Safe Use of Corticosteroids in Non-Infectious Uveitis

Matteo Belletti,1,2 Rosario Izquierdo-Escamez,3 Carolina Tornero,4 Otto Olivas-Vergara,5 Diana Peiteado,4 Ester Carreño1 1Department of Ophthalmology, Hospital Universitario La Paz, Madrid, Spain; 2Department of Ophthalmology, IRCSS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy; 3Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain; 4Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain; 5Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, SpainCorrespondence: Ester Carreño, Department of Ophthalmology Hospital Universitario La Paz, P.° de la Castellana 261, Fuencarral-El Pardo, Madrid, 28046, Spain, Email [email protected]: Corticosteroids continue to represent the cornerstone of uveitis management, owing to their potent anti-inflammatory effects, which are pivotal for suppressing intraocular inflammation and mitigating the risk of irreversible visual impairment. This review focuses on the safety considerations associated with corticosteroid therapy across multiple administration routes, including topical, periocular, intravitreal, and systemic. Optimal corticosteroid therapy requires a personalized, stepwise approach, commencing with the least invasive modality at the lowest effective dose and escalating based on anatomical involvement, disease severity, and individual risk profiles, to balance efficacy with safety. Special attention is given to strategies for mitigating well-recognized local and systemic adverse effects, such as ocular hypertension, cataracts, osteoporosis, and increased cardiovascular risk. Beyond synthesizing current evidence, this review offers a novel perspective by integrating systemic and local therapy risks and by highlighting safety strategies that can guide individualized regimens. Finally, we identify persisting knowledge gaps, including the lack of long-term comparative safety data, limited evidence on risk stratification, and the need for biomarkers to guide therapy, which represent critical avenues for future research. Adjunctive use of immunosuppressive or biologic agents enables improved long-term control and facilitates corticosteroid tapering.Keywords: uveitis, non-infectious uveitis, corticosteroids, glucocorticoids, safety