Diabetic retinopathy (DR) occurs to some extent in most people with at least 20 years duration of diabetes mellitus. Progression of DR to its sight threatening stages is usually associated with worsening of underlying retinal vascular dysfunction and disease. The plasma kallikrein kinin system (KKS) is activated during vascular injury, where it mediates important functions in innate inflammation, blood flow, and coagulation. Recent findings from human vitreous proteomics and experimental studies on diabetic animal models have implicated the KKS in contributing to DR. Vitreous fluid from people with advanced stages of DR contains increased levels of plasma KKS components, including plasma kallikrein (PK), coagulation Factor XII, and high molecular weight kininogen. Both bradykinin B1 (B1R) and B2 (B2R) receptors isoforms are expressed in human retina, and retinal B1R levels are increased in diabetic rodents. Activation of the intraocular KKS induces retinal vascular permeability, vasodilation, and retinal thickening, and these responses are exacerbated in diabetic rats. Preclinical studies have shown that administration of PK inhibitors and B1R antagonists to diabetic rats ameliorates retinal vascular hyperpermeability and inflammation. These findings suggest that components of plasma KKS are potential therapeutic targets for diabetic macular edema.