Corticosteroid Eye Drops Research Articles

Clinical features of episcleritis and scleritis in some Japanese patients.

We retrospectively examined 52 patients (60 eyes) with episcleritis and scleritis. Their mean ages were 57 and 47 years, respectively. Slight female predominance was noted. Most patients had unilateral involvement. The ocular symptoms at the initial visit were redness and ocular pain. Some eyes with scleritis were complicated with uveitis, corneal lesions, and elevated intraocular pressure. In most affected eyes, corticosteroid eyedrops alone resolved the disease. We believe that in addition to ophthalmological examinations, standard physical and specific laboratory investigations should be performed in patients with episcleritis and scleritis.

Marked Intraocular Pressure Response to Instillation of Corticosteroids in Children

AbstractWe examined intraocular pressures of patients with strabismus whose eyes were instilled with corticosteroid eyedrops after a strabismus operation. Group A consisted of 11 children under 10 years of age whose eyes were instilled with 0.1% dexamethasone; Group B consisted of nine patients 10 years old or older whose eyes were instilled with 0.1% dexamethasone; and Group C consisted of 13 children under 10 years of age whose eyes were instilled with 0.1% fluorometholone. In Group A, four patients had intraocular pressures greater than 30 mm Hg, five had intraocular pressures from 21 to 30 mm Hg, and two had intraocular pressures under 21 mm Hg one or two weeks postoperatively. The intraocular pressure decreased to less than 21 mm Hg one week after discontinuation of dexamethasone treatment in all nine patients. No patients in Groups B or C had intraocular pressures greater than 20 mm Hg. Our results suggest that marked ocular hypertensive response to 0.1% dexamethasone treatment occurs frequently in children under 10 years of age.

Topical Indometacin, a prostaglandin inhibitor, in acute anterior uveitis. A controlled clinical trial of non‐steroid versus steroid anti‐inflammatory treatment

Forty-nine patients were included in a controlled clinical trial comparing the effect of topical non-steroid versus potent steroid preparation in acute anterior non-granulomatous uveitis. Twenty-five patients were randomized to 1% Indometacin and 24 patients to 0.1% Dexametason treatment 6 times a day. There was no difference between the two groups initially. After 7 days of treatment we found significantly less inflammation in the steroid treated group, this significant difference disappearing on day 14. We conclude that whenever adverse reactions to corticosteroid eye drops are suspected or proven, Indometacin eye drops make up a useful alternative to even strong solutions of steroids. The study was carried out in the following practices: L. Ahrendt, L. Damgård-Jensen, P. Eldrup-Jørgensen, J. Elmeros, H. Heuer, S. Jensen, M.H. Kjeldsen, P. Nellemann Sørensen, H. Petersen, N. Vedel-Jensen.

The Red Eye

The patient with a red eye constitutes a very common clinical problem encountered in the Emergency Department setting. Conjunctivitis, the most common cause of the red eye, generally is not associated with disturbance of vision or associated ocular pain. If either of these symptoms is present, a more serious disorder must be suspected. Treatment of infectious conjunctivitis is guided by interpretation of a Gram's stain and subsequent culture of any exudate present. Initial treatment of most cases includes use of topical antibiotic and local comfort measures. Complications of infectious conjunctivitis include more invasive disease such as keratitis or abscess formation, with potential corneal perforation and destruction. All patients should be referred for ophthalmologic followup, both to assess adequacy of treatment and to treat unexpected complications. Remember that allergic conjunctivitis is a common condition that responds to antihistamine decongestant medications given orally or topically. Occasionally these conditions are caused by self-prescribed use of ocular medication, and discontinuation of all eye medication is required. Corticosteroid eye drops are rarely indicated and should be used only at the direction of an ophthalmologist. When the diagnosis is uncertain, treatment is best withheld, as shotgun therapy is seldom beneficial.

Medical Management of a High Bleb Phase after Trabeculectomies

In the first 2 months after trabeculectomy, elevated intraocular pressure (IOP) associated with a high bleb develops in some patients. This has been referred to as an encysted bleb, and some have recommended surgical techniques to repair it and to restore controlled IOP. This clinical picture occurred in 18 of 181 eyes (10%) undergoing simple trabeculectomy with a limbus-based conjunctival flap and tenonectomy. It did not occur among 69 eyes in which trabeculectomy with a fornix-based flap was combined with extracapsular cataract extraction (ECCE). Its occurrence may, therefore, be related to surgical technique. In eyes with this syndrome, the authors used IOP-lowering eyedrops and/or pills, along with continued corticosteroid eyedrops. None required surgical manipulation. All 18 eyes achieved long-term IOP control, and in 14 all medications were ultimately discontinued. An hypothesis is suggested to explain the occurrence of this event and the rationale for this therapy. A trial of IOP-lowering treatment is indicated in the management of a high bleb phase after filtering surgery.

The Red Eye

The patient with a red eye constitutes a very common clinical problem encountered in the Emergency Department setting. Conjunctivitis, the most common cause of the red eye, generally is not associated with disturbance of vision or associated ocular pain. If either of these symptoms is present, a more serious disorder must be suspected. Treatment of infectious conjunctivitis is guided by interpretation of a Gram's stain and subsequent culture of any exudate present. Initial treatment of most cases includes use of topical antibiotic and local comfort measures. Complications of infectious conjunctivitis include more invasive disease such as keratitis or abscess formation, with potential corneal perforation and destruction. All patients should be referred for ophthalmologic followup, both to assess adequacy of treatment and to treat unexpected complications. Remember that allergic conjunctivitis is a common condition that responds to antihistamine decongestant medications given orally or topically. Occasionally these conditions are caused by self-prescribed use of ocular medication, and discontinuation of all eye medication is required. Corticosteroid eye drops are rarely indicated and should be used only at the direction of an ophthalmologist. When the diagnosis is uncertain, treatment is best withheld, as "shotgun" therapy is seldom beneficial.

Ocular allergy. Scratching the surface of the red eye.

The primary care physician may be the first physician to evaluate conjunctivitis caused by allergy or infection. A proper diagnosis can usually be made by asking the patient a few simple questions. Treatment with eyedrops is not always necessary. When the diagnosis is uncertain, treatment is best withheld, because "shotgun" therapy is seldom beneficial. Corticosteroid eyedrops are rarely necessary. When they are used, the physician must monitor intraocular pressure and examine the eye with a slit-lamp microscope for signs of cataract and opportunistic infection. Because there is a tendency to overtreat eye disorders, improvement of ocular inflammation is more often accomplished by stopping drug administration than by starting it.

Medical Treatment of Glaucoma Associated with Cicatricial Retinopathy of Prematurity

Corticosteroid eyedrops decreased the intraocular pressures of seven children with painful glaucoma secondary to grade V retinopathy of prematurity. Initial intraocular pressures ranged from 48 to 60 mm Hg in the affected eyes. After follow-up periods of six months to seven years, the intraocular pressures ranged from 12 to 21 mm Hg. None of the children required surgery and three no longer require any medication. Corticosteroid eyedrops decreased the intraocular pressures of seven children with painful glaucoma secondary to grade V retinopathy of prematurity. Initial intraocular pressures ranged from 48 to 60 mm Hg in the affected eyes. After follow-up periods of six months to seven years, the intraocular pressures ranged from 12 to 21 mm Hg. None of the children required surgery and three no longer require any medication.

Topical corticosteroid response and retinopathy in juvenile-onset diabetes mellitus.

In a prospective study, 64 patients with insulin-dependent juvenile-onset diabetes mellitus were followed for eight to 12 years to determine if those with higher spontaneous intraocular pressures (IOPs) would be protected from the development of retinopathy. The patients were also classified initially as high (GG), intermediate (NG), or low (NN), responders on the basis of their IOP response to corticosteroid eyedrops. High responders were found to be considerably in excess (25 per cent) of the proportion found in the general population (6 per cent). Retinopathy developed significantly less often and was less severe in the high (GG) corticosteroid responders. Although the GG diabetics had significantly higher mean baseline IOPs than the less responsive NN and NG groups in each corticosteroid response category, the mean IOP of the group with retinopathy was not significantly different from that without retinopathy. This suggested that factors associated with the GG response other than increased IOP might be important in the relative resistance to diabetic retinopathy.

Opticrom for vernal keratoconjunctivitis

Opticrom eyedrops (Fisons) contain 2% sodium cromoglycate and are intended for treating allergic diseases of the eye, particularly vernal keratoconjunctivitis or ‘spring catarrh’ which, despite its name, is usually most severe in the summer. Vernal keratoconjunctivitis involves the cornea and conjunctiva of young people who are usually atopic (that is, have a personal or family history of eczema, allergic rhinitis or asthma). It presents with itching, photophobia and blepharospasm which may be so severe as to be incapacitating. There may be a stringy mucous discharge, a cobblestone-like papillary hypertrophy of the tarsal conjunctiva visible on everting the upper lid, and sometimes vegetations on the limbal conjunctiva. Corneal erosions and ulcers may occur in severe cases. Although corticosteroid eye-drops remain the mainstay of treatment, their prolonged use occasionally causes blindness from glaucoma1 or from the exacerbation of a pre-existing herpes simplex keratitis.

Topical corticosteroid therapy and pituitary-adrenal function.

Systemic absorption has been reported after the use of corticosteroid eye drops. Prolonged use could result in adrenocortical insufficiency and an associated adrenal crisis under stressful situations. For that reason, we studied the hypothalamic-pituitary-adrenal axis of patients receiving corticosteroid eye drope. Fifteen patients were given 0.1% dexamethasone sodium phosphate eye drops, one drop (approximately 1/30 ml) to each eye four times a day for six weeks. This dosage resulted in partial adrenal suppression, manifested by reduced levels of plasma cortisol. However, in each case, the hypothalamic-pituitary-adrenal axis, as evaluated with the use of the oral metyrapone tartrate test, was intact.

Corticosteroid eyedrops and intra-ocular pressure

Corticosteroid eyedrops are used for various allergic or inflammatory conditions of the eye. The dangers of topical corticosteroids in virus infections, particularly herpes simplex, have been stressed, but it is less well known that topical corticosteroids can also in some people cause a serious rise in intra-ocular pressure.

Primary acute angle-closure glaucoma damage to cornea and lens.

The following corneal conditions will be considered: (1) pressure oedema; (2) oedema following endothelial damage; (3) persistent folds in Descemet's membrane; (4) vascularization; (5) lipoid infiltration; (6) band-shape degeneration. Oedema of the cornea caused by a sudden elevation of intra-ocular pressure is a diagnostic feature of acute angle-closure glaucoma. If the intra-ocular pressure rises to 40 mm. Hg within some hours, corneal oedema is likely to occur, but corneal oedema may not accompany intra-ocular pressures of 80 mm. Hg if the increase has occurred slowly over some months or years. The acute pressure oedema tends to involve all the cornea, but not infrequently only the central area may be affected leaving the periphery clear. The pressure oedema affects especially the epithelium and superficial stroma so that it can be temporarily cleared with topical glycerine to permit gonioscopic and other examinations (Cogan, 1943). With reduction in intra-ocular pressure it disappears quickly. When a severe attack of angle-closure glaucoma has persisted for twenty-four hours or more, the intra-ocular pressure may still be reduced rapidly by appropriate treatment, but the cornea remains oedematous. This type of oedema then shows as a thickening of the cornea with folds in Descemet's membrane. It is slow to clear, taking several days or even some weeks. It is less readily cleared with glycerine, and its persistence in the presence of low intra-ocular pressures is a striking feature. It is not cleared by hypertonic infusions such as 20 per cent. mannitol. It is probably caused by aqueous seeping through damaged endothelium and its clearing is dependent upon the recovery of these cells. Its regression is frequently assisted by topical corticosteroid eyedrops. Folds in Descemet's membrane may persist long enough for them to develop hyaline appearances and they may then become permanent.

ELEVATED INTRAOCULAR PRESSURE FOLLOWING CORTICOSTEROID EYE DROPS.

IN THE COURSE of studies on immunogenic mechanisms in primary glaucoma, 1,2 a series of over 100 patients receiving topical corticosteroid drops to one eye was carefully followed. This brief report is presented to alert physicians to the large and significant increases in intraocular pressure observed in so many of the patients studied. A more detailed publication of the investigation is planned for the ophthalmologic literature. 3 Method In the series were 43 patients with proved primary open-angle glaucoma (unoperated on) selected because of their excellent pressure control (all values 20 mm Hg or less; mean value 17.1 mm Hg). All patients were over 40 years old; 15 of the patients had untreated early glaucoma. The remainder were continued on whatever ocular or systemic medication they had been using for their glaucoma. In addition, the series contained 25 volunteers selected so as to exclude individuals with any suspicion of glaucoma,