Eyebrow Pain Following Eye Exam After Prednisone Eye Drop Treatment
You should discontinue the prednisone eye drops immediately and seek urgent ophthalmology evaluation within 24-48 hours to rule out steroid-induced complications, particularly elevated intraocular pressure (IOP), infectious keratitis, or rebound inflammation. 1
Immediate Assessment Priorities
The new eyebrow pain following your eye exam raises several concerning possibilities that require prompt evaluation:
- Elevated intraocular pressure (IOP) is a common adverse effect of topical corticosteroids and can present as periorbital or eyebrow pain, particularly after 10+ days of use 1
- Steroid-induced glaucoma can develop with topical corticosteroid use and may cause referred pain to the eyebrow region 1
- Rebound inflammation may occur when corticosteroids are reduced or discontinued, temporarily increasing symptoms including pain 2
- Infectious keratitis must be ruled out, as corticosteroids can mask or worsen bacterial, fungal, or viral infections while appearing to initially improve symptoms 2
Why This Matters Now
The timing of your eyebrow pain immediately after an eye exam is significant:
- The eye exam itself may have detected elevated IOP that was previously asymptomatic 1
- Manipulation during the exam (such as tonometry or dilation) may have triggered pain in an eye with underlying steroid-induced complications 1
- If inflammation or pain persists longer than 48 hours or becomes aggravated after starting prednisone drops, you should discontinue use and consult a physician 1
Critical Next Steps
Stop the prednisone eye drops immediately unless specifically instructed otherwise by your ophthalmologist, as continued use without proper monitoring risks serious complications 1
Your ophthalmologist needs to perform:
- IOP measurement to assess for steroid-induced ocular hypertension or glaucoma 1
- Slit-lamp examination to evaluate for infectious keratitis, corneal ulceration, or other complications that may have been masked by the steroids 2
- Dilated fundus examination to assess the optic nerve for any damage from elevated IOP 1
- Corneal cultures if any infiltrate or ulceration is present, as unusual organisms (atypical mycobacteria, Nocardia, fungi) can develop under steroid coverage 2
Common Pitfalls to Avoid
Do not restart or continue prednisone drops without ophthalmology clearance, as this is the most critical error patients make when symptoms seem to improve temporarily 2, 1
Key mistakes include:
- Assuming eyebrow pain is unrelated to the eye condition or treatment 1
- Continuing steroids beyond 2 days if symptoms fail to improve, which increases risk of complications 1
- Failing to monitor IOP when using topical corticosteroids for 10+ days 1
- Missing infectious keratitis because steroids temporarily suppress inflammatory signs while the infection worsens 2
What Your Ophthalmologist Will Likely Do
If IOP is elevated:
- Discontinue or taper the prednisone drops 1
- Initiate IOP-lowering medications if pressure is significantly elevated 1
- Monitor IOP closely until it normalizes 1
If infectious keratitis is suspected:
- Obtain corneal scrapings for culture before starting treatment 2
- Initiate intensive broad-spectrum topical antibiotics 2
- Completely discontinue corticosteroids until infection is controlled 2
If rebound inflammation is the cause:
- Consider a slower taper of corticosteroids rather than abrupt discontinuation 2
- Switch to a "softer" steroid like loteprednol etabonate that has lower risk of IOP elevation 3, 4
- Add non-steroidal anti-inflammatory options like topical cyclosporine if chronic inflammation is present 3