A 32-year-old woman presents with acute anterior uveitis with 2+ anterior chamber cells and fibrin. She has no systemic disease on workup. What is the drug of choice for initial management?

Explanation

## First-Line Topical Corticosteroid in Anterior Uveitis **Key Point:** Prednisolone acetate 1% is the gold standard topical corticosteroid for anterior uveitis because of superior corneal penetration and anti-inflammatory potency. ### Why Prednisolone Acetate? 1. **Corneal penetration**: Prednisolone acetate suspension has the highest corneal bioavailability among topical steroids due to its ester formulation and particle suspension. 2. **Anti-inflammatory efficacy**: Provides rapid suppression of anterior chamber inflammation (cells, flare, fibrin). 3. **Dosing frequency**: Hourly dosing in acute uveitis (tapering as inflammation resolves) is standard. 4. **Safety profile**: Well-tolerated with appropriate monitoring for steroid-induced glaucoma and cataract. ### Adjunctive Management | Agent | Role | Dosing | |-------|------|--------| | **Cycloplegic agents** (Tropicamide 1%) | Relieve pain, prevent posterior synechiae | 3–4 times daily | | **NSAIDs** (Indomethacin, Ketorolac) | Adjunctive anti-inflammatory | 4–6 times daily | | **Systemic corticosteroids** | Reserved for severe/posterior involvement | Oral prednisolone 1 mg/kg/day | **Clinical Pearl:** Prednisolone phosphate (solution form) has better corneal penetration than acetate in some studies, but acetate suspension is preferred in most Indian ophthalmology protocols due to cost and availability. **High-Yield:** Always taper topical steroids gradually (over 2–4 weeks) to prevent rebound inflammation. Abrupt discontinuation can cause acute exacerbation.