Steroids in ophthalmology

Corticosteroids, used cautiously, are one of the most potent and effective modalities of treatmentavailable for ocular inflammation, but their use is not without potential complications. Topical, subconjunctival, and sub-tenon application of corticosteroids are preferable to systemic administration in anterior segment diseases depending on the severity and level of inflammation. Systemic steroids are indicated in severe sight threatening diseases. The most common complicactions associated with long term steroid use are cataract and raised intraocular pressure. To prevent the ocular complications of steroid therapy, routine screening for cataracts, which occur most commonly as a sequela of continuous systemic steroid use, may be performed by slit-lamp examinations. Glaucoma is more often associated with topical ocular or periocular steroids than with systemic steroids; recommended screening includes a baseline intraocular pressure measurement, then routine pressure measurements are taken on subsequent follow-ups. Ocular rebound inflammation may develop secondary to rapid tapering or abrupt discontinuation of topical ocular steroid use and is best prevented with gradual tapering. Opportunistic infections of the eye include bacterial, viral, and fungal infections and are most often associated with the use of topical ocular steroids. Ophthalmologic evaluation is indicated promptly if patients treated with ocular steroids develop ocular discharge, pain, photophobia, or redness. In this review article we have highlighted the different topical steroids along with their use, side-effects and complications, periocular injections and intraocular injections along their steps of administration.