This handout is for uveitis (anterior / intermediate / posterior / panuveitis). Your care team identified this based on: painful, photophobic red eye with blurred vision, circumcorneal (ciliary) injection ± constricted/irregular pupil — acute anterior uveitis/iritis, the commonest presentation (sun jabs am j ophthalmol 2005).
Other reasons your team may use this plan: floaters and painless visual blurring with little/no external injection — intermediate (vitritis/snowballs) or posterior uveitis (chorioretinitis) until proven otherwise (sun 2021 classification criteria); hypopyon or recurrent acute non-granulomatous anterior uveitis — hla-b27 spondyloarthropathy spectrum / behçet pattern (sun 2021; aao uveitis guidance); known hla-b27 spondyloarthropathy / sarcoidosis / behçet / jia, or an at-risk child needing asymptomatic-uveitis screening slit-lamp (grassi j rheumatol 2007 — jia uveitis 20% prevalence, 88.7% within 4 y of arthritis onset).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| infectious_screen_syphilis_tb_then_pathogen_directed_gate | — | — | — | AAO IMT guidance 2017/2018 + Sharma Int J STD AIDS 2024 — syphilis is the great masquerader; treatable infection must be excluded/treated before or alongside immunosuppression; anti-TNF requires TB screen. Route id.syphilis.core.v1 / id.tuberculosis.core.v1 by engine_id. |
| valaciclovir | 1 g | PO | TID | Pathogen-directed therapy for HSV/VZV anterior uveitis and ARN; corticosteroid only added under antiviral cover (SUN 2021 herpetic criteria; AAO uveitis guidance) |
| aciclovir | 10 mg/kg | IV | q8h | IV aciclovir induction for acute retinal necrosis before oral step-down (SUN 2021; AAO) — renal-dose by eGFR |
Plan: Uveitis — infection-gated tiered anti-inflammatory & steroid-sparing ladder
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease arc (the deep tail of this engine): structured corticosteroid-sparing taper to ≤7.5 mg prednisone with sustained inactivity (FAST endpoint); long-term antimetabolite/biologic continuation with periodic CBC/LFT/renal + biologic infection surveillance; recurrence counselling and rapid-access pathway for HLA-B27 recurrent AAU; complication surveillance and management routing — uveitic glaucoma (→ ophtho.acute-angle-closure-glaucoma.core.v1 for secondary glaucoma), cataract, band keratopathy, persistent CME, hypotony; PAEDIATRIC JIA asymptomatic-uveitis screening slit-lamp schedule by ANA/age/subtype with early methotrexate/adalimumab (Grassi J Rheumatol 2007; Wennink Acta Ophthalmol 2022 — earlier IMT improved outcomes; Ramanan NEJM 2017). Co-manage the systemic association via its engine_id.
Guideline: SUN (Standardization of Uveitis Nomenclature) Working Group anatomic classification & grading (Jabs et al, Am J Ophthalmol 2005) + SUN Classification Criteria for the Uveitides (Am J Ophthalmol 2021) + AAO / Ocular Immunology guidance on noncorticosteroid systemic immunomodulatory therapy in non-infectious uveitis (2017/2018, currency re-checked 2026-05-17) + FAST uveitis trial (Rathinam, JAMA 2019) + VISUAL I/II adalimumab (Nguyen/Jaffe, Lancet 2016) + MUST trial (Ophthalmology 2015) + POINT trial (Thorne, Ophthalmology 2018) + SYCAMORE (Ramanan, NEJM 2017)