Ocular infection corticosteroids

Adverse reactions associated with administration of the corticosteroid ophthalmic preparations include elevated IOP with optic nerve damage, loss of visual acuity, cataract formation, delayed wound healing, secondary ocular infection, exacerbation of comeal infections, dry eyes, ptosis, blurred vision, discharge, ocular pain, foreign body sensation, and pruritus. 

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... 

Idoxuridine (1 drop into infected eye/hr during the day and q. 2 hours at night) is indicated in the treatment of herpes simplex keratitis. By altering normal DNA synthesis, idoxuridine inhibits the reproduction of herpes simplex virus. IDU replaces thymidine in the enzymatic step of viral replication, produces faulty DNA, and hence a structure that loses its ability to infect and destroy ocular tissue. Corticosteroids can accelerate the spread of a viral infection and are usually contraindicated in herpes simplex epithelial infections. Idoxuridine occasionally causes irritation, pain, pruritus, inflammation or edema of the eyes or lids and allergic reactions, photophobia, corneal clouding, stippling, and punctate defects in the corneal epithelium. The punctate defects may be a manifestation of the infection, as healing usually takes place without interruption of therapy. 

Topical corticosteroids are employed in some cases of bacterial keratitis. The suppression of inflammation may reduce corneal scarring. However, local immunosuppression, increased ocular pressure, and reappearance of the infection are disadvantages to their use. There is no conclusive evidence that they alter clinical outcomes. If the patient is already on topical corticosteroids when the keratitis occurs, discontinue use until the infection is eliminated.19... 

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). 

Since corticosteroids reduce the immunological defences of the body to most types of infection, their use in the eye should be monitored carefully. The specific type of ocular disease and its response to steroid therapy may determine whether to use topical, systemic and/or local injections. Systemic side effects do not generally occur with limited topical administration. 

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