## First-Line Topical Corticosteroid for Acute Anterior Uveitis **Key Point:** Prednisolone acetate 1% is the gold standard topical corticosteroid for anterior uveitis because of its superior corneal penetration and anti-inflammatory potency. ### Why Prednisolone Acetate? | Feature | Prednisolone Acetate 1% | Dexamethasone | Betamethasone | Fluorometholone | |---------|------------------------|---------------|---------------|------------------| | **Corneal penetration** | Excellent (suspension form) | Moderate (solution) | Moderate | Poor | | **Anti-inflammatory potency** | High | High | Moderate | Low | | **Anterior chamber penetration** | Superior | Good | Fair | Fair | | **First-line use** | Yes | Reserved for severe/posterior involvement | Second-line | Mild cases only | | **Dosing in acute uveitis** | 4–6 times daily | 1–2 times daily | 2–3 times daily | 3–4 times daily | **High-Yield:** Prednisolone acetate suspension (not solution) penetrates the cornea better because the suspended particles increase contact time and absorption. ### Adjunctive Measures 1. **Cycloplegic agents** (cyclopentolate 1% or tropicamide 1%) — relieve ciliary spasm and pain; prevent posterior synechiae 2. **Systemic corticosteroids** — reserved for severe anterior uveitis or posterior segment involvement 3. **Immunosuppressants** — for chronic or recurrent uveitis (azathioprine, mycophenolate) **Clinical Pearl:** In acute anterior uveitis without systemic disease, topical corticosteroids and cycloplegics are usually sufficient. Systemic workup (ANA, HLA-B27, chest X-ray, ACE level) is performed to exclude underlying conditions (sarcoidosis, ankylosing spondylitis, tuberculosis, syphilis). **Tip:** Frequency of prednisolone acetate is titrated based on response — start 4–6 times daily, then taper over 4–6 weeks to avoid rebound inflammation.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.