Purpose . To determine the efficacy and complications of intravitreal gentamicin injection (IVGI) to treat Equine Recurrent Uveitis (ERU) in North American horses. To determine the influence of leptospirosis infection on the efficacy and the long-term complications/effects of IVGI. Methods. Forty-six cases from 2016-2022 were reviewed. Horses that met the inclusion criteria for diagnosis of ERU and received intravitreal treatment with 4mg of preservative-free gentamicin were included in the study. One follow-up examination was required to assess control of inflammation (no aqueous flare and normal intraocular pressure), visual status and complications. Leptospirosis titers and c-values were evaluated when available. Results. Forty-five eyes from 26 horses met study inclusion criteria and were included in data analysis. Only 5 eyes with pre-injection glaucoma received IVGI which failed to control/improve the glaucoma were not included in data analysis. Twenty-four of 35 eyes (69%; 95%CI 52-81) were controlled at the last follow up with the minimum follow-up between 14-30 days and maximum follow-up period of 6 years. Post injection complications included cataract formation/maturation in 14 of 36 (39%; 95%CI 25-55), retinal detachment and degeneration in 9 of 33 (27%; 95%CI 15-44). Eight horses had a Leptospira c-value available and 3/3 with a c-value <4 were controlled post injection as opposed to 2/5 with a c-value >4. Conclusions. Intravitreal injection of preservative-free low dose gentamicin effectively controls ERU. None.