Presentation: ocular pain, photophobia, and excessive tearing; VA not usually affected
Hallmark signs: "cells and flare"
Uveitis can be either acute or chronic.
Chronic is more often associated with the following systemic problems but not limited to, ankylosing spondylitis, Bechets syndrome, IBS, Reiter's syndrome, juvenille rheumatoid arthritis, sarcoidosis, syphilis, Lyme's disease and/or tuberculosis.
Tx:
-Immobilize ciliary body to decrease pain and lessen the problem-Homatropine 5% QID, Scopolamine 0.25% QID, or Atropine 1% BID.
-Stop the inflammatory response-Pred Forte 1% q15 min for the first 6 hours, then continue q1h for the rest of the day. Have the patient follow-up within 24 hrs (at the longest wait 72 hours).
-Depending on the severity of the uveitis, discontinue the cycloplegic and taper the steroid.
Clinical Pearls:
-Don't taper the steroid until the "cells and flare" are gone.
-Treat this aggressively but follow the condition closely.
That's all for today's lesson.
3 comments:
thanks for the review of uveitis lil one! i didnt know we werent suppose to taper steroids until it was controlled...thanks for saving me from a potential law suit! keep these quick reviews coming PLEASE
Definitely, a "by-the-book" treatment plan. However, in the real world, neither homatropine nor scopolamine are ever available at any pharmacy, and atropine will dilate most light irises for at least one week after discontinuation. Cyclopentolate 1% QID is a much more readily available and patient-friendly option that will do the job equally well. This may not help you on a board exam, but it will definitely help you in the clinic.
Whether the steroid is administered as an eye drop, pill or injection depends on the type of uveitis you have. Because iritis affects the front of the eye, Treatment for Uveitis usually treats with eye drops.
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