Intraocular pressure corticosteroid increasing

If mast cell stabilizers or multiple-action agents are not successful, a trial of a topical NSAID is appropriate. Ketorolac is the only approved topical agent for ocular itching. NSAIDs do not mask ocular infections, affect wound healing, increase intraocular pressure, or contribute to cataract formation like the topical corticosteroids. However, for allergic conjunctivitis, topical ketorolac is not as effective as olopatadine or emedas-tine in trials.15 Full efficacy of ketorolac takes up to 2 weeks.17... 

Iritis, which affects up to 25% of patients undergoing fomivirsen therapy, can be managed with topical corticosteroids. Vitreitis and increased intraocular pressure may also result from fomivirsen administration. Fomivirsen is contraindicated in patients who have been treated with cidofovtr within the previous 2 to 4 weeks because cidofovir increases the risk of ocular inflammation. 

The most commonly observed side effects associated with vidarabine are lacrimation, burning, irritation, pain, and photophobia. Vidarabine has oncogenic and mutagenic potential however, the risk of systemic effects is low because of its limited absorption. It should not be used in conjunction with ophthalmic corticosteroids, since these drugs increase the spread of HSV infection and may produce side effects such as increased intraocular pressure, glaucoma, and cataracts. 

Increases in intraocular pressure and development of posterior subcapsular cataracts are femiliar sequelae to corticosteroid therapy. Increased intraocular pressure after IVTA is considerably more common than endophthalmitis and has been established in different studies. Results are not readily comparable, because different amounts of triamcinolone were administered. However, it should be noted that approximately 30% or more of patients had an increase in intraocular pressure, regardless of the dose given, which is consistent with the finding that a significant number of patients are steroid... 

The ocular side effects of corticosteroids are many and are related to the route of administration. The most common concerns are increased intraocular pressure (lOP) and cataracts, but delayed epithelial woimd healing and increased risk of infection due to immime modulation and decreased tear lysozyme levels are issues for the cornea. Changes to other ocular tissues have been noted (subconjunctival hemorrhages, blue sclera, eyelid hyperemia and edema, retinal emboUc events, central serous choroidopathy) and neurologic compUcations reported (diplopia, nerve palsies, intracranial hypertension) (see Appendix 35-1). 

Intravitreal injections to deliver corticosteroids minimize systemic side effects however, they may be associated with complications such as retinal detachment, retinal tears, vitreous hemorrhage, endophthalmitis, increased intraocular pressure (IOP), cataract formation, and, with repeated use (required for successful treatment), fibrosis and ptosis. The most common side effect is increased IOP, which has been found on rare occasion to increase drastically (up to 50mmHg in one case report by Detry-Morel et al.) (16,34,35). Close IOP monitoring is crucial following intravitreal injection. 

This drug is one of the few corticosteroids that has a decreased potential for mediation of increased intraocular pressure. In addition, it has a low potential for systemic absorption. 

Karrison, and J.T. Ernest, Corticosteroid treatment for inflammatory bowel disease in pediatric patients increases intraocular pressure, Gastroenter. 102 1957(1992). 

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