Treatments

Corticosteroids

Corticosteroids, often known as steroids, are the first-line systemic therapy for most patients with non infectious uveitis.

The medication lowers the inflammation in the body and reduce the immune system activity.

Steroids are a man-made version of hormones normally produced by the adrenal glands, two small glands sitting on top of the kidneys.

They are available in different forms, including tablets (oral steroids). When taken by mouth, steroids are preferably taken in the morning after breakfast.

Depending upon the severity of the uveitis, oral steroids are usually started at a loading dose of 0.5-1 mg/kg/day. As the inflammation improves, the drug is tapered by 5-10 mg per week which is adjusted depending on the response achieved.

Once the eye is completely quiescent, the patient is usually kept on a maintenance dose ranging from 2.5-7.5 mg/day. A reasonably long period of low-dose corticosteroids is required as maintenance therapy in most cases.

Long-term use of steroids might cause potential side effects

They will therefore be prescribed at the lowest effective dose for the shortest possible time. Not everyone will develop side effects from the use of steroids and the presence of side effects varies from person to person. However, high doses for long periods of time increases the likelihood of having side effects, which include:

Acne
Thin skin and easy bruising
Delayed wound healing
Increased growth of body hair
Water retention
Increased appetite and weight gain
Cushing’s syndrome, a combination of fatty deposits that develop in the face, stretch marks across the body and acne
Stomach irritation
Stomach ulcers
Difficulty sleeping

Mood changes and mood swings, such as becoming aggressive, irritable and short-tempered with people
Depression and mental health problems
High blood pressure - blood pressure needs to be monitored regularly
Worsening of diabetes - blood sugar needs to be monitored regularly
Muscle weakness
Osteoporosis (weak and brittle bones) - a DEXA scan is recommended to patient on long term use of steroids
Stunted growth
Susceptibility to infection, particularly chickenpox, shingles and measles. Patients should try to avoid close contact with people with infection and seek medical advice immediately if exposed

Prolonged use of steroids can also cause ocular complications, including glaucoma and cataract.

patients experience

If patients experience side effects after taking steroids, they should not interrupt therapy abruptly since this can be associated with serious health issues secondary to suppression of the adrenal glands, especially if the treatment has been going on for some time (more than 3 weeks).

A slow taper dosage over a few weeks or months is recommended for the discontinuation of the therapy , This allows the body and in particular the adrenal glands time to adjust. Most side effects should improve when reducing the dosage or eventually stopping the medication.

Certain medical conditions, such as active infections, contraindicate the use of steroids. Other conditions required caution in administration. The doctor needs to be informed in case of:

Steroids can often be taken in pregnancy or while breastfeeding. However, they are usually prescribed if the risks of not being treated outweigh the risks associated with the medication.

Osteoporosis may develop even when the dose of the steroid is low (7.5mg or less) and the doctor will discuss actions with you, including the need for a bone densitometry scan or the initiation of specific drug therapy.

healthy lifestyle choices

Making healthy lifestyle choices, like a healthy diet and exercise, is recommended while on steroid treatment. In particular, lifestyle changes should include:

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