Gallemore's Corner
Ron Gallemore, M.D.
May 2015

Steroid Drops: Proceed with Caution

Inflammation plays a central role in a wide spectrum of ocular disorders including uveitis, dry eyes, macular edema and even some forms of glaucoma. Steroid drops often play a central role in the management of select cases. Steroid drops also pose risk as well as benefits and here we review what to keep in mind.

Infection
Steroids inhibit the immune system so they are contraindicated in the setting of any infection. While this seems obvious, the distinction between infectious and non-infectious inflammation may be subtle. In the setting of keratitis, for example, an occult herpetic, bacterial or fungal infection may be present. When unsure based on clinical examination alone, consider appropriate testing.

Glaucoma
Steroids can increase intraocular pressure. Patients with preexisting glaucoma are at greater risk for a steroid response. The longer the term of steroid use, the higher the risk of a pressure increase.  Make sure patients understand importance of follow-up care and continual monitoring of intraocular pressure.

Cataract
Some patients are particularly sensitive to steroid-induced cataract formation. In particular, those with prior steroid exposure, preexisting cataract, and diabetes.

Diabetes and Hypertension
While topical steroids achieve little systemic absorption, some does occur. Susceptible patients may experience an increase in blood glucose levels and blood pressure and should be warned as such if prolonged steroid use is being considered.

Strong Steroid
Difluprednate is a topical strong steroid. All of the above concerns apply only more so. Frequent follow-up is key and a risk-benefit analysis should be made when initiating treatment with this medication.

Topical steroids will remain a key aspect of our management of inflammatory ocular diseases. Patients should be informed of the risks, benefits, and alternatives and be monitored closely.



Retina Macula Institute and the Retina Macula Research Center
Don T. Pham, B.S.
Ron P. Gallemore, M.D., Ph.D.
4201 Torrance Blvd
Torrance, CA 90503
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