; 105 (8): 1485-8.
4. Loskoutov IA. Metronidazole treatment for ocular demodicosis. European Journal of Ophthalmology. 1995; (Suppl, 5) N 2a: 247.
5. Ilyin I.I., Loskutov I.A., Loktina V.I. Ocular manifestations of demodicosis.Dermatol Bulletin. and venerol. 1992; 2: 50-2.
6. Gareis O, Lang G. Allergic diseases of the lid, conjunctiva and cornea. Current Opinion in Ophthalmology 1993; 4 (4): 34-40.
7. Leonardi A, Borghesan F, Avarello A. et al. Effect of lodoxamide and disodium cromglycate on tear eosinophil cationic protein in vernal keratoconjunctivitis. Br J Ophthalmology 1997; 81: 23-6.
8. Loskutov I.A., Pavlova M.L., Simonova M.V. Diagnosis and treatment of Sjogren’s disease. Eye 1988; 4: 30-2.
9. Chatzistefanou K, Markomichelakis N, Christensen W, et al. Characteristics of uveitis presenting for the first time in the elderly. Ophthalmology 1998; 105 (2): 347-52.

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Skleritis: description of the disease, causes, symptoms, cost of treatment in Moscow

Scleritis is an inflammatory process that affects the sclera. It is characterized by slow progression.

The eyeball consists of three membranes:

• inner – retina;

• medium – vascular;

• outer – sclera.

The sclera is formed from connective fibers arranged in a chaotic manner. Due to this, they have a white color. Anatomically, the sclera is located next to other structures of the eyeball – the choroid, iris, cornea, ciliary body. Therefore, with the development of the inflammatory process, it passes to all adjacent parts.

The outer shell or sclera itself consists of three layers:

• Surface – episclera.It is based on loose tissue, equipped with a large number of small blood vessels.

• The middle one is the sclera itself. In it, collagen fibers are tightly connected to each other.

• The inner layer is brown or dark. It is named so due to the fact that it is based on many chromatophore cells containing pigment.

Outside, the sclera is protected by a special transparent and thin shell – the conjunctiva.It is formed by a cylindrical stratified epithelium.

There are different forms of scleritis. By morphological nature, it is divided into:

• Anterior – damage to the visible part of the sclera.

• Posterior – an inflammatory process in the posterior part of the sclera, which is not visible on examination. A more rare disease and in most cases has a severe course.

Anterior scleritis may be necrotizing or non-necrotizing.The necrotizing lesion can proceed without inflammation. A non-necrotizing lesion is divided into nodular and diffuse. Also, purulent scleritis is distinguished in the classification.

Among all existing forms, the anterior scleritis has the greatest prevalence – 98% of cases. Posterior scleritis accounts for 2% of cases.

More often, the disease is diagnosed in women – in 70%. The peak incidence is from 30 to 55 years. In childhood, pathology is less common.

Causes of scleritis

Pathology begins to develop for many reasons. The main one is rheumatological diseases. Often scleritis occurs as a result of polyarthritis, rheumatism.

Other diseases that cause scleral inflammation:

• Panophthalmitis.

• Endophthalmitis.

• Corneal ulcer.

• Streptococcal infections.

• Pneumococcal pneumonia.

• Gout.

• Inflammation of the paranasal sinuses.

• Sarcoidosis

• Syphilis.

• Tuberculosis.

• Herpes zoster.

The following factors can initiate the development of the inflammatory process:

• Chemical or mechanical injury to the eye.

• Therapy using ultraviolet beta radiation.

• Removal of the pterygium is a triangular ingrowth near the palpebral fissure, based on the affected conjunctival tissue.

The post-surgical form of the disease can last up to 6 months from the date of the operation.

Scleritis is also a symptom of the following pathologies:

• rheumatoid arthritis;

• recurrent arthritis;

• polyarteritis nodosa;

• systemic lupus erythematosus;

• ankylosing spondylitis;

• Wegener’s granulomatosis.

If the cause of scleritis is an autoimmune disease, then there are frequent relapses.

How does the disease manifest

With the development of scleritis, pain in the eye appears. At the beginning of the inflammatory process, the patient feels discomfort, the pain is inconsistent and moderate. With more severe damage to the sclera, the pain becomes constant and intense, it can shoot in the eyebrow, temple, and jaw.

Outwardly, severe redness of the eye is noticeable, which may have a slightly purple tint.It is this feature that will make it possible to distinguish scleritis from episcleritis. With the expansion of blood vessels, hyperemia covers the entire area of ​​the cornea. Local redness, in one place, covers one quadrant of the eyeball, or extensive and involves the entire surface of the eye, depending on the degree of inflammation. An extensive lesion provokes the development of a necrotic process and the appearance of edematous nodes.

Puffiness with scleritis is explained by the connection of the conjunctiva of the eye with the affected area of ​​the sclera.

Damage to the scleral tissue causes excessive lacrimation. The reason is the irritation of the nerve endings. Lacrimation becomes more severe with severe pain.

If there is a strong infiltration, that is, uncharacteristic elements, particles have penetrated deeply into the membrane tissue, then necrotic processes begin at the site of the lesion, scarring occurs, which slowly thinns the sclera.

The appearance of pale yellow spots on the sclera indicates either the onset of necrosis or its stratification.Sometimes such spots are the only manifestation of latent scleritis.

If retinal detachment or damage to its central zone occurs, visual acuity is significantly reduced. The same complication causes the sclera to melt and the inflammatory process to the tissues that are located deeper.

Vision deteriorates when lesions protrude on the sclera. They are called staphylomas. The development of complications such as astigmatism or other changes in the iris and stratum corneum affects visual function.

Some patients develop photophobia. After stopping the inflammation, grayish spots may remain on the sclera. These are the places where the shell has thinned out. Through them, you can view the ciliary body and the choroid pigment.

Anterior sclerite

Anterior scleritis is characterized by slow progression. With this form of the disease, binocular eye damage occurs. Patients complain of severe pain when touching the site of edema.

With prolonged absence of therapy, pathology affects the sclera around the circumference of the limbus.As a result, severe keratitis and iridocyclitis develop. The purulent form of the disease is dangerous by the rupture of the abscess and the appearance of complications such as hypopyon, iritis.

Necrotic lesion of the outer shell of the eyeball causes increasing pain, which gradually turns into constant. Painkillers don’t work. The pain begins to radiate to the jaw, brow arch, temporal region.

Complications of necrotizing scleritis:

• perforation of the sclera;

• panophthalmitis;

• endophthalmitis.

With necrotizing scleritis, there may be no inflammation. In this case, it is necessary to examine the patient for the presence of rheumatoid arthritis. The danger of the absence of inflammation is that the patient does not receive treatment, there is a gradual thinning of the sclera and its rupture with any mechanical injury.

Non-necrotizing anterior scleritis has the following forms:

• Diffuse.The pathological process affects large areas of the anterior part of the outer connective tissue of the eye.

• Nodular. It is characterized by the presence of one or more lesions of the sclera in the form of nodules. They are static, located above the shell, painted in a faint purple color. In 25% of cases, it leads to a deterioration in vision, while it is considered the most favorable form, since with timely and adequate therapy there is a chance to avoid serious complications.

Inflammation of the sclera can go to the cornea, as a result of which inflammation of the ciliary body, iris, sclerosing keratitis develops. In these conditions, adhesions form between the pupillary edge of the iris and the lens. Possible opacity of the anterior chamber of the eye, the occurrence of precipitates in the posterior wall of the cornea.

Sclerite of the back shell

Posterior scleritis is rarely diagnosed. When contacting the clinic, the patient complains of tension in the eye, pain.In some cases, swelling of the optic nerve, retinal detachment, limitation of the mobility of the eyeball appear.

With damage to the posterior layer of the sclera, pronounced signs may be absent altogether. And when examined by an ophthalmologist, the inflammatory process will not be noticeable.

Most often, scleritis of the posterior membrane occurs as a result of syphilis, tuberculosis, rheumatism or herpes in a patient.

The disease can be diagnosed by a violation of the functionality of the visual organ, retinal edema, eyelid.Accurately confirming posterior scleritis can be done by ultrasound or tomography.

Often, posterior scleritis is a complication and provokes a chronic increase in intraocular pressure, the development of cataracts, keratitis, iridocyclitis.

Scleritis in children

Scleritis in newborns develops as a result of the vigorous activity of bacteria. It is explained by the imperfect immune system of the body. Anterior scleritis is more often diagnosed. There is practically no posterior scleritis in newborns.

With the development of the disease, the baby develops severe pain, which is why he sleeps poorly, refuses to breast, and cries constantly.

With the right treatment, the symptoms go away quickly. If the parents did not go to the ophthalmologist in time, scleritis in a newborn child gives complications that appear for a long time.

In children over one year old, the disease has the same symptoms and course as in adults.

More often, scleritis develops in children suffering from allergic reactions, chronic diseases, metabolic disorders in the body.

Examination and differential diagnosis of scleritis

Signs of pathology develop quickly – within 2 days. It is important to consult a doctor in a timely manner, undergo an examination and receive treatment.

It is necessary to distinguish inflammation of the sclera from other externally similar eye diseases:

• Conjunctivitis.This is an inflammation of the conjunctiva – the mucous membrane of the eye. It lines the inside of the eyelids and the sclera.

• Episcleritis. Has a similar symptomatology with scleritis. The manifestations are less pronounced, there is no decrease in vision. To differentiate diseases, a special test is carried out with an adrenergic agonist solution, phenylephrine.

• Irit. Development of an inflammatory process that affects the iris. It changes its color, the reaction to the action of light is disrupted.Redness appears around the cornea.

• Iridocyclitis. In parallel with the iris, the ciliary body is affected. And since it is responsible for accommodation as a result of a change in the curvature of the lens, the patient’s visual acuity necessarily decreases.

It is impossible to establish an accurate diagnosis based on clinical signs alone. An examination by an ophthalmologist and instrumental examination methods are required.

Diagnosis of scleritis involves the following procedures:

• External examination. Visually, the doctor determines conjunctival edema, hyperemia, damage to blood vessels, the presence of a purulent infiltrate. The edematous zone stands out well, has strict boundaries. On palpation, the patient notes severe pain.

• Ophthalmoscopy. With the help of the technique, it is possible to identify prominence of the optic nerve head, detachment of the choroid and retina, which arise as a result of the accumulation of exudate.

• Biomicroscopy. Allows you to determine the area of ​​overhang of the chemotic conjunctiva over the limbus. There is a brownish-red tint in this place, and the affected area itself has a gelatinous consistency. If there are infiltrates on the cornea, they can also be detected using biomicroscopy. When performing biomicroscopy using a slit lamp, a violation of the vascular pattern is visible, which is characteristic of diffuse scleritis. The method makes it possible to visualize necrotic changes in the sclera, ulcers in the nearest parts of the conjunctiva.In dynamics, the expansion of the necrotic zone is revealed.

• Ultrasound in B-mode. Determines the presence of thickening in the posterior part of the connective tissue membrane of the eye, as well as the accumulation of exudate in the area of ​​the episcleral space.

• CT scan. Shows the change in the thickness of the sclera.

• Fluorescence angiography. The method is effective for necrotizing scleritis.Reveals avascular zones, vascular occlusion zones, and a tortuous course.

• Tonometry. With scleritis, it determines an increase in intraocular pressure above normal.

Forecast and prevention of scleritis

There are no special preventive measures that could prevent the development of scleritis. Non-specific preventive measures involve the timely treatment of chronic diseases, inflammatory processes affecting the sinuses of the nasal cavity (sinusitis).It is important to strictly adhere to the rules of antiseptics and asepsis during eye surgery.

Those who have diabetes mellitus, tuberculosis, rheumatism, sexually transmitted diseases should focus on the treatment of the underlying disease. In the presence of systemic pathologies, it is important to visit an ophthalmologist twice a year for a routine examination.

Anyone who is at risk, for any discomfort in the eyes, should consult a doctor and talk about the main diagnosis.

The prognosis for scleritis depends on a number of factors. This is the timeliness of the diagnosis, the treatment received, the form of the disease and the severity of its course, the cause of the pathology. Diffuse scleritis is considered the most favorable. An unfavorable prognosis is given to those whose scleritis is provoked by Pseudomonas aeruginosa.

Dexamethasone instructions for use: indications, contraindications, side effects – description Dexamethasone eye drops 0.1%: vial. 10 ml 1 pc.(17727)

It should be used with caution in parasitic and infectious diseases of a viral, fungal or bacterial nature (currently or recently transferred, including recent contact with a patient) – herpes simplex, herpes zoster (viremic phase), chickenpox, measles, amebiasis, strongyloidosis ( established or suspected), systemic mycosis; active and latent tuberculosis. Application for severe infectious diseases is permissible only against the background of specific therapy.

It should be used with caution within 8 weeks before and 2 weeks after vaccination, with lymphadenitis after BCG vaccination, with immunodeficiency conditions (including AIDS or HIV infection).

It should be used with caution in diseases of the gastrointestinal tract: gastric ulcer and duodenal ulcer, esophagitis, gastritis, acute or latent peptic ulcer, recently created intestinal anastomosis, ulcerative colitis with the threat of perforation or abscess formation, diverticulitis.

It should be used with caution in diseases of the cardiovascular system, incl. after a recent myocardial infarction (in patients with acute and subacute myocardial infarction, it is possible to spread the focus of necrosis, slow down the formation of scar tissue and, as a result, rupture of the heart muscle), with decompensated chronic heart failure, arterial hypertension, hyperlipidemia), with endocrine diseases – diabetes mellitus ( including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing’s disease, with severe chronic renal and / or hepatic failure, nephrourolithiasis, with hypoalbuminemia and conditions predisposing to its occurrence, with systemic osteoporosis, psychosis, myasthenia gravis , obesity (III-IV degree), with poliomyelitis (except for the form of bulbar encephalitis), open and closed angle glaucoma.

Before and during GCS therapy, it is necessary to monitor a complete blood count, blood glucose levels and plasma electrolytes.

In case of intercurrent infections, septic conditions and tuberculosis, it is necessary to simultaneously carry out antibiotic therapy.

Dexamethasone-induced relative adrenal insufficiency may persist for several months after its withdrawal. Considering this, in stressful situations that arise during this period, hormonal therapy is resumed with the simultaneous administration of salts and / or mineralocorticoids.

When using dexamethasone in patients with corneal herpes, the possibility of corneal perforation should be borne in mind. During treatment, it is necessary to monitor intraocular pressure and the condition of the cornea.

With the sudden withdrawal of dexamethasone, especially in the case of previous use in high doses, the so-called withdrawal syndrome (not due to hypocorticism) occurs, manifested by anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness.After discontinuation of dexamethasone, relative adrenal insufficiency may persist for several months. If during this period stressful situations arise, they are prescribed (according to indications) at the time of GCS, if necessary in combination with mineralocorticoids.

During the treatment period, monitoring of blood pressure, water-electrolyte balance, peripheral blood picture and glycemic level, as well as observation of an ophthalmologist is required.

In children, during long-term treatment, careful monitoring of the dynamics of growth and development is necessary.Children who, during the period of treatment, were in contact with patients with measles or chickenpox, are prophylactically prescribed specific immunoglobulins.

Dexamethasone (eye drops) – instructions for use of the drug

Instructions for use

Trade name

Dexamethasone

International Non-proprietary Name

Dexamethasone

Dosage form

Eye drops 1 mg / ml 10 ml

Ingredients

1 ml contains:

active substance – dexamethasone sodium phosphate in terms of 100% dry matter 1.0 mg;

excipients: boric acid, sodium tetraborate, disodium edetate, benzalkonium chloride, water for injection.

Description

Transparent colorless liquid

Pharmacotherapeutic group group

Preparations for the treatment of eye diseases. Anti-inflammatory drugs. Glucocorticosteroids. Dexamethasone. ATX code S01BA01

Pharmacological properties

Pharmacokinetics

Ophthalmic bioavailability of dexamethasone after topical application to the eye of the drug was studied in patients who underwent cataract surgery.The maximum level of dexamethasone in the intraocular fluid, equal to about 30 ng / ml, was reached within 2 hours. Further, there was a decrease in concentration with a half-life of 3 hours.

Dexamethasone is excreted from the body by metabolism. Approximately 60% of the dose is excreted in the urine as 6-β-hydrohydexamethasone. Unchanged dexamethasone was not detected in urine. The plasma half-life is relatively short – 3-4 hours. Dexamethasone is approximately 77-84% bound to serum albumin.The clearance ranges from 0.111 to 0.225 l / h / kg, the volume of distribution ranges from 0.576 to 1.15 l / kg. The oral bioavailability of dexamethasone is approximately 70%.

Pharmacodynamics

Corticosteroids have an anti-inflammatory effect by inhibiting vascular adhesion molecules of endothelial cells, cyclooxygenase I or II and the release of cytokines. As a result, the formation of inflammatory mediators decreases and the adhesion of leukocytes to the vascular endothelium is inhibited, thus preventing their penetration into the inflamed tissues of the eye.Dexamethasone has a pronounced anti-inflammatory effect with reduced mineralocorticoid effects compared to some other steroids and is one of the most potent anti-inflammatory drugs.

Indications for use

• Treatment of steroid-sensitive non-infectious inflammatory and allergic conditions of the conjunctiva, cornea and anterior segment of the eye, including inflammatory reactions in the postoperative period.

Method of administration and dosage

Use in adults, including elderly patients.

In severe or acute inflammation, 1-2 drops should be instilled into the conjunctival sac of the affected eye (s) every 1-2 hours as initial therapy.

In case of a positive effect, the dose should be reduced to 1-2 drops into the conjunctival sac of the affected eye (s) every 2-4 hours.

Further, the dose can be reduced to 1 drop 3-4 times a day, if this dose is sufficient to control inflammation.

If the desired result is not achieved within 3-4 days, additional systemic or subconjunctival therapy may be prescribed.

For chronic inflammation, the dose is 1 or 2 drops into the conjunctival sac of the affected eye (s) every 3-6 hours, or more often if necessary.

For allergies or minor inflammation, the dose is 1-2 drops into the conjunctival sac of the affected eye (s) every 3-4 hours until the desired effect is achieved.

The duration of the drug use varies from several days to 2 weeks.

Do not stop therapy prematurely (see section “Special instructions” ).

It is recommended to constantly monitor the intraocular pressure.

After instillation, careful eyelid closure or nasolacrimal occlusion is recommended. This reduces the systemic absorption of drugs injected into the eye, which reduces the likelihood of systemic side effects.

If several medicines for topical application in the eye are used simultaneously, the interval between their application should be at least 5 minutes.Eye ointments should be applied last.

Application for violations of the liver and kidneys.

Dexamethasone has not been studied in patients with kidney or liver disease. However, due to the low systemic absorption of dexamethasone after topical application of this drug, dose adjustment is not necessary.

Method of application.

Shake well before use.

To prevent contamination of the dropper edge and suspension, care must be taken not to touch the eyelid, adjacent areas or other surfaces with the edge of the dropper bottle.

Attention! Do not tighten the cap tightly before use! Tighten the cap of the bottle as much as possible before the first use. In this case, the spike, which is located on the inside of the cap, pierces the hole. Immediately before use, hold the bottle with the drug in the palm of your hand to warm it up to body temperature. Unscrew the cap, remove and, slightly pressing on the body of the bottle, drip the solution into the eye. After instilling the drug, screw the cap tightly and store the drug according to the recommendations given in the instructions.

Side effects

Immune system disorders: hypersensitivity.

From the nervous system: dysgeusia, dizziness, headache.

From the side of the visual organs: sensation of discomfort in the eyes, keratitis, conjunctivitis, keratoconjunctivitis dry, corneal coloration, photophobia, blurred vision, itching of the eyes, sensation of a foreign body in the eyes, increased lacrimation, unusual sensation in the eyes, the formation of scales along the edges of the eyelids, irritation eyes, redness of the eyes, increased intraocular pressure, decreased visual acuity, erosion of the cornea, ptosis of the eyelids, pain in the eyes, mydriasis.
Prolonged use of topical corticosteroids in the eye can lead to an increase in ocular pressure with subsequent damage to the optic nerve, deterioration of visual acuity and visual field impairment, as well as to the formation of posterior subcapsular cataracts (see section “Oso b instructions” ).

Since the drug contains corticosteroids, in the presence of diseases leading to thinning of the cornea or sclera, the risk of perforation increases after prolonged use.

Corticosteroids may decrease resistance to infections (see section “Special instructions” ).

Contraindications

• hypersensitivity to the active substance or to any of the components of the preparation
• acute untreated bacterial infections
• Acute superficial keratitis due to herpes simplex
• vaccinia and chickenpox and other viral infections of the cornea and conjunctiva (excluding herpes zoster keratitis)
• Fungal diseases of the structures of the eye
• mycobacterial infections of the eye
• eye tuberculosis
• children under 18 years old
• pregnancy and lactation

Drug Interactions

Specific drug interaction studies for the drug Dexamethasone eye drops have not been conducted.

There are known cases of interactions associated with the systemic use of dexamethasone. However, systemic absorption of dexamethasone with topical ophthalmic application is low, so the risk of drug interactions is minimal.

When using more than one topical ophthalmic drug, the interval between taking the drugs should be at least 5 minutes.

Special instructions

• For ophthalmic use only.
• Prolonged use of topical corticosteroids in the eye can lead to ocular hypertension and / or glaucoma with subsequent damage to the optic nerve, deterioration of visual acuity and visual field impairment, and posterior subcapsular cataract formation. Patients with long-term use of topical corticosteroids in the eye should constantly and regularly monitor intraocular pressure.
• Corticosteroids may reduce resistance to bacterial, viral, or fungal infections, interfere with the detection of such infections, and mask clinical signs of infection by preventing antibiotic failure from being detected.In case of persistent formation of corneal ulcers, the possibility of fungal infection in patients who have been or are being treated with corticosteroids should be considered. Treatment should be discontinued if a fungal infection occurs.
• Corticosteroids applied topically to the eye may delay the healing of corneal wounds.
• It is known that in the presence of diseases that cause thinning of the cornea or sclera, topical application of corticosteroids can cause perforation.
• The drug should be used with extreme caution and only in combination with antiviral therapy in the treatment of stromal keratitis or uveitis caused by herpes simplex; it is necessary to periodically carry out biomicroscopy using a slit lamp.
• It is not recommended to wear contact lenses when treating eye inflammations.
• In addition, this product contains benzalkonium chloride, which may irritate the eye and is known to discolor soft contact lenses. Contact with soft contact lenses should be avoided. Patients should be warned to remove contact lenses before using Dexamethasone eye drops and to wait 15 minutes after instillation before inserting contact lenses.
• Treatment should not be stopped prematurely, as sudden cessation of topical treatment with large doses of steroids may cause re-inflammation of the eye.

Pediatric use

The efficacy and safety of using the drug for children have not been established.

Application during pregnancy and lactation

It is not recommended to use the drug during pregnancy.

Systemic administration of corticosteroids results in their appearance in human breast milk in amounts that may affect a breastfed baby.However, with topical application of the drug, the systemic manifestation is low. It is not known whether Dexamethasone passes into breast milk. The risk to a breastfed baby cannot be ruled out. Consideration should be given to temporarily stopping breastfeeding while using Dexamethasone or stopping / abstaining from drug therapy, given the potential benefits of using the drug for the mother and the benefits of breastfeeding for the baby.

Peculiarities of the drug’s effect on the ability to drive vehicles and potentially dangerous mechanisms

Dexamethasone does not affect or slightly affects the ability to drive vehicles or other mechanisms.As with other eye drops, temporary blurred vision or other visual impairments can affect the ability to drive vehicles or other mechanisms. If blurred vision occurs during instillation, the patient must wait until vision clears up before driving vehicles or machinery.

Overdose

There are no reports of any serious systemic reactions due to drug overdose.

In case of topical application of overdose, rinse the eye (s) with warm water to remove drug residues.

There is no specific antidote for topical application of corticosteroids.

Treatment is symptomatic.

Form of issue and packaging

10 ml each in polyethylene bottles, sealed with caps.

A self-adhesive label is attached to the bottle.

The bottle, together with the instructions for medical use, is placed in a cardboard box.

Storage conditions

Store in original packaging at temperatures between 2 ° C and 8 ° C.

Keep out of reach of children.

Shelf life

3 years

After opening the bottle, the drug is usable for 28 days.

Do not use the drug after the expiry date stated on the package.

Terms of dispensing from pharmacies

Prescription

Manufacturer

PJSC “Farmak”, Ukraine, 04080, g.Kiev, st. Frunze, 74.

Marketing Authorization Holder

PJSC “Farmak”, Ukraine

Name, address and contact details of the organization on the territory of the Republic of Kazakhstan that accepts claims from consumers on the quality of products (goods) and is responsible for post-registration monitoring of the safety of the medicinal product

Representative office of PJSC “Farmak” in the Republic of Kazakhstan

Republic of Kazakhstan, g.Almaty, index 050012, st. Amangeldy 59 “A” Business center “Shartas”, 9th floor.

Tel +7 (727) 267 64 63, fax +7 (727) 267 63 73, e-mail: [email protected]

90,000 Iritis: causes, symptoms, signs, treatment, diagnosis, prevention

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