Immune-Mediated Uveitis

Clinical Description

Inflammation of the uvea. Usually associated with systemic disease: arthritis,

Signs and Symptoms

• Redness, Photophobia/tearing, Blurred vision/floaters, Circumlimbal injection, flare, cells in anterior chamber, posterior synechiae

Investigations

• FBC, ESR/CRPVDRL/RPR, HIV, serum ACE
• Imaging: Chest xray/CT chest

Treatment

• Treatment of immune-mediated uveitis involves predominantly the use of anti- inflammatory and immunosuppressive agents.
• Mydriatics
• Tropicamide (0.5% and 1%),
• Cyclopentolate (0.5% and 1%),
• Phenylephrine (2.5% and 10%)
• Atropine 0.5% to 1%
• Steroids
• Topical steroids useful only for anterior uveitis because therapeutic levels are not reached behind the lens.
• Periocular steroids
• Therapeutic concentrations maybe achieved behind the lens e.g.

Triamcinolone Acetonide (Kenalog) and depot steroids such as

Methylprednisolone Acetate (Depomedrone).

• Intraocular steroids
• Intravitreal injection of Triamcinolone Acetonide (4mg in 0.1ml) or Slow-release steroid implant (Flucinolone Acetonide) via pars plana. Useful in patients with posterior uveitis.
• Systemic steroids
• Give oral Prednisolone 1mg/kg
• Intravenous injection of Methylprednisolone 1g/day for 3 days.

Antimetabolites

• Azathioprine 1mg/kg/day once a day or in 2 divided doses. Double dose after 1-2 weeks. For Sight- threatening uveitis and as a steroid-sparing therapy in patients with intolerable side effects from systemic steroids
• Methotrexate 10-15mg/week (children can be given 30mg/week) as a steroid- sparing agent in patients with uveitis associated with Sarcoidosis. Folic Acid 2.5- 5.0mg/day is co-administered to reduce bone marrow toxicity.
• Patients must refrain from alcohol.
• Mycophenolate Mofetil 1g every 12hrs which may be increased to 4g daily. A good alternative to azathioprine in unresponsive or intolerant patients.
• Contraindicated in children. Monitoring involves a weekly full blood count for 4 weeks and then monthly.