Triangle symbol on the eye is almost always a pterygium (pronounced tuh-RIJ-ee-um): a triangular, wing-shaped, fleshy growth that starts on the white part of the eye (conjunctiva) and can extend onto the clear front window (cornea). It is common in people who spend a lot of time outdoors in strong sunlight, wind, or dusty air. The shape looks like a small wedge or triangle pointing toward the pupil.
Arlt’s triangle is a triangle-shaped cluster of tiny white or greasy-looking deposits called keratic precipitates (KPs) that collect on the inner (endothelial) surface of the cornea. Gravity and the flow of aqueous humor make these deposits settle in a base-down triangle on the lower part of the cornea. When an eye doctor looks with a slit-lamp microscope, they see these KPs forming a triangle with the base along the lower cornea and the apex pointing upward. This pattern is highly suggestive of anterior uveitis, meaning inflammation inside the eye, mostly confined to the iris and ciliary body.
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What are KPs? They are small clumps of inflammatory cells and proteins that stick to the corneal endothelium.
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Granulomatous vs non-granulomatous: In granulomatous uveitis, KPs are often larger and “mutton-fat” (greasy, waxy). In non-granulomatous uveitis, KPs tend to be small and fine. Both can arrange in Arlt’s triangle.
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Why a triangle? The aqueous fluid circulates from the ciliary body toward the cornea and downward with convection currents; heavier cells settle inferiorly, creating the triangular footprint.
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Clinical meaning: Seeing Arlt’s triangle supports the diagnosis of anterior uveitis and helps the clinician distinguish it from purely external causes of redness (like simple conjunctivitis), because KPs are inside the eye.
Anterior uveitis is inflammation inside the front of the eye, mainly affecting the iris (iritis) and sometimes the ciliary body (iridocyclitis). It causes pain, light sensitivity, and blurred vision. Inflammation releases white blood cells and proteins into the aqueous humor, leading to cells and flare (microscopic floating particles and haze), KPs on the cornea (often in Arlt’s triangle), pupil sticking (posterior synechiae), and sometimes raised eye pressure or low pressure. It may be isolated to the eye or associated with autoimmune disease or infection.
Types
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Arlt’s Triangle (front of the eye; uveitis sign)
Small clumps of inflammatory cells (called keratic precipitates) settle on the inner surface of the cornea in a neat, inverted triangle—wider at the bottom—because of currents inside the eye. This pattern strongly suggests granulomatous anterior uveitis (a type of eye inflammation). EyeWikiVagelos CollegeReview of Optometry -
Triangular conjunctival growth (pterygium, “surfer’s eye”)
A fleshy, triangular wedge of tissue grows from the white of the eye toward the clear cornea, usually starting on the side closest to the nose. It’s linked to UV exposure (sun/bright outdoor environments). AAOWebMD -
“Triangle Sign” on B-scan ultrasound (back of the eye; choroid)
On an ultrasound scan, a dark, triangular area just in front of the optic disc can help doctors distinguish total choroidal detachment from other problems like suprachoroidal hemorrhage. Recent research describes this as a helpful, repeatable marker. Ophthalmology TimesPMCOphthalmology Advisor -
Amalric Triangular Sign (retina/choroid ischemia)
A triangular patch of choroidal/retinal damage points toward an occlusion of the posterior ciliary artery, a vessel that feeds the back of the eye. It can appear with central retinal artery occlusion or related vascular events. PMC -
Lacrimal gland “wedge/triangle” sign (orbit)
Imaging may show a triangle-shaped wedge of abnormal tissue extending toward the back of the eye socket in lacrimal gland tumors, especially in more aggressive disease. AAO JournalAAO -
“Triangle sign” in advanced cataract (Morgagnian lens)
In a certain mature cataract (Morgagnian), slit-lamp features can form a triangle sign that helps tell it apart from a lens that’s slipped out of position. EyeWiki
These are the most common triangle-pattern clues doctors mean when they say “triangle sign.”
Causes
A. Causes linked to Arlt’s Triangle (granulomatous anterior uveitis)
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Sarcoidosis – immune condition that inflames many organs, including the eye. Vagelos College
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Tuberculosis – chronic infection that can trigger granulomatous uveitis. EyeWiki
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Syphilis – systemic infection that can inflame the eye. EyeWiki
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Leprosy – less common but documented granulomatous uveitis cause. EyeWiki
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Brucellosis or coccidioidomycosis – unusual infections reported to cause this pattern. EyeWiki
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Herpes simplex virus (HSV) – viral anterior uveitis may still show KPs in/near Arlt’s triangle. PubMed
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Varicella-zoster virus (VZV) – another viral cause of anterior uveitis. PubMed
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Cytomegalovirus (CMV) – can cause a characteristic uveitis pattern with KPs. PubMed
B. Causes linked to triangular conjunctival growth (pterygium)
- Chronic ultraviolet (UV) light exposure – main driver, especially in sunny/windy climates. AAO
- Chronic irritation (dust, wind, dry air) – environmental triggers that promote growth. AAO
C. Causes linked to the B-scan “Triangle Sign” (choroidal detachment/hemorrhage)
- Post-surgical hypotony (low eye pressure after glaucoma or other surgery) – the top cause for choroidal effusions/detachments. EyeWikiAAO
- Inflammation/uveitis leading to fluid in the suprachoroidal space. Glaucoma Today
- Use of anticoagulants/antiplatelets increasing bleeding risk (suprachoroidal hemorrhage). PentaVision
- Major eye trauma with sudden pressure changes and vessel rupture. Medscape
- Marked IOP fluctuations or severe hypotony during surgery (e.g., infusion loss). Nature
D. Causes linked to Amalric triangular sign (posterior ciliary artery ischemia),
- Giant cell arteritis (GCA) – vasculitis that targets short posterior ciliary arteries; an ophthalmic emergency in older adults. EyeWikiPubMed
- Embolic/occlusive disease of posterior ciliary arteries (ischemic events affecting choroid/optic nerve). IOVS
E. Causes linked to lacrimal “triangle/wedge” sign (orbit)
- Lacrimal gland carcinoma (e.g., adenoid cystic carcinoma) – aggressive tumors can form a wedge extending toward the orbital apex. AAO Journal
- Lacrimal gland lymphoma – malignant lymphoid growth with characteristic imaging patterns. AAO Journal
- Chronic dacryoadenitis – long-standing inflammation/enlargement of the lacrimal gland that can mimic mass patterns. AAO Journal
Symptoms
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Red, irritated eye – common with anterior uveitis or pterygium.
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Eye pain or ache – inflammation (uveitis) or suprachoroidal hemorrhage can be painful. PentaVision
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Sensitivity to light (photophobia) – classic for uveitis; light worsens discomfort. Review of Optometry
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Blurred vision – swelling, inflammatory debris, or media opacities reduce clarity.
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Foreign-body sensation or gritty feeling – frequent with pterygium and dry-eye irritation. AAO
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Tearing or watery eye – surface irritation triggers reflex tears. AAO
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Visible pink, triangular growth toward the cornea – hallmark of pterygium. AAO
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Sudden severe pain with rapid vision loss – red flag for suprachoroidal hemorrhage. PentaVision
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Shadow, curtain, or peripheral dark area – can accompany large choroidal detachments. Verywell Health
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Floaters or hazy view – inflammatory cells or hemorrhage scatter light.
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Headache, scalp tenderness, jaw pain in older adults – systemic clues to GCA when eye findings suggest ischemia; urgent. WebEye
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Color desaturation or reduced contrast – ischemia/optic nerve involvement.
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Double vision or eye movement pain – possible with orbital/lacrimal gland disease. AAO Journal
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Eyelid swelling/fullness near the temple – can occur with lacrimal gland masses or inflammation. AAO Journal
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Asymmetry or bulging (proptosis) – orbital processes may push the eye forward. AAO Journal
Diagnostic tests
A) Physical exam (doctor-performed observations and instruments)
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Slit-lamp biomicroscopy – shows Arlt’s triangle (triangular KPs) and surface changes; the defining exam for anterior uveitis and pterygium. EyeWikiReview of OptometryAAO
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Direct/indirect ophthalmoscopy – evaluates the retina/choroid for detachment, hemorrhage, or ischemic triangular lesions. PMC
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Intraocular pressure (IOP) measurement – very low IOP suggests hypotony (risk for choroidal effusion/detachment). AAO
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Eyelid, lacrimal gland, and orbital palpation/inspection – checks for mass, tenderness, or fullness suggesting lacrimal disease. AAO Journal
B) Manual/bedside tests (simple tools or no machines)
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Visual acuity with pinhole – quickly separates optical blur from retinal/neurologic vision loss.
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Swinging-flashlight test (pupil test) – detects optic-nerve/retinal signal problems by looking for a relative afferent pupillary defect.
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Confrontation visual fields or Amsler grid – screens for field defects, scotomas, or distortion from macular/choroidal disease.
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Color vision plates (Ishihara) – checks optic nerve/macula function that can be reduced in ischemic disease.
C) Lab and pathological tests
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ESR and CRP – very important in suspected giant cell arteritis, which attacks posterior ciliary arteries and can cause vision-threatening ischemia. EyeWikiPubMed
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Syphilis serology (RPR/VDRL and treponemal tests) – rules in/out a treatable cause of uveitis with Arlt’s triangle. EyeWiki
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TB testing (IGRA/Quantiferon or TST) and chest imaging – evaluates tuberculosis-related uveitis. EyeWiki
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ACE/lysozyme, sarcoid work-up – supports sarcoidosis as a cause of granulomatous uveitis. Vagelos College
D) Electrodiagnostic tests
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Full-field ERG (electroretinography) – measures retinal function; helps separate retinal vs. optic-nerve causes of vision loss.
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Multifocal ERG – maps macular function to detect localized ischemic damage.
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VEP (visual evoked potential) – tests the optic pathway when ischemia or inflammation is suspected.
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EOG (electro-oculogram) – assesses retinal pigment epithelium function; supportive in chorioretinal disease.
E) Imaging tests
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B-scan ultrasound of the eye – key test for the posterior “Triangle Sign” and for spotting choroidal detachment vs. suprachoroidal hemorrhage. Ophthalmology TimesPMC
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OCT and OCT-A (optical coherence tomography/angiography) – cross-sectional images of retina/choroid; shows fluid, detachments, or ischemia patterns.
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Fluorescein and indocyanine green angiography – live dye studies that highlight retinal and choroidal blood flow; can reveal Amalric-type triangular ischemic zones. PMC
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CT/MRI of the orbits – defines triangle/wedge-shaped lacrimal gland masses and their spread toward the orbital apex. AAO Journal
Non-Pharmacological Treatments
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Education & adherence coaching: Understanding steroid schedules and follow-ups prevents relapse and complications.
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Sunglasses/photophobia management: Tinted lenses reduce light-triggered pain.
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Rest in acute phase: Lower visual strain reduces discomfort.
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Warm compress for lid comfort: Eases surface irritation (does not treat intraocular inflammation directly).
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Avoid contact lens wear during active inflammation: Reduces infection/irritation risk.
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Trigger review and avoidance: Note flares after systemic illness, trauma, or meds (e.g., rifabutin); avoid triggers when possible.
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Smoking cessation: Smoking worsens ocular inflammation and healing.
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Systemic disease control with lifestyle: For spondyloarthritis/IBD, consistent exercise, sleep, and diet help overall inflammatory tone.
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Stress management (mindfulness/CBT): High stress can amplify pain perception and immune activity.
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Screen time hygiene: Frequent breaks (20-20-20 rule) to lower strain during recovery.
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Protective eyewear in dusty/windy environments: Minimizes surface irritation that can aggravate symptoms.
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Hydration and humidified air: Comforts the ocular surface during photophobia and tearing.
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Eye shield at night if severe photophobia: Prevents accidental rubbing.
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Hygienic eye care: Clean lids/lashes; never share eye drops; proper drop technique to avoid contamination.
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Monitoring diary: Track onset, triggers, response to therapy—helps tailor work-up (e.g., HLA-B27 pattern).
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Vaccination review with physician: General health maintenance reduces infection triggers (done under medical guidance).
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Ergonomics & safe driving guidance: Manage glare and light sensitivity; avoid night driving during flares.
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Co-management of comorbidities: Blood sugar, blood pressure, and autoimmune disease activity optimized with primary/specialist care.
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Allergen/environment control if concurrent allergic eye disease: Reduce confounders (dust mites, pet dander).
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Regular follow-up schedule: Early detection of complications (synechiae, CME, glaucoma) even after symptoms calm.
Drug Treatments
(Typical adult dosing ranges—clinicians individualize; pediatric/pregnancy/renal/hepatic adjustments apply.)
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Prednisolone acetate 1% ophthalmic (Topical corticosteroid)
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Class: Corticosteroid (topical).
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Dose/Timing: 1 drop every 1–2 hours while awake in acute phase; taper slowly over weeks.
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Purpose: Rapidly reduces intraocular inflammation.
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Mechanism: Inhibits phospholipase A2 → lowers prostaglandins/cytokines.
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Side effects: Steroid response IOP rise, cataract with prolonged use, infection risk.
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Difluprednate 0.05% ophthalmic (Topical corticosteroid; potent)
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Class: Corticosteroid (topical, high potency).
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Dose/Timing: 1 drop q.i.d. (or more) → taper.
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Purpose/Mechanism: Same as above; enhanced penetration.
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Side effects: Higher risk of IOP rise; careful monitoring.
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Atropine 1% or Homatropine 5% (Cycloplegic/mydriatic)
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Class: Antimuscarinic.
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Dose/Timing: Atropine 1% b.i.d.–t.i.d.; Homatropine 5% b.i.d.
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Purpose: Pain relief (paralyzes ciliary spasm) and prevents posterior synechiae.
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Mechanism: Blocks iris/ciliary muscle acetylcholine receptors.
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Side effects: Blurred near vision, light sensitivity, rare systemic anticholinergic effects.
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Topical NSAID (e.g., Ketorolac 0.5%)
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Class: NSAID (topical).
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Dose/Timing: 1 drop q.i.d.
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Purpose: Adjunct for pain; may help cystoid macular edema (CME) risk.
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Mechanism: COX inhibition → prostaglandin reduction.
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Side effects: Surface irritation, rare corneal issues with overuse.
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IOP-lowering drops (e.g., Timolol 0.5%, Brimonidine 0.2%, Dorzolamide 2%)
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Class: Beta-blocker, alpha-agonist, carbonic anhydrase inhibitor.
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Dose/Timing: b.i.d. typically.
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Purpose: Treat steroid response or uveitic ocular hypertension.
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Mechanism: Reduce aqueous production/increase outflow.
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Side effects: Timolol—bradycardia/bronchospasm; brimonidine—fatigue; CAIs—bitter taste.
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Note: Avoid prostaglandin analogues in active uveitis unless specialist advises.
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Oral Prednisone
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Class: Systemic corticosteroid.
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Dose/Timing: 0.5–1 mg/kg/day, taper over weeks based on response.
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Purpose: For severe, bilateral, or steroid-refractory cases.
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Mechanism: Broad anti-inflammatory and immunosuppressive effects.
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Side effects: Hyperglycemia, hypertension, mood changes, gastric irritation, osteoporosis, infection risk.
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Methotrexate (MTX)
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Class: Antimetabolite immunomodulator (DMARD).
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Dose/Timing: 15–25 mg once weekly + folic acid; onset 6–8 weeks.
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Purpose: Steroid-sparing for chronic/recurrent non-infectious uveitis.
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Mechanism: Inhibits dihydrofolate reductase; modulates T-cell cytokines.
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Side effects: Hepatotoxicity, cytopenias; needs CBC/LFT monitoring, avoid in pregnancy.
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Mycophenolate mofetil (MMF)
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Class: Antimetabolite immunomodulator.
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Dose/Timing: 1–1.5 g twice daily.
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Purpose: Steroid-sparing alternative.
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Mechanism: Inhibits inosine monophosphate dehydrogenase → blocks lymphocyte proliferation.
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Side effects: GI upset, leukopenia; infection risk; lab monitoring.
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Adalimumab
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Class: Anti-TNF-α biologic (monoclonal antibody).
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Dose/Timing: 40 mg subcutaneously every 2 weeks (loading per label/practice).
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Purpose: Non-infectious uveitis not controlled by steroids/DMARDs.
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Mechanism: Neutralizes TNF-α, a key cytokine in ocular inflammation.
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Side effects: Infection risk, TB reactivation (screen first), injection site reactions.
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Antiviral therapy when infectious (e.g., Acyclovir/Valacyclovir for HSV/VZV; Ganciclovir/Valganciclovir for CMV)
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Class: Antivirals.
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Dose/Timing: HSV/VZV: Acyclovir 400–800 mg 5×/day or Valacyclovir 1 g t.i.d. initially; CMV often needs ganciclovir/valganciclovir dosing per specialist.
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Purpose: Treats the root viral cause in viral anterior uveitis.
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Mechanism: Inhibits viral DNA polymerase.
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Side effects: Renal toxicity (acyclovir—hydrate), cytopenias (ganciclovir); adjust for renal function.
Important: If infection is suspected, steroids must be paired with appropriate antimicrobial therapy under specialist guidance. Never self-start or stop these medicines.
Dietary Molecular Supplements
(Discuss with a clinician; these do not replace standard care.)
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Omega-3 fatty acids (EPA/DHA; ~1–2 g/day): Anti-inflammatory lipid mediators may lower cytokine tone.
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Vitamin D3 (per deficiency; often 1000–2000 IU/day, individualized): Immune modulation; deficiency links to inflammatory disease risk.
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Curcumin (turmeric extract; e.g., 500–1000 mg/day standardized): NF-κB pathway modulation; bioavailability-enhanced forms preferred.
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Quercetin (e.g., 500 mg/day): Flavonoid with mast-cell and cytokine effects.
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EGCG/green tea extract (e.g., 200–400 mg/day): Antioxidant; may reduce oxidative stress in inflamed tissues.
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Resveratrol (e.g., 100–250 mg/day): Sirtuin/anti-inflammatory signaling effects.
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Lutein + Zeaxanthin (per label): Antioxidant support for retinal health; helpful if CME risk.
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N-acetylcysteine (e.g., 600 mg b.i.d.): Glutathione precursor; antioxidant.
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Probiotics (CFU per product): Gut-eye axis modulation; small studies suggest immune benefits.
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Zinc (8–11 mg/day) ± Selenium (55 mcg/day): Cofactors in antioxidant enzymes and immunity.
Note: Quality control and interactions vary; avoid high-dose combos without medical advice.
Regenerative/Stem-Cell” Drugs
These are specialist-managed and, in some cases, investigational or used for systemic disease that secondarily helps uveitis. Doses are individualized.
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Infliximab (anti-TNF-α, IV infusions): For refractory non-infectious uveitis (e.g., Behçet). Mechanism: blocks TNF-α. Risks: infusion reactions, infection/TB (screen first).
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Tocilizumab (anti-IL-6): For uveitis with macular edema refractory to anti-TNF. Mechanism: IL-6 receptor blockade. Risks: infection, liver enzyme elevations.
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Rituximab (anti-CD20): Selected refractory autoimmune uveitis. Mechanism: B-cell depletion. Risks: infusion reactions, infections.
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Abatacept (CTLA-4–Ig): T-cell co-stimulation blocker for certain autoimmune profiles.
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JAK inhibitors (e.g., tofacitinib): Oral immune modulation in refractory cases under study/off-label pathways; monitor labs/infections.
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Mesenchymal stem-cell therapy (investigational): Proposed immunomodulation and tissue support; not standard of care; dosing/long-term safety under study.
Surgeries/Procedures
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Synechiolysis (breaking posterior synechiae): Restores pupil shape and function when iris sticks to lens.
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Peripheral iridectomy/iridotomy: For pupillary block or angle closure risk due to posterior synechiae/iris bombe.
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Cataract surgery (phacoemulsification with IOL): Performed after inflammation is well-controlled (often ≥3 months quiet).
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Glaucoma surgery (trabeculectomy/tube shunts): For uveitic glaucoma when drops fail; done after inflammation is controlled.
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Pars plana vitrectomy: For dense vitreous opacities, persistent inflammation, diagnostic sampling, or tractional complications.
Prevention Tips
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Prompt treatment of flares per plan to prevent complications.
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Do not stop steroids abruptly; follow the taper exactly.
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Screen and manage systemic autoimmune disease with rheumatology.
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In infection-prone regions, test appropriately (TB, syphilis) when advised.
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Protect eyes from trauma (sports eyewear).
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Avoid contact lens use during active inflammation.
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Keep personal eye-drop hygiene (no sharing, clean tips, check expiries).
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Stop smoking; limit secondhand smoke.
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Maintain good general health (sleep, exercise, balanced diet).
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Keep all follow-up appointments even when symptoms ease.
When to See a Doctor (Red Flags)
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Severe pain, sudden vision drop, or halos with nausea/vomiting (possible acute pressure rise).
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Marked light sensitivity or new floaters/curtain of vision (posterior extension or retinal issues).
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No improvement within 24–48 hours after starting prescribed drops.
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Recurrent episodes or bilateral symptoms.
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Any systemic symptoms (fever, rash, joint pain, mouth/genital ulcers).
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History of TB, syphilis, or shingles with new eye redness.
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Immunocompromised state (HIV, chemotherapy, transplant).
Diet: What to Eat and What to Avoid
Eat (support anti-inflammatory balance):
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Colorful vegetables and fruits (antioxidants, polyphenols).
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Omega-3-rich foods (fatty fish, flax, walnuts).
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Lean proteins (supports healing).
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Whole grains and legumes (fiber helps systemic inflammation).
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Hydration (adequate water intake).
Avoid/limit:
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Excess refined sugars and ultra-processed foods (can worsen systemic inflammatory tone).
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Excess alcohol (irritates and interacts with meds).
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Very high-salt meals if on steroids (fluid retention).
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Trigger foods if you notice personal patterns (keep a diary).
Frequently Asked Questions
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Is the “triangle symbol” itself harmful?
No. Arlt’s triangle is a sign your doctor sees. It signals inflammation (anterior uveitis) that needs treatment. -
Can anterior uveitis go away on its own?
Mild cases may improve, but untreated uveitis risks synechiae, glaucoma, cataract, and macular edema. Proper therapy is best. -
Why do I need dilating drops?
They relieve pain from ciliary spasm and prevent the pupil from sticking (synechiae), preserving normal pupil movement. -
Are steroid eye drops dangerous?
They’re highly effective, but can raise eye pressure and, with prolonged use, increase cataract risk. That’s why monitoring and tapering are crucial. -
How long will I use drops?
Acute uveitis often needs weeks with a slow taper; chronic or recurrent disease may need longer or steroid-sparing medicines. -
Will I need oral medicines or injections?
Severe, bilateral, or recurrent cases may need oral steroids, immunomodulators, or biologics. Your specialist will decide. -
What if my uveitis is from infection?
Then you’ll need antimicrobials (antivirals/antibiotics) plus careful steroid use under supervision. -
Can blue light glasses help?
They may reduce glare/photophobia, but they don’t treat the inflammation. Use them as comfort aids only. -
Is it contagious?
Non-infectious uveitis is not contagious. Infectious uveitis depends on the germ and overall contact risk—your doctor will advise. -
Do diet and supplements cure uveitis?
No. They can support general health but do not replace medical therapy. -
Can I keep wearing contact lenses?
Not during active inflammation. Resume only after your doctor confirms the eye is quiet. -
Why measure eye pressure so often?
Steroids and inflammation can raise IOP → risk of glaucoma. Regular checks are protective. -
I feel better—can I stop my drops?
Don’t. Stopping early can trigger a rebound flare. Follow the prescribed taper exactly. -
Will I get uveitis again?
Some people do (e.g., HLA-B27). A plan for early treatment reduces damage. -
What is the long-term outlook?
With prompt, guided care, most patients maintain good vision. Outcomes depend on cause, severity, and adherence.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 29, 2025.
