When Your Uveitis Treatment Isn’t Working

If you have uveitis, medications called corticosteroids (aka steroids) are usually the first ones you’ll try.  They work fast to ease inflammation inside your eye.

But there are potential problems with taking steroids for the long term. Taken in high doses or for a long time, they can cause serious side effects like:

  • Brittle bones
  • Diabetes
  • Glaucoma

If a short course of steroids doesn’t ease your symptoms, you and your eye doctor have other options.

Antimetabolites

You might hear these called “steroid-sparing medicines.”

They don’t work as fast as steroids, but you can take them for longer. The most common ones for uveitis are:

  • Azathioprine (Imuran)
  • Methotrexate (Rheumatrex)
  • Mycophenolate mofetil (CellCept)

They control inflammation by powering down your immune system. But they also make it harder for your body to fight off infections. Tell your doctor right away if you have signs of infection like a cough or fever.

If you take these, you’ll need regular blood tests to make sure your liver and bone marrow stay healthy.

Calcineurin Inhibitors

They block an enzyme called calcineurin that sparks inflammation. Examples include:

  • Cyclosporine (Neoral)
  • Tacrolimus (Prograf)

Your doctor may try them when antimetabolites don’t work well enough.

They can cause high blood pressure and kidney problems, so your doctor should check for these often once you start taking them.  

You shouldn’t use cyclosporine if you’re an older adult because it can harm your kidneys.

Biologics

They ease inflammation by blocking the work of chemicals or cells in your body that cause it. If your uveitis is severe or comes back after treatment, your doctor may decide to try one.

You get these powerful medicines through a shot or IV. You should have tests for TB, pneumonia, and other infections before you start treatment. Biologics can make infections worse. They might also raise your chance of some types of cancer.

One biologic has been approved by the FDA for uveitis. It’s called adalimumab (Humira). But doctors sometimes prescribe others that they think might work. If your doctor does, check with your insurance company. It may not cover a medicine if the FDA hasn’t approved it for your condition.

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Steroid Implant

A surgeon places this tiny capsule inside your eye. It’s used for uveitis in the back of your eye, where it’s hard to treat. The implant releases a low dose of steroids for 2 or 3 years.

It may work faster than steroids you take by mouth. But it can cause other eye diseases like glaucoma and cataracts. Scientists are working on an implant that contains less steroid. This might cut down on side effects.

Surgery

A few people may need an eye operation called vitrectomy. It removes the vitreous, the jelly-like part of your eye. Saline, a gas bubble, or oil is used to replace what your surgeon takes out. In time, your eye makes new fluid to fill in the space. After a vitrectomy, you may see more clearly. As with most surgeries, there is a chance of complications. They can include:

  • Bleeding
  • Infection
  • Cataracts
  • Glaucoma

Antibiotics and Antivirals

If an infection caused your uveitis, your eye doctor will prescribe antibiotics or antiviral medicine to treat it. You might take steroids at the same time.  

WebMD Medical Reference Reviewed by Alan Kozarsky, MD on October 22, 2018

Sources

SOURCES:

National Eye Institute.

American Academy of Ophthalmology.

Autoimmunity Reviews: "Immunotherapeutic strategies in autoimmune uveitis."

UptoDate: "Pharmacology of cyclosporine and tacrolimus."

Drug Design, Development and Therapy: "Profile of adalimumab and its potential in the treatment of uveitis."

Nisha Acharya, MD, director, Uveitis and Ocular Inflammatory Disease Service, F.I. Proctor Foundation, University of California, San Francisco.

Retinal Physician: "Pars Plana Vitrectomy in Uveitis Management."

American Journal of Ophthalmology: "Pars Plana Vitrectomy for the Treatment of Uveitis."

American Uveitis Society.

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