IMMUNOMODULATORY DRUGS IN OPHTHALMOLOGY: A COMPREHENSIVE REVIEW OF INDICATIONS, CONTRAINDICATIONS AND EMERGING EVIDENCE

Background: Ocular inflammatory and autoimmune diseases represent a heterogeneous group of conditions that, when inadequately controlled, lead to irreversible structural damage and visual impairment. Conventional corticosteroids, while effective for acute suppression, are associated with a well-documented constellation of sight-threatening and systemic adverse effects with prolonged use, necessitating the integration of steroid-sparing immunomodulatory therapy (IMT). Methods: A comprehensive narrative review of peer-reviewed literature published between 2015 and 2025 was conducted using PubMed, MEDLINE, and Cochrane databases, encompassing randomized controlled trials, systematic reviews, meta-analyses, and landmark observational cohort studies. Results: Immunomodulatory drugs spanning antimetabolites, calcineurin inhibitors, alkylating agents, and biologic agents demonstrate variable but clinically meaningful efficacy across uveitis, scleritis, ocular mucous membrane pemphigoid, thyroid eye disease, and other immune-mediated ocular conditions. Biologic therapies—particularly anti-TNF agents, IL-6 inhibitors, and IL-17 pathway antagonists—have substantially expanded therapeutic options. Conclusion: A systematic, evidence-based approach to IMT selection, guided by disease phenotype, systemic associations, and patient-specific factors, is essential for optimizing visual outcomes while minimizing treatment-related morbidity.