Drug-induced uveitis

Abstract

A number of medications have been associated with uveitis. This review highlights both well-established and recently reported systemic, topical, intraocular, and vaccine-associated causes of drug-induced uveitis, and assigns a quantitative score to each medication based upon criteria originally described by Naranjo and associates.

Rifabutin Induced Uveitis in HIV-Dangers of Drug Interactions in Patients on ART

“…The importance of reviewing treatment charts and awareness of drug interactions in cases such as these would obviate the need for unnecessary and extensive investigations that patients of uveitis are usually subjected to. An early suspicion of rifabutin induced uveitis could also prevent invasive ocular procedures like aqueous sampling and a detailed drug history should be elicited in unexplained uveitis [15]. In our patient, rapid resolution of uveitis ( Figures 3 and 4) was followed by total visual recovery within 3 months time.…”

Challenges of Diagnosing Viral Anterior Uveitis

“…[20][21][22] Topical prostaglandin analogues may cause an acute non-granulomatous or chronic granulomatous AU. Topical brimonidine has been associated with a chronic AU, characterized by diffusely distributed stellate or micro-granulomatous KPs and a mild anterior chamber reaction, with or without concurrent conjunctivitis.…”

“…23 Intravitreal triamcinolone acetonide or anti-vascular endothelial growth factor (VEGF) injections may cause a mild AU or a sterile endophthalmitis with hypopyon in more severe cases. 20 An acute bilateral hypopyon may develop in immunocompromised patients who receive rifabutin as prophylaxis against Mycobacterium avium complex. 20,21 Biphosphonates that are used for the treatment of osteoporosis may cause an acute bilateral nongranulomatous AU with or without scleritis.…”

Drugs, Inflammation, and the Eye

“…[1][2][3][4] Other reports have provided this critical piece of evidence, however, and it now appears clear that use of brimonidine, the bisphosphonates, and immune checkpoint inhibitors can be associated with ocular inflammation in a small minority of patients. Together, these articles highlight both the expanding spectrum of drug-induced ocular inflammation and the importance of a thorough drug history in the evaluation of all patients with ocular or orbital inflammation.…”

“…[1][2][3][4] In most instances, such drug-induced ocular inflammation is believed to be a relatively nonspecific immune response to local tissue toxicity. More specific immune reactions appear to be less common, but have been suggested for several agents, including the tumor necrosis factor-alpha (TNFa) inhibitors, 5 paradoxically used to treat inflammatory disease, and, the recently introduced, immune checkpoint inhibitors.…”