Medication Induced


Systemic drugs

Type of Uveitis/Severity

Bisphosphonates (alendronate [8], ibandronate, risedronate, zoledronic acid [9], pamidronate [7])

Anterior uveitis (mild to severe)

Cidofovir [5, 6]

Anterior uveitis (mild to severe)

Diethylcarbamazine [19]

Anterior to posterior uveitis (mild to severe)

Fluoroquinolones (ciprofloxacin, ofloxacin, gatifloxacin, levofloxacin, moxifloxacin [1, 11, 12], norfloxacin)

Anterior uveitis (mild to severe); may be associated with iris transillumination defects

Ibuprofen [17]

Anterior uveitis (mild)

Oral Contraceptives [17]

Anterior uveitis/retinal vasculitis

Quinidine [16]

Anterior uveitis (mild to moderate)

Rifabutin [3, 4]

Anterior uveitis (moderate to severe); hypopyon; retinal vasculitis

Sulfonamides [10]

Anterior uveitis (mild to moderate)

Topiramate [15]

Anterior uveitis (mild to severe); hypopyon

Tumor necrosis factor inhibitors (Etanercept, Infliximab, Adalimumab) [13, 14]

Anterior uveitis (mild to moderate)

Topical agents

Type of Uveitis/Severity

Metipranolol [18]

Anterior uveitis (mild to moderate)

Glucocorticosteroids [20]

Anterior uveitis (mild to moderate; may be related to steroid withdrawal)

Brimonidine [21]

Anterior uveitis (mild to moderate; may be granulomatous)

Prostaglandin analogs (latanoprost [22], travoprost, bimatoprost)

Anterior uveitis (mild; may be associated with cystoid macular edema)

Intraocular agents

Type of Uveitis/Severity

Anti-VEGF agents (ranibizumab, bevacizumab, pegaptanib, afilbercept) [23]

Panuveitis (mild to severe)

Cidofovir [5, 6]

Panuveitis (mild to severe)

Triamcinolone acetonide [24]

Panuveitis (mild to severe)

Vaccinations

Type of Uveitis/Severity

Bacille Calmette-Guerin (BCG) [25]

Anterior uveitis to panuveitis (mild to severe)

Measles, mumps, rubella (MMR) [26]

Anterior uveitis to panuveitis (mild to severe)

Influenza [27]

Anterior uveitis to panuveitis (mild to severe)

Hepatitis B [28]

Anterior uveitis to panuveitis (mild to severe)





Conclusion


Medication-associated uveitis is a rare adverse effect of drug administration that can typically induce mild to moderate intraocular inflammation. The prognosis is generally favorable as the uveitis responds well to cessation of the offending agent and use of topical and/or systemic corticosteroids. With the expanding armamentarium of available therapeutic agents, the list of drugs that can potentially induce uveitis continues to increase. At the time of this publication, multiple case series have reported uveitis associated with use of ipilimumab (a CTLA-4 inhibitor) in the treatment of metastatic melanoma [29]. The physician must be cognizant that certain medications may be associated with intraocular inflammation and have a high index of suspicion if established Naranjo criteria are fulfilled.


References



1.

Fraunfelder FW, Rosenbaum JT. Drug-induced uveitis. Incidence, prevention and treatment. Drug Saf. 1997;17(3):197–207.CrossRefPubMed

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Aug 17, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Medication Induced

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