Many options exist for uveitis management in children

June 30, 2008

Posterior uveitis can be difficult to manage in children, but manage it you must, said Susan Lightman, MD, PhD, FRCP, FRCOphth, Department of Clinical Ophthalmology, Institute of Ophthalmology, University College, London.

Posterior uveitis can be difficult to manage in children, but manage it you must, said Susan Lightman, MD, PhD, FRCP,FRCOphth, Department of Clinical Ophthalmology, Institute of Ophthalmology, University College, London.

She suggested dividing these patients into two groups: those with unilateral disease who can be treated with periocular orintraocular steroids, and those with bilateral disease who will generally need steroids or immunosuppressive agents.

In children with vitritis or mild cystoid macular edema (CME), Dr. Lightman recommends periocular steroids. The peak effectof this therapy will occur around 6 weeks. The effects can last for more than 3 months, and the therapy can be repeated. Thedownside: it often requires general anesthesia to administer, and it can cause a rise in IOP.

For children with severe vitritis and CME with visual loss, Dr. Lightman advised stepping up the therapy to intraocularsteroids, being sure to monitor the IOP rise closely.

In bilateral or severe unilateral disease, oral steroids may be necessary to control the inflammation.

"Be aware that there are social side effects as well as systemic side effects," Dr. Lightman said. "Steroids can cause 'moonface' and hirsutism, and children can be cruel."

She recommended administering one-half the adult dose in persons aged less than 12 years, and using prednisone 2.5 mg/dayduring periods of growth.

If the inflammation remains unchecked even with high-dose steroids, it's time to consider second-line agents such asmethotrexate, cyclosporine, azathioprine, and mycophenolate.

"Whatever you do, you must control the inflammation," Dr. Lightman said.