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. 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. Viruses can be treated with antiviral medicine. Bacterial infections can be treated with antibiotics. Fungal infections can be treated with antifungal medicine. 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. 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. 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. Page last reviewed: 03 January Next review due: 03 January Steroid medicine Most cases of uveitis can be treated with steroid medicine. 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.
Steroid injections If the middle or back of your eye is affected or steroid eyedrops have not worked, you may need steroid injections. You'll usually only require 1 injection while your symptoms are at their worst. Steroids tablets or capsules Steroids tablets or capsules are the strongest form of steroids. Read more about steroids. 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.
The ideal scenario would be to control your uveitis with a prednisolone dose of less than 10 mg daily. Very occasionally, you may need an infusion of steroid into your veins for very severe inflammation. The main advantage of systemic steroids is that the anti-inflammatory effect covers the entire eye. Systemic administration is therefore very effective for widespread ocular inflammation. However, it is also associated with systemic side effects of steroids. The problem with steroids is that they will cause wide-ranging side effects.
In the eye, steroids can cause the lens to become opaque and form a cataract. They can also elevate the eye pressure sufficiently to cause damage to the optic nerve, thus leading to glaucoma. Elsewhere in the body, steroids can weaken your bones and cause osteoporosis. They reduce the ability of the body's immune system to fight against infection.
They can significantly affect blood sugar control for those with diabetes mellitus. They can also cause high blood pressure and gastric ulcers. Steroids will also likely affect your sleep and mood. Hence, steroids should not be used on a long-term basis if at all possible. However, sometimes the uveitis recurs as soon as the steroids are discontinued. If long-term use is unavoidable, then your ophthalmologist will strive to get you on the minimum possible dose required to control the inflammation.
If you are on systemic steroids, it is important that you have regular monitoring of your eye and general health. You may also need to take tablets to strenghten your bones and to protect your stomach from gastric ulceration. You must not take steroids if you have an active infection. Make sure you discuss your health condition with your ophthalmologist before you start on oral steroid medications.
In severe cases of inflammation, the inflammation does not settle despite prolonged uveitis treatment with systemic steroids. When this happens, additional treatment is required to control the uveitis. Immunosuppresive agents work by suppressing your body's immune cells, thereby giving additional anti-inflammatory action. Biologic agents are antibodies that can manipulate the inflammatory response in uveitis to achieve control. Examples of biologic agents include Infliximab , Etanercept and Adalimumab.
When used in conjunction with steroids, both immunosuppressive and biologic agents can be very effective uveitis treatment modalities. They are either taken orally or injected, and therefore like steroids, they are also associated with significant side effects. They should only be used under close supervision with specialists experienced in the use of these medications. Side effects include liver failure, kidney failure, reduced immunity against infection and potential increased risk of blood cancers.
If you are on immunosuppressive or biologic agents, you will need to undergo regular blood tests. Mydriatics: These are medications that dilate the pupil. By dilating your pupil, you relax the muscles in the iris and relieve the muscle spasm caused by the uveitis. This makes the eye feel more comfortable and less light sensitive.
Mydriatics are also important to break any adhesions between the iris and the lens posterior synechiae. Mydriatic medications can either be applied as eye drops or given as injections around the eyeball. Examples include: Cyclopentolate , Tropicamide , Phenylephrine and Atropine.
This is an eye with uveitis that had degrees of posterior synechiae, where the whole pupil was stuck down to the lens surface. Treatment with mydriatic eye drops has successfully broken most of the adhesions, and has allowed the pupil to dilate normally again. Non-steroidal anti-inflammatory drugs NSAIDs : These are also anti-inflammatory medications, but work on a biochemical pathway that is different to steroids, hence the term 'non-steroidal'.
They are not as strong as steroids, but can be useful against mild forms of uveitis. NSAIDs are taken either as tablets or as eye drops. They have a lower side effect profile and are somewhat safer to take compared to steroids.
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