From the Guidelines
Corticosteroid eye drops are indicated in general practice for short-term use in moderate-to-severe dupilumab-related ocular surface disorders (DROSD), as well as in cases of bacterial keratitis where the corneal infiltrate compromises the visual axis, after at least 2 to 3 days of progressive improvement with topical antibiotic treatment and after fungal infection has been ruled out 1.
Key Considerations
- Judicious use with close follow-up is essential to minimize the risks of long-term topical corticosteroid therapy, including cataract and glaucoma 1.
- Introduction of corticosteroid-sparing therapy should be considered for those cases where topical corticosteroid drops are required for more than 6 weeks 1.
- Monitoring of intraocular pressure (IOP) is crucial when initiating topical corticosteroid therapy, and patients should be examined within 1 to 2 days after initiation 1.
- Risks and benefits of corticosteroid therapy should be discussed with the patient, including the potential for increased symptoms as corticosteroids are reduced or eliminated 1.
Specific Indications
- DROSD: short-term use of ocular topical corticosteroids (e.g., preservative-free dexamethasone 0.1%, prednisolone 0.5%, or hydrocortisone 0.335% eyedrops) may be beneficial for moderate-to-severe cases 1.
- Bacterial keratitis: topical corticosteroid therapy may be added to the treatment regimen after at least 2 to 3 days of progressive improvement with topical antibiotic treatment and after fungal infection has been ruled out 1.
From the Research
Indications for Corticosteroid Eye Drops
Corticosteroid eye drops are indicated for the treatment of various ocular inflammatory diseases, including:
- Uveitis 2
- Anterior ocular inflammation 2
- Corneal neovascularization and inflammation 2
- Posterior subcapsular cataract 3, 4, 5
- Glaucoma 3, 4, 5
- Optic neuritis 3
- Thyroid ophthalmopathy 3
Administration and Dosage
The administration and dosage of corticosteroid eye drops depend on the specific condition being treated and the severity of the inflammation. For example:
- For non-infectious ocular inflammatory diseases, such as uveitis, eye drops may be administered as often as once every hour 2
- For post-cataract surgery inflammation, a fixed topical corticosteroid-antibiotic combination may be prescribed for 1-2 weeks 6
Benefits and Risks
Corticosteroid eye drops have several benefits, including:
- Effective treatment of ocular inflammation 2, 3, 4
- Reduction of symptoms and improvement of vision 2, 3, 4 However, they also carry several risks, including:
- Ocular hypertension and glaucoma 3, 4, 5
- Posterior subcapsular cataract 3, 4, 5
- Tear-film instability, epithelial toxicity, and crystalline keratopathy 4
- Decreased wound strength, orbital fat atrophy, ptosis, and limitation of ocular movement 4