Forlan silenced the home fans at Loftus Versfeld Stadium when he drilled a shot over the home goalkeeper Itumeleng Khune from 30 yards with the ball deflecting off Aaron Mokoena on 23 minutes.
The night got worse for the home fans on 80 minutes when Khune was rightly sent off for a late two-footed tackle on Luis Suarez only five yards from goal.
Forlan endured a five-minute wait until Moeneeb Josephs's arrival before he could take the penalty, but he slammed the ball high to the substitute keeper's right.
Alvaro Pereira nodded the third from Suarez's cross seconds before the end to complete an overwhelming and deserved victory for the South American side, who displayed a cutting edge missing in the 0-0 draw with France in their opening match.
South Africa must beat France in their final group match to keep alive their hopes of a place in the last 16. Uruguay will probably require only a draw against Mexico to progress.
Uruguay made a sharp opening, playing with a three-pronged attack that saw Forlan sit slightly deeper with Suarez, Edinson Cavani and Pereira operating in a fluid attacking format.
Uruguay were first to threaten when Forlan attempted a free-kick from 25 yards. Steven Pienaar, who was later sacrificed to make way for Josephs, charged it down too early.
The Everton player was booked before Forlan's second effort was hit straight at the wall. The danger signs were already there for South Africa, but they failed to heed the warning.
The visiting players continued to push. Jorge Fucile meandered up a flank, but he couldn't get hold of a shot and the ball failed to trouble Khune in the home goal.
Some more nice play between Forlan and Suarez allowed the Ajax player to win space, but he was off balance and the ball flew harmlessly wide.
South African's Bongani Khumalo got his head on a free-kick, but could not direct it goalwards as the home side struggled to make any telling impression on the visiting goal.
Forlan silenced the large crowd and their blaring vuvuzelas when he thumped an effort into the net before racing to celebrate with the delighted Uruguayan bench.
It marked the end of a long wait for a first World Cup goal by a member of the Forlan family: Diego's father Pablo Forlan was selected for the 1966 World Cup squad, but didn't play in England. He played in three 1974 matches without scoring.
Diego failed to score in one 2002 World Cup match and in the 2010 opener against France, but this was worth the wait.
He would soon have a second as Uruguay continued to leave at least two men up at all times, which was commendable.
Kagisho Dikgacoi was booked for a late foul on Suarez. He will miss the final group match against France, an occasion that may be South Africa's final fling at these finals.
Khune was sent off after he brought down Suarez with his feet and Forlan punished the 10 men with an expert penalty.
They completed the job deep in injury time. Forlan was again involved in a lovely move before Suarez turned provider for Pereira to net.
Some of the home supporters had already been spilling out of the ground and their team, despite not lacking heart, may soon be emptied out of their home tournament.
South Africa face a fraught finish to avoid becoming the first host nation to fail to progress beyond the first round.
Match Facts
South Africa v Uruguay
Goals 0-3
1st Half Goals 0-1
Shots on Target 3-6
Shots off Target 16-3
Blocked Shots 5-9
Corners 3-4
Fouls 13-10
Offsides 3-2
Yellow Cards 2-2
Red Cards 1-0
Passing Success 86.5%-70%
Tackles 16%-25%
Tackles Success 87.5%-79.1%
Possession 57.6%-42.4%
Territorial Advantage 50.5%-49.5%
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