Abstract
Corticosteroids form the cornerstone of treatment for noninfectious uveitis, but their safety profile and adverse effects render their use a double-edged sword. As a result, the local benefits of treating ocular inflammation may be outweighed by systemic adverse effects, and it is mainly for this reason that steroid-sparing agents are used. Most of these systemic immunomodulatory drugs used in ophthalmology have been adopted from other specialties, such as rheumatology and, while their safety profiles make them valid alternatives to long-term high-dose corticosteroids, systemic side effects still prove problematic for a significant proportion of patients. The desire to avoid these systemic side effects has driven the continuing search for effective agents with an improved safety profile, but also the increasing use of local drug administration, which avoids systemic side-effects, but may lead to ocular complications. Here we review both approaches and discuss the possible risks and benefits of each.