Anterior uveitis is associated with travoprost

Uveitis and iritis are rare adverse effects of prostaglandin F2 α analogues¹ and are most common with latanoprost.² A 77 year old woman with no previous history of iritis started travoprost eye drops in November 2002 for advanced pseudoexfoliation glaucoma and cataract in both eyes. Two months later, owing to inadequate control of ocular pressure, she had phacotrabeculectomy in the right eye; she had stopped the travoprost the night before. A week later she complained of swelling and discomfort in the operated eye. We advised her to use her topical steroid more often. The eye settled down and pressure stabilised. In August 2003 she had phacotrabeculectomy in her left eye and again stopped travoprost. As intraocular pressure was still high two weeks later, she restarted taking travoprost. After three weeks she had severe iritis (3+ cells and flare) and corneal oedema and began to take timolol. However, intraocular pressure rose again and she chose to restart travoprost. Five days later acute iritis developed in the left eye, which resolved only after stopping travoprost and starting a combination of a β blocker and dorzolamide eyedrops to control the intraocular pressure. The patient's other drugs included bendrofluazide, diltiazem, ramipril, doxazosin, and chlordiazepoxide.

The close temporal association between starting travoprost and the onset of iritis, and recurrence after rechallenge suggests an adverse reaction to travoprost, scoring eight with the Naranjo algorithm.³ In the only reported case of iritis associated with travoprost,⁴ the patient was not rechallenged with the drug. The manufacturers of travoprost and the Medicines and Healthcare Products Regulatory Agency are aware of only one other case of uveitis associated with travoprost in the United Kingdom. Similar to patients who had adverse reactions to latanaprost, this woman developed iritis after incisional surgery.⁵