Uveitis Treatment Isn’t Working?

What to do when your uveitis eye drops or uveitis treatment isn’t working. You have options including new uveitis therapies that are FDA-approved for Uveitis. 

By the end of this article:

  • You will have an understanding of the background of Standard Steroid use in Ophthalmology.

  • Know what the new Treatments are for Uveitis and their possible side-effects.

  • Look at the latest Treatment for Uveitis with a novel HOCL Eye Drop for Infection and Inflammation Control.

Gordon and Mclean first used topical corticosteroids in the 1950s in ophthalmology (1) and it was considered revolutionary. For over 70 years, corticosteroids have been the most common method of treating ocular noninfectious inflammation.

Rather than being an appropriate treatment for the patient, steroids relieve the inflammation as a short-term benefit. Topical corticosteroids are still the main treatment for eye inflammation and pain, including corticosteroid injections because of how fast they work.

An estimated 20% of patients with uveitis develop uveitic glaucoma, which is characterized by progressive optic nerve damage, often associated with intraocular pressure. Corticosteroids and their use are often the cause. As eye pressure rises, the optic nerve becomes damaged. Patients should be made aware that the long-term effects of steroid use can result in devastating consequences. 

Since the optic nerve transmits light and images to the brain, damage causes progressive and sometimes permanent vision loss. Symptoms include:

  • Blurred vision

  • Halos around lights

  • Headache

  • Eye pain

There are potential problems with taking oral corticosteroids/ 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.

Latest Medications for Uveitis

Antimetabolite Medications

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)

  • Tocilizumab (Actemra) is relatively new. It’s FDA-approved for treating giant cell arteritis. In those patients, it’s helped to minimize the long-term side effects of oral steroids, but it also works very well for patients with uveitis. (2)

    Antimetabolite Side-effects

Because this treatment downregulates your immune system it also makes 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 as a Medicine

This therapy blocks an enzyme called calcineurin that sparks inflammation. Examples include:

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

Calcineurin Inhibitors Side-effects

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

This therapy affects 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 Side-effects

Biologics as a therapy can make infections worse. They might also raise your chance of some types of cancer.

One biologic therapy has been approved by the FDA for uveitis. It’s called adalimumab (Humira). The side effects may include pain, rashes, nausea, and sometimes skin cancer.

Steroid Implant Surgery

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.

Steroid Implant Side-effects

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 made by the vitreous that has been removed. After a vitrectomy, you may see more clearly.

Complications of a Vitrectomy

As with most surgeries, there is a chance of complications. They can include:

  • Bleeding

  • Infection

  • Cataracts

  • Glaucoma

Antibiotics and Antivirals

If an infection is the cause of your uveitis, your eye doctor can prescribe antibiotics or antiviral medicine to treat your Uveitis. You might take steroids at the same time.  

Antibiotic drops Side-effects

Antibiotic eye drops and ointment can cause mild stinging, blurred sight or a funny taste in the mouth soon after putting them in. (4)

Antibiotic drops Side-effects

Signs of Allergic Reactions to antibiotic eye drops are: (4)

  • Severe redness, swelling, and irritation of the eye or eyelids

  • Swelling of eyelids, lips, or face

  • Difficulty breathing

  • Rash on the skin

Antiviral drops Side-effects

The main side effects of antiviral eye drops, include influenza-like symptoms, hematologic abnormalities and neuropsychiatric symptoms. The influenza-like syndrome can be prevented by paracetamol taken at the time of the injection. (3)

The major side effects of antiviral drops, include influenza-like symptoms, hematologic abnormalities and neuropsychiatric symptoms. The influenza-like syndrome can be prevented by paracetamol taken at the time of the injection. (3)

Can Uveitis be Cured

New Treatment for Uveitis with a novel HOCL Eye drop for Infection and Inflammation Control

Uveitis eye drops not working? Ocusolve is a new non-steriodal eye drop and is preservative-free. The active ingredient is well tolerated by sensitive individuals and has a high Therapeutic index. Ocusolve shows promise for those living with long-term chronic uveitis.

There is a direct Comparison Chart at the bottom of the page to help you make an educated decision.

References

1. Local Delivery of Corticosteroids in Opthalmology: A Review- Adrian T. Fung, MMed, Tuan Tran, MBBS MMed,  Lyndell L. Lim, DMedSci et al https://www.ncbi.nlm.nih.gov/ article Jan 2020

 2. Treating Uveitis. The State of the Art- Christopher Kent reviewofophthalmology.com/article May 2021

3. Antibiotic Eye drops/ Ointment- NHS FOUNDATION Trust –https://www.moorfields.nhs.uk/article 20 November 2017

3. Antibiotic Eye drops/ Ointment- NHS FOUNDATION Trust –https://www.moorfields.nhs.uk/article 20 November 2017

 

Article by