Uveitis Care Medications

Definition

In the medical field, uveitis is defined as any inflammation involving the uveal tract, composed of iris, choroid and ciliary body. To avoid complications, uveitis must be treated promptly: just think that 10-15% of affected individuals become blind. The patients most at risk are men and women aged between 25 and 50 years.

Causes

Exogenous uveitis is the immediate expression of surgery, corneal ulcers, perforating wounds or viral / bacterial / fungal infections. The endogenous variant of uveitis (which constitutes the vast majority of ocular pathologies) appears to be caused by toxoplasma infections, Behçet's disease, rheumatic diseases, Fuchs syndrome; however, it should be pointed out that about 50% of endogenous uveitis does not recognize any precise cause.

Symptoms

The signs that distinguish uveitis can be summarized as follows: alteration / obscuring of vision, pain in the eyes, hypersensitivity to light, red eyes, perception of spots in front of the eyes, presence of white dots in the iris. Symptoms may appear suddenly or gradually, depending on the causative agent, and may involve only one eye or both.

Complications: blindness, cataract (lens opacity), optic nerve damage, retinal detachment, glaucoma

Information on Uveitis - Uveitis Treatment Drugs is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Uveite - Uveitis Treatment Medicines.

drugs

The treatment of uveitis focuses both on reducing inflammation and decreasing symptoms; there is no particular prevention for escaping uveitis, other than protecting oneself from sexually transmitted diseases - such as HIV and syphilis - that could predispose the patient to uveitis.

To reduce inflammation, the most commonly used drugs are corticosteroids, to be taken topically (in the form of eye drops) and / or systemically (oral or intravenous administration); some particularly aggressive forms of uveitis require topical (in the eye) injection of steroid drugs (the injection should be clearly performed by experienced healthcare professionals). In some patients, steroid therapy does not immediately exert the desired therapeutic effect; in cases of gravity, it is conceivable to implant a special device in the eye that is able to slowly release - but continuously - the right amount of drug. The therapy is normally long: it can last, in fact, for 24-30 months.

In addition to corticosteroids, mydriatic and cycloplegic drugs are used in treatment for mild to medium uveitis.

When uveitis is caused by bacterial or protozoan infections (often supported by Toxoplasma gondii ), antibiotics and antimalarials are the therapy of choice, even in the absence of corticosteroids. The same goes for viral infections: viral uveitis can be easily treated with specific antiviral medicines.

In case of severity, when the uveitis does not respond to corticosteroid treatment, a therapy with immunosuppressive drugs is conceivable: this therapeutic approach is generally reserved for patients who show a high risk of blindness.

In cases where the eye is heavily compromised, surgery is the last possible option to save sight: vitrectomy removes the gelatinous material accumulated in the eye (vitreous).

Steroids to reduce inflammation associated with uveitis with unknown aetiology

Dexamethasone (eg decadron, soldesam, Luxazone 0.2%, Visumetazone COLL. 3ML 0.1%, Luxazone UNG. OFT. 3G 0.2%): in the form of eye drops, apply the product 4-6 times a day, or every 30-60 minutes in case of severe infection. Continue therapy until symptoms are reduced. In the form of a cream, apply the product 3-4 times a day. Consult your doctor.
For non-infectious forms of uveitis affecting the posterior segment of the eye, it is possible to use this drug in an alternative way: 1 implant (with 0.7 mg of dexamethasone) can be surgically injected into the vitreous cavity of the eye involved uveitis.
Cortisone (eg Cortis Acet, Cortone): when topical application of corticosteroids is not sufficient to completely cure uveitis, it is possible to take them orally or intramuscularly: it is recommended to take 25-300 mg of the drug per day (depending on the severity of the symptoms), splitting the load into two daily doses.
Triamcinolone (eg. Kenacort, Triamvirgi, Nasacort): indicated to treat uveitis that does not respond effectively to topical standard corticosteroid treatment. The drug is administered intravitreally, at a dose of 4 mg (100 microliters of 40 mg / ml suspension or 50 microliters of 80 mg / ml suspension)
Rimexolone (eg Vexol, eye drops): it is recommended to instill the drug in the eye, in the form of eye drops, at a dose of 1-2 drops during daylight hours, in the first week; proceed, in the second week of therapy, by instilling 1 drop every 2 hours, during the day. Proceed based on the patient's response to treatment.

Other drugs and combinations of corticosteroid drugs used in uveitis therapy:

prednisolone / sulfacetamide sodium (eg Blephamide)
loteprednol / tobramycin (eg Zylet)

Antibiotics for the treatment of bacterial insulted uveitis (monotherapy)

Sulfasalazine (eg Salazopyrin EN): is a drug belonging to the class of aminosilicate antibiotics. For recurrent acute anterior uveitis, it is recommended to start therapy with a dose of 500 mg, to be increased gradually each week. The maintenance dose is expected to take 1 gram of active, twice a day, for a year. Do not exceed 3 grams per day.

Combined drugs: corticosteroids + antibiotics : to speed up the healing time, many antibiotics are combined with corticosteroids, prepared in eye drops or ointments to be applied directly to the conjunctival sac involved in uveitis.

Hydrocortisone associated with neomycin and polymyxin B (eg Mixotone): it is a pharmacological combination consisting of a steroid drug (hydrocortisone) and 2 active antibiotics. This drug fully exercises its therapeutic activity when applied locally. In the form of eye drops, instill in the conjunctival sac of the affected eye (or in both) 1-2 drops of product, every 3-4 hours, to reduce bacterial infection and, at the same time, exert a powerful anti-inflammatory effect. Increase the frequency of administration in the event of severity. These three drugs can also be formulated with bacitracin, a high antibiotic drug.
Dexamethasone + tobramycin (eg TobraDex): also this formulation consists of a steroid (dexamethasone) and an antibiotic. In the form of an ointment, apply a small amount in the lower conjunctival sac, 3-4 times a day. As an ophthalmic suspension, instill 1-2 drops in the lower conjunctival sac every 4-6 hours; it is possible to increase the frequency of administration in case of severe uveitis (every two hours for the first 2 days of therapy).
Gentamicin / prednisolone (eg Pre-G): for the treatment of bacterial uveitis, it is recommended to instill a drop of product in the conjunctival sac of the affected eye, 2-4 times a day. The drug is also available in the form of an ointment to be applied to the eye 1-3 times a day.

Mydriatic drugs : these drugs have the ability to dilate the pupil, indicated to treat inflammation and eye infections, in order to prevent the formation of posterior synechiae.

Cyclopentolateo (eg. Ciclolux 1% COLL): muscarinic antagonist drug used in the treatment of uveitis. Instill one or two drops into the affected eye. Repeat every 5-10 minutes, as needed.
Omatropin (eg Omatropin LUX 1% COLL): this is a short-acting muscarinic antagonist, indicated for the treatment of anterior uveitis. Instill 1-2 drops in the eye affected by uveitis, every 3-4 hours. The lacrimal sac must be compressed with your fingers for a few minutes after applying the eye drops.
Atropine (eg Atropine LUX, Atropi S FN coll, Atropi S FN ophthalmic ointment): in the form of an ointment, apply 0.3-0.5 cm of product in the conjunctival sac of the eye affected by uveitis, 1-3 times a day. Atropine is also available as a solution to be instilled in the eye: the indicative dosage is to apply 1-2 drops of the drug in the affected eye, 4 times a day.

Immunosuppressive drugs : patients who do not respond to the therapies listed above for the treatment of uveitis, should use suppressive drugs of the immune system:

Methotrexate or methotrexate (eg Methotrexate): indicated for severe forms of uveitis, resistant to steroids. For the dosage: consult a doctor.
Azathioprine (eg Azatiopirin, Immunoprin): for the treatment of choroidal neovascularization, it is recommended to take the drug at a dose of 1-1.5 mg / kg per day, in combination with prednisolone or ciclosporin.
Mycophenate mofetil (eg. Mycophenate mofetil teva): second-choice drug for the treatment of uveitis, to be used even when azathioprine does not fully exert its therapeutic effect. Take approximately 1 gram of drug twice a day. Do not exceed 4 g per day.
Etanercept (eg. Enbrel): indicated for the treatment of severe uveitis in affected children over the age of 3 years. It is recommended to administer the drug at a dose of 0.4mg / kg per dose, up to a maximum of 25 mg. The product should be administered subcutaneously, twice a week.
Adalimumab (eg Humira): injected under the skin, the drug is a powerful anti-inflammatory, to be used as a second choice for the treatment of autoimmune uveitis refractory or associated with idiopathic arthritis. Indicatively, the dosage suggests to administer 40 mg of active every 15 days, up to one year.
Infliximab (eg remicade) intravenously, it is recommended to administer the drug at a dose of 5 mg / kg, in a single IV weekly infusion. Repeat the administration after 2 and 6 weeks. Proceed with an injection every 2 months.

For the glaucoma-dependent forms of uveitis, Toxoplasma gondii infections and autoimmune diseases, the treatment of the underlying disease must be carried out: the healing of the cause causes, in fact, also the removal of uveitis.

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