Ocular allergy and uveitis are varied groups of inflammatory eye disorders characterized by complex and as yet ill-defined pathogeneses. Alpha-1 antitrypsin (AAT) is the archetype of the serine protease inhibitor supergene family. AAT deficiency is one of many factors that may be involved in abnormalities such as liver and lung disease, inflammatory joint diseases, and inflammatory eye diseases. In the present review, the role played by AAT in ocular inflammation is analyzed, particularly in vernal keratoconjunctivitis (VKC) and uveitis. Tear trypsin inhibitory capacity was shown to be reduced in VKC patients. In uveitis patients, a significant difference in AAT phenotypes was found compared to normal subjects. We propose that a reduced inhibitory capacity of ATT and AAT might facilitate or prolong different types of ocular inflammation.