Treatment of ocular inflammation in children.

Ocular inflammation in children is of substantial epidemiologic importance, particularly since uveitis in children produces more vision loss than it does in adults. This is partially because there is a higher rate of posterior uveitis in childhood uveitis than in the adult population. Treatment of ocular inflammation in children, ranging from conjunctivitis to keratitis to scleritis to uveitis, depends, of course, on whether or not the problem is microbial, traumatic, malignant, or autoimmune. Most of the cases that are vision threatening are autoimmune, and corticosteroids represent the mainstay of short-term therapy. However, abundant evidence exists which shows that all too often imprudent, prolonged use of corticosteroids is employed with resultant iatrogenic damage, including cataract, glaucoma, and secondary infection.A new paradigm for treating ocular inflammation (uveitis in particular) is espoused in this article. It is based on a limited tolerance to corticosteroid use and a more proactive approach to corticosteroid-sparing immunomodulatory therapy in an effort to induce a durable remission off all corticosteroids.