Update on the management of non- infectious uveitis

Uveitis is inflammation of the anterior, intermediate and/or posterior part of the uvea — the pigmented vascular coat of the eye. It can be infectious or non- infectious, idiopathic or secondary to systemic conditions. Uveitis has a wide range of presentations, from asymptomatic to rapidly sight-threatening disease, and can lead to permanent vision loss in the absence of early therapy. Ethnicity, genetics and the environment can account for regional variations in patterns of uveitis. Management of uveitis remains a challenge because of the diverse heterogeneity in presentation, and a paucity of randomized controlled trials evaluating different drug regimens. Despite being the mainstay of therapy for uveitis, corticosteroid monotherapy is increasingly viewed as unsuitable due to its significant side-effects. A stepwise approach is often adopted whereby least-to-more aggressive forms of therapy are trialed to induce remission. Treatment regimens are shifting from low-dose chronic corticosteroids for maintenance to medium-to-high-dose therapy to control acute inflammation, followed by rapid initiation of immunomodulatory therapy or biologics. This review provides a comprehensive overview of the challenges in managing patients with uveitis, as well as important advances in its investigations and treatment.