Few conditions remind us as forcefully as noninfectious uveitis how urgently we must act when inflammation takes hold in the eye. If caught early and treated appropriately, the inflammatory cascade may be suppressed before it becomes chronic. If left untreated, however, the consequences may be severe and lasting.
Noninfectious uveitis encompasses inflammation of the uveal tract, including the iris, ciliary body, and choroid.1 Typical causes include autoimmune dysregulation, systemic inflammatory diseases such as sarcoidosis or ankylosing spondylitis, and ocular trauma. The condition is more common than many clinicians appreciate, accounting for roughly 10% to 15% of all cases of legal blindness in the developed world. It disproportionately affects working-age adults, typically those aged 20 to 50 years.2-4 For these patients, the disease carries not only the threat of irreversible vision loss but also a significant burden on daily functioning, employment, and quality of life.
The Negative Effects of Undertreatment
Common presentations of noninfectious uveitis include blurred vision, a red eye, photophobia, and irritation. Given the nonspecific nature of these symptoms, the diagnosis is frequently missed at initial presentation, and topical antibiotic drops are commonly prescribed before uveitis is considered. When the drops fail, patients may be referred to an optometrist or a general ophthalmologist before finding their way to a uveitis or retina specialist. By that time, the inflammation has had time to establish itself and, in some cases, has already begun damaging delicate ocular structures.
Untreated inflammation may cause scarring and lead to posterior synechiae, cystoid macular edema, epiretinal membrane formation, and in the worst cases, tractional retinal detachment.5 Macular edema is the most common cause of vision loss in noninfectious uveitis,6 and it is largely preventable with timely, appropriately aggressive treatment.
When Topical Therapy Is Not Enough
The treatment algorithm for noninfectious uveitis begins with topical corticosteroid drops. Although effective for anterior uveitis, topical corticosteroids do not sufficiently penetrate the vitreous cavity and posterior pole to control disease involving these areas.
Several clinical red flags indicate that it is time to escalate treatment. Persistent macular edema that does not resolve with topical therapy is the most compelling. Intermediate or posterior uveitis that does not respond to drops, or flares every time a taper is attempted, is another clear signal. In these situations, an intravitreal or sub-Tenon injection of a corticosteroid may be used to deliver medication directly where it is needed in a concentration that drops cannot achieve.
Choosing Among Corticosteroid Options
Multiple corticosteroid approaches are available for the management of noninfectious uveitis, including injectable triamcinolone, sustained-release dexamethasone implants, and fluocinolone implants. The optimal choice depends on disease location, desired duration of effect, treatment burden, lens status, and tolerance for potential adverse effects such as cataract progression and elevated intraocular pressure (IOP).
Injectable triamcinolone, delivered either intravitreally or via sub-Tenon administration, provides a meaningful anti-inflammatory effect without committing to a longer-duration implant.
Historically, generic, compounded, and off-label triamcinolone preparations have been used because alternatives were limited or unavailable. A commercially available option specifically intended for ocular use, triamcinolone acetonide injectable suspension 40 mg/mL (Triesence, Harrow), is once again available. This preservative-free formulation may reduce the risk of ocular toxicity, and its uniform triamcinolone particle size may provide a more predictable and reproducible pharmacokinetic profile compared with generic formulations. As clinicians, we want to know what to expect from a treatment, and uniform particle size may support greater consistency.
Intravitreal implants such as dexamethasone intravitreal implant 0.7 mg (Ozurdex; AbbVie) and fluocinolone acetonide intravitreal implant 0.19 mg (Iluvien; ANI Pharmaceuticals) may be used to provide sustained corticosteroid therapy for noninfectious uveitis affecting the posterior segment. The dexamethasone implant provides a shorter-acting, biodegradable treatment option, whereas the fluocinolone implant may be considered when longer-term suppression and reduced treatment frequency are priorities, particularly in patients with chronic disease.
Both implants deliver corticosteroid locally to the posterior segment, but their duration of effect differs substantially. Ozurdex contains dexamethasone in a biodegradable polymer implant and generally provides treatment over a period of several months, whereas Iluvien is designed to release fluocinolone acetonide for up to 36 months. Both are associated with corticosteroid-related adverse effects, particularly elevated intraocular pressure and cataract formation, and require appropriate patient selection and monitoring.7,8
Treatment Considerations
Selecting the best therapeutic approach to noninfectious uveitis requires balancing factors such as formulation consistency, sterility assurance, preservative exposure, duration of effect, reimbursement, and treatment burden. In practice, inertia often influences therapeutic decision making. Once a workflow is established, change can be slow. As additional options have become available again, however, clinicians have an opportunity to reassess which formulation best aligns with the needs of individual patients and practice settings.
Practical considerations are also important. Injectable triamcinolone is attractive because the reimbursement pathway is generally established. In my practice’s experience, coverage is usually obtainable when a benefits investigation is performed appropriately.
Patients who stand to gain the most from injectable corticosteroid therapy are generally those with intermediate uveitis, posterior uveitis, or panuveitis, particularly when macular edema is present or topical therapy has proven insufficient. The goal extends beyond suppressing a flare; it is to provide durable, steady-state control that minimizes the frequency of recurrences and office visits. A single injection of triamcinolone acetonide may provide anti-inflammatory activity for several months, with the effect naturally tapering as the drug is metabolized. This mechanism may reduce treatment burden and simplify adherence.
Route of Administration and Best Practices
One practical advantage of triamcinolone acetonide injectable suspension 40 mg/mL is flexibility in administration. It can be injected intravitreally to achieve a higher concentration in the posterior segment or via the sub-Tenon route, which is traditionally favored by many uveitis specialists.
I choose the route based on the specific clinical scenario. For eyes with a single-chamber configuration, such as those that have undergone secondary intraocular lens (IOL) implantation, I prefer a sub-Tenon injection because intravitreal triamcinolone particles can migrate anteriorly into the anterior chamber. I also prefer the sub-Tenon route in vitrectomized eyes to avoid diffuse particle clouds.
Although this article focuses primarily on ocular inflammation management, it is important to note injectable triamcinolone may also provide secondary procedural advantages in selected surgical settings. Intraoperative use affords excellent visualization of the vitreous during complex posterior segment surgeries, which is particularly useful when inducing a posterior vitreous detachment and ensuring complete vitreous removal. As a fellowship director, I find this benefit valuable for surgical education and trainee development.
A practical workflow I adopted is to use a small volume of triamcinolone acetonide injectable suspension 40 mg/mL intraoperatively for vitreous visualization and then, at the close of the case, use the remainder of the vial for a sub-Tenon injection. This provides postoperative anti-inflammatory coverage and reduces dependence on patient adherence to postoperative drops. For more complex cases involving greater intraocular manipulation, a sub-Tenon depot is particularly useful for controlling more substantial postoperative inflammation.
I recommend initiating a benefits investigation even before it is clear triamcinolone acetonide injectable suspension 40 mg/mL will be needed. If a patient presents with uveitis and is started on topical therapy, having insurance verification underway avoids administrative delays between the patient and treatment.
Conclusion
Noninfectious uveitis is best managed with appropriately aggressive treatment to prevent vision-threatening complications. As therapeutic approaches have evolved, eye care specialists can now choose from multiple corticosteroid options. The availability of both injectable triamcinolone and sustained-release implant technologies allows treatment to be individualized based on disease characteristics and patient needs. For patients whose disease cannot be adequately controlled with topical therapy alone, injectable corticosteroids remain an important therapeutic option. RP
References
1. Takeuchi M, Mizuki N, Ohno S. Pathogenesis of non-infectious uveitis elucidated by recent genetic findings. Front Immunol. 2021;12:640473. doi:10.3389/fimmu.2021.640473
2. Liu D-Y, Kuo H-T, Hsu AY, et al. Risk of glaucoma in patients with idiopathic noninfectious uveitis: a multi-institutional real-world retrospective cohort study. Am J Ophthalmol. 2026;285:63-72. doi:10.1016/j.ajo.2026.01.020
3. Shah A, Berkowitz ST, Tsui E, Gonzales JA, Crowell EL, Gangaputra S. Forecasting the workforce of uveitis specialists. Am J Ophthalmol. 2026;287:58-66. doi:10.1016/j.ajo.2026.03.021
4. Joltikov KA, Lobo-Chan AM. Epidemiology and risk factors in non-infectious uveitis: a systematic review. Front Med (Lausanne). 2021;8:695904. doi:10.3389/fmed.2021.695904
5. Yap A, Lu LM, Sims JL, Welch S, Niederer RL. Epiretinal membrane in uveitis: rate, visual prognosis, complications, and surgical outcomes. Clin Exp Ophthalmol. 2024;52(1):54-62. doi:10.1111/ceo.14338
6. Koronis S, Stavrakas P, Balidis M, Kozeis N, Tranos PG. Update in treatment of uveitic macular edema. Drug Des Devel Ther. 2019;13:667-680. doi:10.2147/DDDT.S166092
7. Jaffe GJ, Pavesio CE. Effect of a fluocinolone acetonide insert on recurrence rates in noninfectious intermediate, posterior, or panuveitis: three-year results. Ophthalmology. 2020;127(10):1395-1404. doi:10.1016/j.ophtha.2020.04.001
8. Jaffe GJ, Martin D, Callanan D, et al. Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis: thirty-four–week results of a multicenter randomized clinical study. Ophthalmology. 2006;113(6):1020-1027. doi:10.1016/j.ophtha.2006.02.021