Ocular Inflammation (Uveitis)
April 2020 - COVID-19 update
Advice for immunosuppressed patients
It is known that infections of any sort can be more serious if your immune system is not working properly.
Patients taking immunosuppression medications may be more severely affected if they do get COVID-19 infection.
Steroids (Prednisolone), immunosuppression (agents listed below) and biologic therapies (listed below) affect the function of the immune system and if you are taking these for uveitis (and/or other conditions) your immune system function will be suppressed to some extent.
The level of immunosuppression depends on the dose, combination of treatments and any other health conditions.
The following medications are all immunosuppressant treatment:
- Azathioprine
- Adalimumab
- Ciclosporin
- Infliximab
- Methotrexate
- Mycophenolate mofetil
- Tacrolimus
You may also be immune suppressed if you have been treated in the last year with cyclophosphamide or rituximab.
Advice on medication
We have taken note of all Government advice, and instructions given by the Chief Medical Officer of Oxford University Hospitals. We have also discussed this specific issue with physician colleagues who also use immunosuppression, and have researched the medical literature.
Having taken these steps, our current advice is that if you are immunosuppressed, you should not stop your medication. If you do so, there is a significant possibility that your eye inflammation will worsen, and any steps then taken to control it may lead to greater problems.
If you are immunosuppressed it is important to take precautions to reduce the risk of infection and we recommend you regularly review the guidance on the Government websites.
Shielding measures
Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19
Shielding is a measure to protect people who are clinically extremely vulnerable by minimising all interaction between those who are extremely vulnerable and others.
The Government is strongly advising people with serious underlying health conditions, such as people on immunosuppression therapies, which significantly increase risk of infection and put them at very high risk of severe illness from coronavirus (COVID-19), to rigorously follow shielding measures in order to keep themselves safe.
If you belong to this group of patients we will write to you with further information and instructions. Until you receive this letter we advise you to shield.
If in doubt, or in case of questions please email: oeh.uveitis@nhs.net
Should patients who become infected cease their medication?
If you develop symptoms of an infection, established practice should be followed and immunosuppressive therapy (tablets [listed above] or injections) paused for the duration of the infection and until you feel better: this must be in consultation with your medical team.
However, do not stop steroid (Prednisolone) therapy abruptly, and seek advice.
Symptoms of coronavirus
Symptoms and what to do - nhs.uk
Medical help
If you are unwell visit NHS 111 online which advises when to contact NHS 111 telephone service.
If you are taking immunosuppression and have symptoms of coronavirus we recommend you contact NHS 111 immediately for advice.
If you do call NHS 111, have a list of your medications and inform 111 of these.
Do not come to Oxford Eye Hospital if you have symptoms or if you have tested positive for coronavirus.
Contact us
If you had an appointment booked in the Uveitis Clinic please contact the secretarial team to arrange a telephone consultation: arrangements can be made for prescription of medicines.
Tel: 01865 234567
For medical advice and medication queries please email: oeh.uveitis@nhs.net
Our advanced clinical Pharmacist will contact you.
Please do not email the secretaries or doctors directly: this is not a secure route of communication and there could be a delay in response.
Further information on coronavirus can be found at www.uveitisstudygroup.org
About the Uveitis Service
Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract.
The uvea is made up of the iris (coloured part of the eye), the ciliary body (ring of muscle behind the iris) and the choroid (layer of tissue that supports the retina).
Common signs of uveitis include:
- pain in one or both eyes
- redness of the eye
- blurred vision
- sensitivity to light (photophobia)
- floaters (shadows that move across your field of vision)
Treatment for uveitis will depend on which areas of the eye are affected and what caused the condition.
Medication is the main treatment, but surgery can be used in particularly severe cases.