Corticosteroid Therapy in Central Stromal Keratitis

Abstract

Use of adrenal corticosteroids in central corneal inflammatory disease has been heat­ edly discussed during the past 15 years. Kaufman and Thomas have recom­ mended topical corticosteroid therapy (com­ bined with IUDR) for disciform lesions in herpetic keratitis, while Thygeson has cau­ tioned that they may encourage virus prolif­ eration and lead to catastrophic events. Theo­ dore believes that some cases of deep stromal herpes cannot be controlled without corti­ costeroids. DeVoe has emphasized that corticosteroid therapy in herpes simplex kera­ titis should not be condemned on the basis of rabbit experiments. Corticosteroids may be used guard­ edly' in herpes zoster keratitis; they probably should be avoided in central bacterial ulcers. However, corticosteroids are the treatment of choice' in allergic cor­ neal disease. The general consensus indicates that the use of corticosteroids depends upon the etiologic agent involved rather than the degree of structural alteration. Specific therapy is always preferable but, when it is not successful, nonspecific (corticosteroid) therapy may be used. Following extensive experimental evalua­ tion of the mechanisms of inflammatory reac­ tivity in the rabbit and guinea pig cornea,