What are the recommended treatment options for managing ocular involvement in Behçet's disease?

Management of ocular involvement in Behçet's disease primarily requires urgent referral to an ophthalmologist for confirmation of diagnosis and initiation of treatment, as uveitis associated with Behçet's is a form of non-infectious uveitis that can cause severe inflammation and vision loss if untreated NICE CKS. Treatment aims to rapidly control ocular inflammation and prevent irreversible damage. Initial therapy typically involves corticosteroids, which may be administered topically, orally, or via periocular or intraocular routes depending on severity, with careful tapering to avoid rebound inflammation NICE CKS. In addition to corticosteroids, systemic immunosuppressive agents such as methotrexate or mycophenolate mofetil are often used to manage chronic or severe cases, reducing the need for prolonged corticosteroid use and minimizing adverse effects NICE CKS. Tumour necrosis factor (TNF) inhibitors, for example adalimumab, have demonstrated efficacy in refractory Behçet's uveitis and are considered in cases unresponsive to conventional immunosuppressants NICE CKS. Cycloplegic agents may also be used adjunctively to relieve pain and prevent synechiae formation NICE CKS. The literature supports these approaches, highlighting the importance of aggressive immunosuppression to control ocular inflammation and preserve vision in Behçet's disease Zeghidi et al. 2014. Close monitoring for treatment efficacy and adverse effects, including intraocular pressure elevation from corticosteroids, is essential and typically managed in secondary care NICE CKS. Surgical interventions such as vitrectomy may be considered in complicated cases with vitreous involvement or persistent inflammation despite medical therapy NICE CKS. Overall, the integrated management strategy combines prompt specialist referral, corticosteroid therapy, systemic immunosuppression, and biologic agents tailored to disease severity, consistent with both UK guidelines and recent literature on Behçet's ocular disease NICE CKS; Zeghidi et al. 2014.