How to Diagnose and Treat Anterior Uveitis – Episode 21

How to Diagnose and Treat Anterior Uveitis – Episode 21


Anterior uveitis is a potentially devastating condition with significant potential clinical sequelae. Patients typically present with complaints of sore eye and light sensitivity. They normally have diffuse bulbar hyperemia with the injection being greatest in the limbic region. The hallmark of this condition is inflammation in the anterior chamber. This is typically best seen in a completely dark exam room and maximum slit lamp magnification while focusing on the anterior chamber. Inflammation is seen when cells are seen here are present in the anterior chamber. Note that in the posterior portion of the anterior chamber, cells will typically rise because this is the natural flow of aqueous and you will see cells descend in the anterior portion of the anterior chamber, just posterior to the cornea. When the diagnosis of anterior uveitis has been made, it is important to treat patient aggressively. The goals of treatment are three-fold. First, rule out any posterior involvement by dilating the pupil and examining the peripheral retina for signs of inflammation. A cycloplegic agent is typically used to dilate the pupil, as this will make the patient feel more comfortable, as well. Second, minimize long-term damage through proper therapeutic interventions. Third, sequester the inflammation quickly. The standard of care for treating patients with anterior uveitis has been branded PredForte. The literature and anecdotal experience supports the importance of this. Remember to remind your patients to shake the bottle vigorously before using it in order to properly mix the suspension. Now unfortunately, even when the prescription is sent to the pharmacy with the instructions “dispense as written,” there have been times when patients have been given generic Prednisolone Acetate. Make sure to have patients bring in their medicine at their follow up visit to ensure that they are in fact using the prescribed medication. Recently, Difluprednate, commercially available as Durezol, has become available and it is a remarkably effective steroid for patients with anterior uveitis. Durezol is an emulsion, which means that the concentration of the medicine is consistent throughout the bottle. The benefit to this is that patients don’t have to shake the drop before using it. Also, recent studies have shown that Durezol dosed 4 times a day is as effective as PredForte dosed 8 times a day. Additionally, Durezol isn’t available as a generic formulation. Now, after starting treatment with steroids, make sure to monitor intraocular pressures at every follow up visit, as steroids can certainly cause pressure spikes. When treating anterior uveitis, make sure to rule out posterior segment involvement and sequester the inflammation quickly. Ensure patients are using the proper drops by having them bring them in at their follow up appointments. Additionally, monitor IOP’s along with inflammation at the follow up visits. Really keeping these things in mind will help improve patient outcomes, which is ultimately why we do what we do. We hope that this has been clinically insightful.

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