What are the consequences of prolonged corticosteroid use in the eye?

From the Guidelines

Prolonged corticosteroid use in the eye can lead to serious complications, including increased intraocular pressure and cataract formation, emphasizing the need for careful monitoring and tapering of steroids to minimize risks. The consequences of prolonged corticosteroid use in the eye are multifaceted, affecting various aspects of ocular health. Key complications include:

• Increased intraocular pressure (steroid-induced glaucoma), which can damage the optic nerve if left untreated 1
• Cataract formation, particularly posterior subcapsular cataracts, as a result of prolonged exposure to corticosteroids 1
• Delayed wound healing due to the immunosuppressive effects of corticosteroids
• Increased susceptibility to infections (bacterial, viral, and fungal) because of the suppressed local immune response
• Thinning of the cornea, which can lead to corneal perforation in severe cases

Specific medications like prednisolone acetate 1%, dexamethasone 0.1%, and fluorometholone have varying potencies and risk profiles, with more potent steroids generally carrying higher risks 1. Patients on long-term ocular steroids (typically beyond 2-4 weeks) should have regular monitoring of intraocular pressure and lens clarity to detect early signs of complications. Tapering rather than abrupt discontinuation of corticosteroids is recommended to prevent rebound inflammation, and the dosage should be slowly adjusted to the minimum effective dose 1. The choice of corticosteroid, considering factors like ocular penetration, can also influence the risk of complications, with options like fluorometholone or loteprednol potentially being less likely to cause elevated IOP or cataract formation 1. Regular follow-up examinations, including measurements of visual acuity, IOP, and slit-lamp biomicroscopy, are crucial for managing patients on prolonged corticosteroid therapy.

From the FDA Drug Label

WARNINGS Prolonged use of corticosteroids may result in posterior subcapsular cataract formation and may increase intraocular pressure in susceptible individuals, resulting in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation. Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex) ADVERSE REACTIONS ... include elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage, posterior subcapsular cataract formation, and delayed wound healing.

The consequences of prolonged corticosteroid use in the eye include:

• Posterior subcapsular cataract formation
• Increased intraocular pressure, potentially leading to glaucoma with damage to the optic nerve and defects in visual acuity and fields of vision
• Delayed wound healing
• Secondary ocular infections (bacterial, fungal, and viral)
• Exacerbation of viral infections, such as herpes simplex 2 2

From the Research

Consequences of Prolonged Corticosteroid Use in the Eye

The use of corticosteroids in the eye can have several consequences, including:

• Increased intraocular pressure (IOP) leading to secondary open-angle glaucoma, similar to chronic simple glaucoma 3, 4
• Corticosteroid-induced cataracts, with a risk of 11-15% 5
• Central serous chorioretinopathy (CSCR), a lesser-known complication that can cause irreversible visual impairment 6
• Posterior subcapsular cataract, with a risk of 11-15% 5
• Reversible but potentially damaging effects on the eye, particularly with long-term use 3, 4

Risk Factors and Prevention

The risk of these complications varies and depends on:

• Dose and duration of corticosteroid administration 5
• Type of corticosteroid used, with some preparations being more potent than others 3
• Individual patient factors, such as terrain and underlying medical conditions 5 Regular ophthalmological examinations are necessary for patients on long-term topical or general corticosteroids to monitor for potential complications 5

Management and Treatment

Treatment of corticosteroid-induced complications may involve:

• Discontinuation of corticosteroid therapy in cases of uncontrolled glaucoma 5
• Tapering of corticosteroids to resolve chronic CSCR 6
• Focal laser photocoagulation for treatment of CSCR 6
• Hypotonic treatment for management of glaucoma 5