Each of them, as categories, has their own advantages and disadvantages, and we can always try and mix and match the patient’s medical condition with what would be the most appropriate immunosuppressive agent. There are a number of different immunosuppressants that can be used. Those patients, when they need these so-called steroid sparing or immunosuppressive agents, have to be carefully evaluated to see if they are going to tolerate those medications. We tend to do this more for inflammation that is deeper in the eyes, or inflammation involving the retina, the choroid, which is the layer deep to the retina, for example. In cases where we can’t use steroid eyedrops, sometimes we use other non-steroid anti-inflammatory agents. So, there are certain cases where we need to work very carefully with the Glaucoma Service here at Wills or a patient’s other glaucoma specialist to manage their uveitis while not making their intraocular pressure (or causing their intraocular pressure) to go out of control. Steroids increase the risk of cataract, and they can increase the risk of glaucoma or they can worsen pre-existing cataract and glaucoma. Steroid eyedrops can be very effective as anti-inflammatories, but they can cause problems. Anterior uveitis is often treated with steroid eyedrops. Treatmentįor many types of uveitis, anterior uveitis (or inflammation involving the front of the eye) is far and away the most common thing that was see. If it’s a non-infectious, uveitis then we have to decide what is the best treatment for that. And as I mentioned, uveitis can occur in the front, middle, or back of the eye. If it’s an infection, we are going to treat the patient with antiviral medications, antibiotics, anti-fungal medications. Clearly the treatment for those is going to be very different. So our first task when we evaluate the patient is to decide is this an infectious or noninfectious uveitis. Clues to other diseases that are going on - things like sarcoidosis, inflammatory bowel disease, different types of arthritis, certain infections - all of those can be critical components of finding out what is going on in the patient's eye. A lot of uveitis can be diagnosed just based on a careful, full ocular examination and a good medical history. When a patient comes in with uveitis, the very first thing we do is take an extensive history.
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