What is the mainstay treatment for non-infectious uveitis?

• A. Antibiotics
• B. Antivirals
• C. Immunomodulatory therapy only
• D. Corticosteroids (topical for anterior uveitis; periocular or systemic for posterior) with immunomodulatory therapy as needed

Answer: (D)

Non-infectious uveitis is treated by rapidly suppressing intraocular inflammation to protect vision. Corticosteroids are the go-to therapy because they provide quick, potent anti-inflammatory control. For anterior uveitis, topical corticosteroids (and cycloplegics) are typically sufficient, but when the inflammation involves the posterior segment or is more extensive, periocular injections or systemic steroids are used to ensure the drug reaches the back of the eye. In chronic or recurrent cases, or when trying to reduce steroid exposure, immunomodulatory therapy is added as needed to maintain control and spare the eye from long-term steroid side effects. Immunomodulators like methotrexate, azathioprine, mycophenolate, cyclosporine, and biologics such as adalimumab are used as steroid-sparing or combination therapies to keep inflammation in check. Antibiotics or antivirals are reserved for infectious uveitis, not non-infectious causes, so they aren’t the mainstay of treatment.