Definitive treatment guidelines have not emerged for CSD because it is a self-limiting illness in many cases, with an overall excellent systemic prognosis. Visual outcomes may be variable, depending on location/severity of intraocular inflammation. A variety of antibiotics, including doxycycline, ciprofloxacin, erythromycin, rifampin, trimethoprim-sulfamethoxazole, and gentamycin, have been used in the treatment of more severe systemic or ocular manifestations, even though their efficacy has not been demonstrated conclusively. A typical regimen for immunocompetent patients older than 8 years consists of doxycycline, 100 mg orally twice daily for 4–6 weeks. For more severe infections, doxycycline may be given intravenously or used in combination with rifampin, 300 mg orally twice daily; among immunocompromised individuals, this treatment is extended for 4 months. Children with CSD may be treated with azithromycin, as safety of ciprofloxacin in individuals younger than 18 years is of concern. The efficacy of oral corticosteroids on the course of systemic and ocular disease is unknown, even though these are frequently used in cases threatening the optic nerve/macula.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.