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All content on Eyewiki is protected by copyright law and the Terms of Service. This content may not be reproduced, copied, or put into any artificial intelligence program, including large language and generative AI models, without permission from the Academy. Uveitis is usually caused by autoimmune or infectious causes, but sometimes systemic or topical drugs can lead to intraocular inflammation. Drug-induced uveitis is a relatively rare occurrence, but can be missed as a cause of ocular inflammation. Drug-induced uveitis is a relatively rare occurrence and is reported to represent less than 0. The time between medication use and occurrence of symptoms varies, ranging from a few days to months. Common symptoms include: pain, photophobia, blurred vision, and redness. The cause for drug-induced inflammation is not well known. Postulates include direct and indirect mechanisms. Direct mechanisms are typically seen soon after medication use, typically occurring with topical or intracamerally instilled drugs. In the late s, Naranjo et al \[3\] proposed a set of criteria to establish a causality of adverse drug effects:. Note that not all these criteria have to be fulfilled. Drug-induced uveitis typically resolves within weeks with discontinuation of the offending agent and treatment of the ocular inflammation. Symptoms of anterior uveitis with or without hypopyon, intermediate uveitis or posterior uveitis may occur between 2 weeks to 7 months following start of therapy \[4\]. Uveitis has been reported to occur with this drug alone \[5\] as well in combination of other anti-microbial agents such as azithromycin, erythromycin, clarithromycin, ethambutol, and fluconazole. Uveitis can also increase in severity with elevation of dose. Cidofovir, a DNA polymerase inhibitor, is administered intravenously and intravitreally for the treatment of cytomegaloviral CMV retinitis. Hypotony and uveitis have also been reported in a patient with non-ocular CMV infection encephalitis \[13\]. This patient had a normal fundus exam, suggesting a direct effect on the ciliary body \[13\] \[14\]. Uveitis has also been reported in patients receiving intravitreal cidofovir for treatment of CMV retinitis. Concomitant use of systemic probenecid decreased the frequency of inflammation \[15\]. Because of its association with immune recovery uveitis, cidofovir should probably not be used if immune recovery is expected \[17\]. Bisphosphonates are used to inhibit bone resorption in patients with osteoporosis. Inflammation has been reported after both nitrogen and non-nitrogen-containing bisphosphonates and also after intravenous or oral use. The interval between exposure and symptoms tends to be shorter with intravenous administrations, with onset as early as 6 hours after IV administration and several days after oral use \[19\]. Most reports of uveitis or scleritis have been after pamidronate disodium \[18\] \[19\] \[20\] \[21\] , but inflammation has also been reported after zoledronate \[22\] , alendronate sodium \[18\] \[23\] , risedronate sodium \[18\] , and etidronate sodium \[18\]. Bisphosphonates stimulate the production of a distinct group of T cells which inhibit bone resorption. The activation of T cells releases cytokines, and this may contribute to an immunologic or toxic reaction which results in the development of uveitis or scleritis \[19\] \[21\]. In 16 of these cases the inflammation was anterior, and in one case, it was posterior \[20\]. In general, the bisphosphonate must be discontinued for scleritis to resolve, even with medical management \[21\]. Uveitis is generally bilateral with onset in the first 48 hours of drug exposure. In many patients, the drug must be discontinued, with favorable resolution after a short course of topical steroids \[20\]. Nonspecific conjunctivitis seldom requires treatment; NSAID eye drops may provide symptomatic relief. Sulfonamides are a primary treatment of many bacterial infections, including urinary tract infections, otitis media, bronchitis, sinusitis, and pneumonia. Ocular side effects are common, with reported symptoms and signs including visual disturbances, keratitis, conjunctivitis , periorbital edema \[24\] , and rarely uveitis. Intraocular inflammation may be the result of direct immunogenicity of sulfonamides or, as in the case of Stevens-Johnson syndrome, the result of a systemic, necrotizing vasculitis \[24\]. Moxifloxacin is a fourth-generation fluoroquinolone used for the treatment of acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, community acquired pneumonia, complicated and uncomplicated skin and skin structure infections, and complicated intra-abdominal infections \[25\]. The first case of systemic moxifloxacin-induced uveitis was described in in a 77 year-old woman treated for pneumococcal pneumonia who developed bilateral acute anterior uveitis and pigment dispersion \[26\]. Multiple cases have been reported since \[27\] , with similar presentations. The relationship between systemic fluoroquinolone treatment and the occurrence of uveitis has been considered 'possible', according to World Health Organization criteria, in a recent retrospective analysis of 40 case reports \[28\]. Moxifloxacin was suspected in 25 of these cases. The presence of both iris transillumination and pigment dispersion appears specific to this syndrome. Intravesical Bacillus Calmette-Guerin BCG is an immunotherapy used to treat non-muscle invasive bladder cancer NMIBC \[29\] Ocular complications of intravesical BCG include panuveitis, anterior uveitis, conjunctivitis, papillitis, and, rarely, culture-positive Mycobacterium bovis endophthalmitis. The exact mechanism of intravesical BCG-associated uveitis remains ill-defined. However, it has been hypothesized that the introduction of M. Patients experiencing isolated eye complications from the intravesical BCG vaccine can present with:. These symptoms can present between weekly instillations or after the 6-week course of intravesical BCG therapy. In the reported literature, symptoms often develop within weeks since the last treatment. Risk-benefit discussions regarding BCG discontinuation should be initiated in patients with ocular complications due to the possibility of prolonged inflammation and strucutral damage to the eye. In patients requiring continued intravesical BCG for the treatment of bladder carcinoma, topical steroids, mydriatics, and cycloplegics can be employed to control inflammation, ease discomfort, and prevent persistent synechiae. In most cases, with appropriate medical treatment, BCG-associated uveitis resolves. However, as with all etiologies of uveitis, providers and patients should be aware of the possibility for recurrent uveitis in the context of continued intravesical BCG as well as complications of prolonged inflammation. It is the most common beta-blocker to cause uveitis \[34\] \[35\] , although the incidence is still rare. It is used as a long-term glaucoma treatment, and is typically well tolerated. Anterior uveitis secondary to brimonidine is rare and typically develops months after initiation of therapy \[40\]. The uveitis may be granulomatous \[41\]. Prostaglandin-analogues are used to treat open-angle glaucoma and ocular hypertension, and act via increasing uveoscleral outflow. They are often first-line treatment for glaucoma and ocular hypertension. In one case series, iritis was seen in 4. This study also reported a 2. Other case reports have showed uveitis caused by bimatoprost \[43\] and travoprost \[44\]. TINU syndrome is a distinct entity that was initially reported primarily in young women, although there is likely no female preponderance and all ages may be affected \[45\]. The renal disease is characterized by acute interstitial nephritis with a predominantly T-lymphocyte infiltrate, whereas the ocular disease is most often a bilateral anterior uveitis that may occur before, simultaneous with, or after the onset of renal disease. Cell-mediated immune dysfunction has been implicated in the pathogenesis of TINU syndrome, but a cause has not yet been identified \[46\]. Associated laboratory evaluation may demonstrate anemia, elevated liver function tests, eosinophilia, and elevated Westergren erythrocyte sedimentation rate \[45\]. Create account Log in. Main Page. Getting Started. Recent changes. View form. View source. View history. Jump to: navigation , search. Article initiated by :. Saraiya, MD. All contributors:. Saraiya, MD , Sanjana Jaiswal. Assigned editor:. Jennifer Cao, MD. Incidence, prevention and treatment. Drug Induced Uveitis. A method for estimating the probability of adverse drug reactions. Rifabutin-associated uveitis. Uveitis associated with rifabutin prophylaxis. Rifabutin prophylaxis and uveitis. Acute uveitis associated with rifabutin use in patients with human immunodeficiency virus infection. Inflammatory opacities of the vitreous in rifabutin-associated uveitis. Anterior uveitis and hypotony after intravenous cidofovir for the treatment of cytomegalovirus retinitis. Anterior uveitis associated with intravenous cidofovir use in patients with cytomegalovirus retinitis. Iritis and hypotony after treatment with intravenous cidofovir for cytomegalovirus retinitis. Analysis and Prevention. Adverse ocular drug reactions recently identified by the national registry of drug-induced ocular side effects. Scleritis and other ocular side effects associated with pamidronate disodium. Ocular side effects associated with bisphosphonates. Bilateral acute uveitis and conjunctivitis after zoledronic acid therapy. Bisphosphonate-associated scleritis: a case report and review. Systemic Sulfonamides as a cause of bilateral, anterior uveitis. Avelox moxifloxacin hydrochloride tablets and Avelox I. Kenilworth, NJ; Oct. Acute and bilateral uveitis secondary to moxifloxacin. Arch Soc Esp Oftalmol. Uveitis-like syndrome and iris transillumination after the use of oral moxifloxacin. Eye Lond. Bilateral uveitis associated with fluoroquinolone therapy. Cutan Ocul Toxicol. BMJ Case Rep. Published May Bilateral uveitis after intravesical BCG immunotherapy for bladder carcinoma. Br J Ophthalmol. J Oncol. Published Mar Semin Ophthalmol. Comparison of ocular beta-blockers. Metipranolol-associated granulomatous iritis. Metipranolol-associated granulomatous anterior uveitis. A 1-year study of brimonidine twice daily in glaucoma and ocular hypertension. A controlled, randomized, multicenter clinical trial. Chronic Brimonidine Study Group. Brimonidine Study Group. Experience and incidence in a retrospective review of 94 patients. Bilateral nongranulomatous anterior uveitis associated with bimatoprost. J Cataract Refract Surg. Granulomatous anterior uveitis associated with bimatoprost: a case report. Bilateral anterior uveitis associated with travoprost. Enhanced recognition, treatment, and prognosis of tubulointerstitial nephritis and uveitis syndrome. The tubulointerstitial nephritis and uveitis syndrome. Drug-induced TINU syndrome and genetic characterization. Clin Nephrol. Clin Exp Nephrol. Acute eosinophilic interstitial nephritis and renal failure with bone marrow-lymph node granulomas and anterior uveitis: A new syndrome. Am J Med ;59 3 The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Learn more Accept. Categories : Articles Uveitis. What links here. Related changes. Special pages. Printable version. Permanent link. Page information. This page was last edited on September 9, , at Privacy policy.
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