Ophthalmic Corticosteroids and Blood Glucose
No, ophthalmic corticosteroid drops do not clinically raise blood sugar in most diabetic patients, though a small, transient increase may occur in those with well-controlled diabetes that returns to baseline after discontinuation without adverse effects.
Evidence on Systemic Absorption
The concern about ophthalmic corticosteroids raising blood glucose has been directly studied:
- In diabetic patients receiving intensive topical dexamethasone (8 drops daily for 7 days), no statistically significant alterations in blood glucose levels occurred overall 1
- No hypoglycemic or hyperglycemic crises were observed in either treatment or control groups 1
Subgroup Considerations
For patients with well-controlled diabetes (glucose ≤135 mg/dL):
- A statistically significant but clinically minor increase in blood glucose was detected at the start of treatment 1
- Glucose levels returned to pretreatment baseline after discontinuation of drops without any side effects 1
For patients with uncontrolled diabetes (glucose >135 mg/dL):
- No statistically significant changes in blood glucose levels were found 1
Clinical Implications
The minimal systemic absorption from topical ophthalmic corticosteroids makes clinically significant hyperglycemia extremely unlikely:
- The primary concern with ophthalmic corticosteroids in diabetic patients is progression of diabetic retinopathy, not blood glucose elevation 2
- Blood glucose control remains the key modifiable risk factor for diabetic retinopathy development and progression 2
- Maintaining HbA1c ≤7% is the target for most diabetic patients to reduce microvascular complications including retinopathy 2
Important Caveats
Monitor patients more carefully if:
- They have well-controlled diabetes at baseline, as they may experience transient glucose elevation 1
- They are using intensive dosing regimens (multiple drops daily) 1
The real risk is not hyperglycemia but rather:
- Increased intraocular pressure from corticosteroid use (steroid response)
- Potential worsening of diabetic retinopathy if systemic glucose control deteriorates 2