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Monday, May 14, 2007

Ocular Steroids: Double-Edged Sword

Name something that is potentially dangerous yet may be essential for you to consume?

No, Hershey’s Syrup is not what I was thinking!

The prescribed use of corticosteroids (or simply steroids) is what medicine calls a “double-edged sword.” That means the drug has powerful benefits but also poses a genuine risk for serious complications.

Ophthalmologists prescribe steroid eyedrops to reduce inflammation in the eye. This is important because scarring from inflammation can permanently destroy the eye’s ability to see. Timely and aggressive use of steroid eyedrops has saved eyesight for millions.

Now, the other shoe. Since they inhibit the inflammatory response, steroids make the healthy eye vulnerable to all kinds of infections that normally it would have no problem eliminating.

Here’s a familiar clinical challenge. Let’s say there is a person with an infectious corneal ulcer (viral, bacterial, or fungal). The eye doctor wants to kill the germs quickly. At the same time the doctor needs to mute inflammation to prevent permanent damage to the transparent cornea. Careful! Adding steroids to an active infection is similar to using jet fuel to extinguish a fire!

Most doctors managing a corneal ulcer patient prescribe powerful broad-spectrum antimocrobial eyedrops to quickly eliminate the germs. This alone begins to quiet the inflammation. Gentle, stepwise introduction of steroid eyedrops will further halt the destructive inflammatory cells, reduce swelling, and preserve vital eye structures.

Excessive or unmonitored use of steroid eyedrops can generate new problems for the eye that may be more severe than the original diagnosis that justified steroid use in the first place.

Topical steroid eyedrops, like Hershey’s Syrup, should only be used with great care and respect.

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Posted by: Bill Lloyd MD at 12:15 pm


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