The philosophy of treatment of uveitis: past, present and future

Treatment of inflammatory diseases of the eye is especially challenging. Although physicians in antiquity had recognized the existence of ocular inflammatory disease, their lack of understanding of the immune system made successful treatment almost impossible. Throughout the 20th century, great advances in the diagnosis and treatment of uveitis led to unique treatment options. The development of corticosteroids in 1949 and its application to the eye in 1950 revolutionized therapeutic strategies. As the use of corticosteroids became more prevalent in treating ocular inflammatory diseases, so did its side effects. Due to the high morbidity in conjunction with long-term corticosteroid use, physicians pursued other agents, specifically through the employment of chemotherapeutic agents. The shift from exclusive corticosteroid monotherapy to steroid-sparing immunomodulatory therapy reshaped the landscape of treating ocular inflammatory disease. Over time, with increased efforts, new therapies were studied, trialed, and brought to the market. Today, in comparison to any other time in history, physicians have available to them the largest array of effective agents for achieving the ultimate goal: corticosteroid-free, durable remission.