Periocular diseases

According to the location of diseases, ocular disorders are grouped as periocular and intraocular conditions. Periocular diseases include ... 

Ideally the effective dose should be used for the shortest time necessary to secure the desired clinical response. The dosage should be individualized as much as possible to the patient and the severity of the condition. The patient s general health must be considered and close supervision maintained to assess the effects of steroid therapy on the course of the disease and possible adverse effects. With ocular disease the route of steroid administration is an important determinant of the pharmacologic and therapeutic effects observed. Topical ocular therapy is usually satisfectory for inflammatory disorders of the eyelids, conjimctiva, cornea, iris, and ciliary body. In severe fiarms of anterior uveitis, topical therapy may require supplementation with systemic or periocular (local injection) steroids. Chorioretinitis and optic neuritis are most often treated with systemic steroids. 

Pruritic and inflamed periocular skin is a common eyelid manifestation of periorbital dermatoses. The poor ability of involved skin to bind water in atopic disease decreases the resistance to irritants and allergens and promotes inflammation. Red itchy eyes are accompanied by erythema, edema, and fine scaling of the eyelids. Papules and fine fissures are sometimes noted, and if the condition is chronic, normal skin lines become thickened and accentuated. Chronic rubbing leads to exacerbation of the symptoms, and brown discoloration of the upper eyelids can be observed. Referred to as lichen simplex chronicus, the changes appear to be more common in women and Asian individuals and result from a repeated rubbing cycle. 

A stepwise approach to therapy was proposed for cases of ocular toxocariasis. For eye disease alone, local and periocular or systemic steroids should be used, with surgery (vitrectomy, membrane peel) when appropriate. For eye disease unresponsive to steroids, a specific anthelmintic agent is added and systemic steroids are continued (e.g., thiabendazole 50 mgAg per day for 7 days plus prednisolone 0.5 to 1.0 mg/kg per day). For eye disease with systemic symptoms (VLM) or high antibody levels, local steroids and mydriatics are used, in addition to oral thiabendazole and oral steroids from the outset. 

Locally administered steroids have been used with variable success. Although topically applied steroids are completely ineffective in alleviating the ocular signs or symptoms associated with class 2 disease, periocular... 

Intraocular injections are associated with significant complications and often must be repeated at regular intervals in patients with a chronic disease such as uveitis. Similar difficulties are associated with periocular injections although the complication rate is lower and those that do occur are usually less severe. The main... 

Corticosteroids have been used to treat a variety of ocular diseases. Traditionally, delivery of corticosteroids for posterior-segment eye diseases has been achieved through oral systemic therapy and periocular injections. Oral corticosteroids have not been widely used to treat DME, but when used for posterior inflammatory uveitis, they require high concentrations to reach therapeutic levels in the posterior segment. These high doses often result in systemic side effects (24). Periocular corticosteroid administration often must be repeated and may be associated with complications such as ptosis and inadvertent needle penetration of the globe. 

Most ocular diseases like dryness, conjunctiva, and eye flu are treated by topical drug application in the form of solutions, suspensions, and ointment. In the earlier period, drug delivery to the eye has been limited to topical application, redistribution into the eye following systemic administration, or direct intraocular/periocular injections. However, one of the major barriers of ocular medication is to obtain and maintain a therapeutic level at the site of action for a prolonged period of time. 

Some ocular diseases require specific treatment given via intravitreal or periocular injection into the eye. 

Absolute hypersensitivity to the drug or any other component of the product. Active or suspected ocular or periocular infection (herpes simplex keratitis, vaccinia, varicella, mycobacterial disease or fungal infection), systemic fungal infections, advanced glaucoma or concurrent administration of live vaccines in patients receiving immunosuppressive doses. 

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