Corticosteroids and the eye

Corticosteroids administered locally, (as eye drops, eye ointment or subconjunctival injections), or by mouth have an important place in treating inflammation, including that which results from surgery.

They should normally only be used under expert supervision. Problems are associated with their use.

Red eye - topical steroids should not be used for undiagnosed red eye. If red eye is due to herpes simplex, corticosteroids will aggravate this condition possibly leading to loss of vision or even loss of the eye.

Side effects - steroid eye drops can raise intra-ocular pressure (IOP) and therefore precipitate glaucoma in patients predisposed to chronic simple glaucoma. Evidence suggests that fluorometholone is less likely to raise IOP though this may be due to reduced penetration of the cornea. A steroid cataract may follow prolonged use with topical steroids. Other side effects include thinning of the cornea and sclera.

Topical ophthalmic steroids placed in descending order of potency:

• prednisolone acetate 1% (most potent)
• dexamethasone 0.1%
• betamethasone 0.1%
• prednisolone sodium phosphate 0.5%
• fluorometholone 0.1% (least potent)

The severity of inflammation determines the choice of steroid.

For the treatment of Macular oedema, see intravitreal corticosteroids

For the general actions, warnings and prescribing notes for steroids, see Corticosteroid responsive conditions