Other Therapeutic Agents
Topical mydriatic and cycloplegic drugs are beneficial for breaking or preventing the formation of posterior synechiae and for relieving photophobia secondary to ciliary spasm. Short-acting cycloplegics, such as tropicamide and cyclopentolate hydrochloride (1%) or phenylephrine (2.5%), allow the pupil to remain mobile and permit rapid recovery when discontinued.
Oral NSAIDs are used in treatment of mild-to-moderate nonnecrotizing anterior scleritis (see Chapter 7) and may have limited utility in treatment of chronic anterior uveitis (eg, JIA-associated anterior uveitis) and possibly macular edema. Oral NSAIDs may also allow the patient to be maintained on a lower dose of topical corticosteroids. Potential complications of prolonged systemic NSAID use include cardiovascular, gastrointestinal, renal, and hepatic toxicity. (See also BCSC Section 1, Update on General Medicine, for more information.) Topical NSAIDs may be used in mild cases of diffuse episcleritis, as well as in macular edema. In rare cases, severe corneal complications, such as keratitis and corneal perforations, may occur with the use of topical NSAIDs. (For further discussion of NSAIDs and corneal complications, refer to BCSC Section 8, External Disease and Cornea.)
The use of oral carbonic anhydrase inhibitors as an adjunct in treatment of uveitic macular edema is supported by a small but significant body of literature spanning several decades. These agents may be particularly useful in diffuse leakage from the retinal pigment epithelium, rather than in leakage from retinal vessels.
Intravenous immunoglobulin has been reported to be effective in some patients with uveitis that is otherwise refractory to IMT, as well as in patients with mucous membrane pemphigoid.
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.