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Medical Author:

Andrew A. Dahl, MD, FACS

Andrew A. Dahl, MD, FACS

Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Anterior Uveitis Treatment

An ophthalmologist (a medical doctor who specializes in eye care and surgery) examining a person with anterior uveitis will obtain a medical history that includes specific questions about the presence of low back pain. In fact, an ophthalmologist may be the first doctor to make the diagnosis of ankylosing spondylitis.

An ophthalmologist also performs a complete eye exam on a person with anterior uveitis. The exam includes a visual acuity test, a pupil examination, a slit-lamp examination, an intraocular pressure measurement, and a careful inspection of the back of the eye after dilating the pupils.

Treatment of anterior uveitis usually consists of dilating eyedrops called cycloplegics. Cycloplegic eyedrops dilate the pupil and relieve the pain caused by the spasm of the iris. Cycloplegic eyedrops also temporarily paralyze the focusing mechanism of the eye. Cycloplegic eyedrops include the following:

• Tropicamide (Mydriacyl, Opticyl, Tropicacyl)



• Cyclopentolate (Cyclogyl)



• Homatropine (Isopto Homatropine)



• Scopolamine ophthalmic (Isopto Hyoscine)



• Atropine (Isopto Atropine)

Additional medications that may be used include one or more of the following:

• Anti-inflammatory drops



• Corticosteroids (prednisolone [Pred Forte])



• Nonsteroidal anti-inflammatory drops (flurbiprofen [Ocufen], ketorolac [Acular or Acular LS], bromfenac [Xibrom], nepafenac [Nevanac])

In certain cases, oral nonsteroidal anti-inflammatory drugs such as ibuprofen and oral corticosteroids such as prednisone may be used. See the article Understanding Ankylosing Spondylitis Medications for more information.

Occasionally, the severity of inflammation may require treatment with corticosteroid injections around the eye. If the intraocular pressure (pressure within the eye) is elevated, additional eyedrops may be required to decrease the pressure.

The person's primary-care doctor may recommend other oral immunosuppressive drugs to be taken in conjunction with the eyedrops prescribed by the ophthalmologist. In recalcitrant cases, injections of immunomodulating drugs such as infliximab, etanercept or adalimumab may be considered.

Complications of repeated episodes of anterior uveitis caused by ankylosing spondylitis may include adhesions of the iris to the lens (meaning that the iris sticks to the lens), cataract formation, glaucoma, and macular edema. Macular edema is a swelling of the center of the retina and can cause decreased vision. To minimize the occurrence of these complications, the ophthalmologist closely observes the person and promptly treats any episodes of anterior uveitis.

Some people who have recurrent anterior uveitis may require continual treatment with eyedrops to prevent these recurrences. People with ankylosing spondylitis must understand that any eye redness or eye pain requires prompt attention by their ophthalmologist.

The ophthalmologist usually consults with the person's primary-care doctor, the rheumatologist (a medical doctor who specializes in diseases of the joints, muscles, and bones), or both, and together, they will use a team approach to manage the care of the person with ankylosing spondylitis and anterior uveitis. Ankylosing spondylitis is a chronic condition that requires a person to be aware of and understand the disease process as well as to be an active participant in the treatment process.