Drug-Induced Uveitis: Patterns, Pathogenesis and Clinical Implications.

Abstract

Drug-induced uveitis is a recognized but often underdiagnosed cause of ocular inflammation, with an increasing number of systemic and topical medications implicated. The clinical presentation is highly variable, ranging from anterior to posterior uveitis, often mimicking autoimmune or infectious etiologies. This review examines the mechanisms underlying drug-induced uveitis, including immune-mediated reactions, direct toxicity, and idiosyncratic responses. A comprehensive evaluation of specific drug classes is provided, covering topical agents (prostaglandin analogues, brimonidine), intravitreal therapies (anti-VEGF agents, triamcinolone and vancomycin), antimicrobials (cidofovir, rifabutin), bisphosphonates, tumor necrosis factor (TNF) inhibitors, immune checkpoint inhibitors, BRAF and MEK inhibitors, and vaccines. For each category, the review discusses the pathogenesis, frequency of occurrence, clinical presentation, diagnostic approach and management strategies. Diagnosing drug-induced uveitis requires a high index of suspicion and a systemic drug history. A structured approach to differentiating drug-induced uveitis from other inflammatory and infectious causes is outlined, emphasizing the key clinical and imaging features that aid in diagnosis. The expanding list of medications associated with uveitis underscores the need for heightened awareness in patients presenting with ocular inflammation. Establishing causality requires a careful balance of clinical pattern recognition, temporal correlation, and structured assessment tools. Understanding the pathogenesis of drug-induced uveitis not only informs treatment decisions, including whether to discontinue or modify therapy, but also helps refine guidelines for drug safety monitoring. As novel therapies, particularly in oncology, immunomodulation and vaccination, continue to evolve, ongoing research and robust pharmacovigilance efforts will be critical in identifying risks, improving diagnostic accuracy, and optimizing patient care.