Practical approach to the use of corticosteroids in patients with uveitis.

Corticosteroids constitute the first line of therapy for patients with noninfectious ocular inflammatory disease. We review factors contributing to the clinical effectiveness of various corticosteroid preparations in patients with uveitis and discuss practical aspects regarding treatment indications, when to administer various agents, and how best to dose and monitor for both treatment and adverse effects. Topically administered corticosteroids are typically indicated for the treatment of anterior uveitis, whereas periocular or intravitreal agents are employed most often in the management of intermediate or posterior intraocular inflammation. Patients with vision-threatening uveitis, bilateral inflammation, or uveitis occurring in the setting of systemic involvement may require oral or intravenous administration of corticosteroids. Noncorticosteroid immunosuppressive agents play an important role in limiting the toxic effects of long-term corticosteroid use.