Local delivery has taken over much of the management of non-infectious uveitis, and the options now form a ladder rather than a list. Topical corticosteroid remains first line for anterior disease. Periocular and intravitreal triamcinolone and the dexamethasone implant cover intermediate and posterior inflammation. Fluocinolone acetonide implants give sustained control in chronic or relapsing disease, at a well-documented price in ocular hypertension and cataract.
Suprachoroidal delivery is the structural change: it targets the posterior segment while sparing much of the anterior chamber exposure that drives pressure rise and lens opacity. Intravitreal methotrexate and sirolimus offer steroid-sparing alternatives, and topical ciclosporin and tacrolimus have a narrow role in chronic anterior disease.
For Indian practice the constraint is availability and cost rather than choice: the dexamethasone implant is widely used, the long-acting fluocinolone implants much less so, and suprachoroidal delivery is not yet routine. The sequencing principle still holds — escalate by disease location and duration, and count the steroid exposure as you go.
- Match the route to the anatomical location of inflammation, not to the severity alone.
- Count cumulative steroid exposure across routes; local is not free of systemic or ocular cost.
- Warn about ocular hypertension and cataract before any sustained-release steroid implant.
- Consider methotrexate or sirolimus intravitreally where steroid response is a problem.
- Exclude infection before any local steroid; this ladder applies only to non-infectious disease.
Why it matters
Local delivery has multiplied the options faster than most clinics have agreed how to sequence them.
Don't overread it
A narrative review of current practice, not a comparison of these routes against each other.
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