I am 65 and have been under physician's care for treatment of uveitis. I was given Pred Forte eyedrops and have been taking them for almost four months. Recently, I went for my monthly checkup and was told I have had a reaction to the drops and now have steroid-induced glaucoma. This was a tremendous shock. What are the solutions? My doctor knew when he prescribed the drops that my grandmother had glaucoma. Was Pred Forte a wise choice for someone who had glaucoma in the family?

J.

Uveitis is an inflammatory condition of one or both eyes that causes eye redness, eye pain and severe sensitivity to light. The cause of this inflammatory condition is usually never determined, although potential causes include infections, such as tuberculosis or syphilis; inflammatory conditions such as sarcoid, inflammatory bowel disease or Reiter's syndrome; or rheumatologic conditions, such as ankylosing spondylitis. Testing for these conditions is generally performed for either the first case of uveitis that affects both eyes and is severe in nature, or if there is recurrences of the uveitis over months to years.

Without treatment, patients with uveitis will end up with internal scarring of the eye, possibly leading to blindness. In addition, patients with uveitis who are not treated will not be able to function because of severe eye pain, redness and light-sensitivity.

The treatment of uveitis requires the use of anti-inflammatory steroid drops, such as Pred Forte. In some cases, oral, anti-inflammatory steroids (Prednisone) or steroid injections are required to calm the inflammation of the eye. Pred Forte has two main ocular side effects with extended use: cataract formation and elevation of intraocular pressure (glaucoma).

For patients who have used Pred Forte for extended periods of time, there is a risk that the lens in the eye may become cloudy (a cataract). If this were to occur, the patient could elect to have cataract surgery and safely remove the cataract and replace it with an intraocular lens. If a patient on Pred Forte has exams that reveal eye pressure is up, the doctor can decide between continuing the Pred Forte and treating the elevated eye pressure with glaucoma medications, or stopping the Pred Forte and trying a different anti-inflammatory medication (such as Vexol or Lotemax) that does not raise the eye pressure as much.

So, given the risks involved with using Pred Forte, why not skip the Pred Forte to begin with and use the anti-inflammatory medications that do not raise the eye pressure? Although this would seem like the best approach, the main problem with these other medications is that they are very weak at reducing inflammation when compared with Pred Forte. These other medications would therefore not work well enough to reduce the inflammation of uveitis. I personally prescribe Pred Forte drops extensively, even in patients with strong family histories of glaucoma, because of the medication's excellent anti-inflammatory properties, Since the elevated eye pressure associated with Pred Forte is reversible, my concern is to use the best medication to eliminate the greatest amount of inflammation.