Medical and Surgical Management of Ocular Inflammatory Disease BY AKBAR SHAKOOR , MD
Ocular inflammatory disease, including uveitis, scleritis, and orbital inflammatory disease, can be acute or chronic, infectious, non-infectious, or present as a masquerade syndrome. Therefore, its management is manifold, and a comprehensive medical and ocular history and targeted laboratory workup are critical to appropriate therapy.
ASSESSMENTS
First, it is important to consider and assess for infectious disease to administer the correct antimicrobial therapy if an infectious process is suspected. Physicians should only consider steroids and other immunomodulatory therapy once ruling out infectious processes.
MEDICAL MANAGEMENT
In the medical management of non-infectious uveitis, corticosteroids play a major role, either by themselves in acute disease, as a bridging therapy in conjunction with corticosteroid-sparing immunomodulatory therapy (IMT),
or in patients on systemic medications. They may be administered topically, regionally (periocular or intravitreal), orally, or intravenously depending on the anatomic location and severity of the uveitis. Avoid long-term exposure to corticosteroids, which can cause a litany of ocular and systemic complications. Topical and locally administered corticosteroids may produce cataracts and induce glaucoma. Systemic administration can cause many side effects, including ocular complications, hypertension, weight gain, diabetes, metabolic syndrome, myopathy, osteoporosis, and avascular necrosis of the hip. To manage chronic ocular inflammatory disease, “cortico steroid-sparing” IMT is often used to limit these complications. Immunomodulatory medications may be grouped into conventional agents, which include: Antimetabolites (methotrexate, mycophenolate mofetil, and azathioprine). T-cell inhibitors (cyclosporine and tacrolimus). Cytotoxic medications (cyclophosphamide and chlorambucil).
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