Thorough medication history key to diagnosing drug-induced uveitis
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FORT LAUDERDALE, Fla. — A thorough medication history is essential for identifying drug-induced uveitis, according to a presenter here.
“Medications are a very uncommon but important and underrecognized cause of uveitis in our population,” Sanjay Kedhar, MD, said at the Retina World Congress. “There are many drugs that have been implicated in causing uveitis, ranging from topical therapies like glaucoma medications all the way to TNF-alpha inhibitors and other systemic medications as well as vaccines.”
Sulfonamides and fluoroquinolones can both cause uveitis, Kedhar said, as well as commonly used ophthalmic medications such as anti-VEGF treatments, brimonidine and prostaglandins.
Bisphosphonates, including pamidronate, alendronate, risedronate and zoledronic acid, can not only cause uveitis, he said, but also scleritis, episcleritis and orbital inflammation. These medications are often overlooked as a cause of uveitis and are associated with a 25% to 50% higher risk for ocular inflammation. They can cause elevations in C-reactive protein and cytokines including IL-1 and IL-6. These patients respond well to anti-inflammatory treatments, but some may need to completely discontinue bisphosphonate medication.
Glaucoma medications can also cause uveitis, Kedhar said, particularly in patients who are using brimonidine. New cancer chemotherapeutics may also be associated with uveitis, but the mechanisms of this effect are still unknown.
“It is incumbent upon us to be aware of these problems as more and more patients are put on these medications,” Kedhar said.
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Kedhar S. Drug induced uveitis. Presented at: Retina World Congress; May 12-15, 2022; Fort Lauderdale, Fla.
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