In case of inflammatory involvement of the back of the eye (intermediate, posterior or pan-uveitis), topical treatment is not enough to achieve high enough concentration of the drug at the posterior segment.

Treatment options thus include local or systemic therapy, based on the laterality of the disease and the presence of an associated systemic disorder.

Local therapy allows direct access to the intraocular space and therefore achieves a high drug concentration at the target of inflammation. The local approach includes the use of steroid injections and devices (Ozurdex and Iluvien). Local therapy can be used alone, commonly in case of unilateral involvement, or in combination with systemic medications, which can be helpful in reducing the burden of the systemic drugs.

Systemic treatment is usually started with oral steroids to induce a rapid response. High dose intravenous steroids might be used as initial treatment for severe sight threatening diseases. In case of severe or refractory disease, the addition of immunosuppressive drugs is important to allow long term control of the disease and minimize the side effects of the steroids. Commonly used Immunosuppressive agents include antimetabolites (mycophenolate, azathioprine, methotrexate) and T-cell inhibitors (ciclosporin, tacrolimus). Biologic therapies, including monoclonal antibody (e.g. anti TNF alfa) and cytokine treatments (e.g. interferon alfa) are also increasingly used.