Steroid Use in Eye Care: Risks and Considerations

Q: Steroid Use in Eye Care: Risks and Considerations

Hello： <br>1. <br>Long-term use of topical corticosteroids and their effects on the eyes： Using a corticosteroid cream for six weeks can indeed have a certain degree of impact on the eyes. <br>Corticosteroids can reduce inflammation, but prolonged use carries a low risk of increa

Corticosteroids

Hello, Doctor.
I previously had recurrent styes, and using a regular eye ointment (without steroids) and eye drops helped them disappear in about 4 to 5 days.
However, there was one occasion when a stye was particularly large, and after applying treatment for two weeks without improvement, the doctor prescribed a steroid-containing medication (such as Betamethasone 3.5g).
At that time, the doctor did not inform me that this medication contained steroids, and the pharmacist also did not provide any usage precautions.
I remember applying the steroid ointment for a full six weeks (three times a day, to the point where the tube was nearly empty).
The stye was painful for almost two months but did not reduce in swelling! Eight months later, I was diagnosed with glaucoma.

1.
Given that I used the steroid ointment for such an extended period, could this have caused some degree of harm?
2.
I also tend to have acne.
If I apply a steroid ointment (prescribed by a dermatologist before my glaucoma diagnosis) on my skin (on my back and the back of my thighs) and face (on my chin), avoiding the area around my eyes, is this acceptable for someone diagnosed with glaucoma?
3.
If I miss a few days of glaucoma medication (non-acute), will this cause a rebound effect? For example, could my intraocular pressure be higher than it was before the diagnosis?
4.
Will corneal edema always present with symptoms? (I previously asked you about my epithelial cell count, which was 28 in the upper half, and my corneal thickness was 1000 micrometers.) Currently, I occasionally experience vertical double vision.
5.
If the issue is not corneal edema and my intraocular pressure decreases, will the epithelial cells heal?
6.
If corneal edema is due to glaucoma, will it resolve on its own after the intraocular pressure decreases?
Thank you for taking the time to read this!

Niming, 20~29 year old female. Ask Date: 2024/06/21

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
Long-term use of topical corticosteroids and their effects on the eyes: Using a corticosteroid cream for six weeks can indeed have a certain degree of impact on the eyes.
Corticosteroids can reduce inflammation, but prolonged use carries a low risk of increasing the chances of glaucoma, cataracts, and infections.
While the diagnosis of glaucoma may be related to long-term corticosteroid use, other factors must also be considered for a comprehensive assessment.
2.
Safety of corticosteroid use on the skin for glaucoma patients: It is generally acceptable for glaucoma patients to use corticosteroid creams on the skin (such as on the back, thighs, and face) as long as they are not applied around the eyes.
However, caution should be exercised to avoid long-term extensive use and to follow the dermatologist's recommendations to prevent systemic side effects of corticosteroids.
3.
Impact of interrupting glaucoma medication on intraocular pressure: For non-acute glaucoma, missing a few days of medication may lead to an increase in intraocular pressure, with a risk of rebound effect, potentially resulting in higher pressure than before diagnosis.
Therefore, it is crucial to adhere strictly to the ophthalmologist's instructions for regular medication use and to avoid interruptions.
4.
Symptoms of corneal edema: Corneal edema typically presents with symptoms such as blurred vision, halos, and eye pain.
Your condition (epithelial cell analysis showing a reduction in the upper half of cells and increased corneal thickness) may be related to corneal edema, but further examination is needed for confirmation.
Occasional vertical diplopia may also be caused by corneal issues.
5.
Possibility of epithelial cell repair: The repair of corneal epithelial cells depends on the control of intraocular pressure.
If the intraocular pressure decreases, there is a possibility for gradual repair of the corneal epithelial cells.
However, this requires time and ongoing control of intraocular pressure, along with regular monitoring.
6.
Self-healing ability of corneal edema: If corneal edema is caused by glaucoma, it may resolve on its own once intraocular pressure is controlled.
However, this also depends on individual constitution and the severity of the condition, and regular ophthalmic check-ups are necessary to ensure proper management of the condition.
Wishing you a speedy recovery.

Reply Date: 2024/06/21

More Info

Understanding the use of steroids in eye care is crucial, especially considering the potential risks and benefits associated with their long-term application. Steroids, particularly corticosteroids, are often prescribed to reduce inflammation and manage various eye conditions, including severe infections, allergies, and autoimmune disorders. However, their use, especially in the context of eye care, requires careful consideration due to the associated risks.

1. Potential Damage from Prolonged Steroid Use: Prolonged use of topical steroids can lead to several complications, including increased intraocular pressure (IOP), which is a significant risk factor for glaucoma. In your case, using a steroid ointment for six weeks could have contributed to the development of glaucoma, particularly if you have a predisposition to elevated IOP. While steroids are effective in reducing inflammation, they can also inhibit the body's natural healing processes and lead to complications such as cataracts and secondary infections. It is essential to monitor IOP regularly if you are using steroids, especially for extended periods.

2. Using Steroids on Other Body Parts: Applying topical steroids to areas such as the back and thighs is generally acceptable, provided that you are not applying them near the eyes. However, individuals diagnosed with glaucoma should be cautious with any steroid use, as systemic absorption can occur, potentially affecting intraocular pressure. It is advisable to consult with your dermatologist and ophthalmologist to ensure that the benefits of using topical steroids outweigh the risks, especially in the context of your glaucoma diagnosis.

3. Rebound Effect from Discontinuing Glaucoma Medication: If you miss a few days of your glaucoma medication, it is possible to experience a rebound effect, where the IOP may rise higher than it was before treatment. This is particularly true for certain classes of glaucoma medications. It is crucial to adhere to your prescribed regimen and consult your ophthalmologist if you have missed doses, as they can provide guidance on how to safely resume treatment.

4. Symptoms of Corneal Edema: Corneal edema may not always present with noticeable symptoms, but it can lead to visual disturbances, such as blurriness or double vision. If you are experiencing occasional diplopia (double vision), it may be related to corneal issues or other ocular conditions. Regular follow-ups with your eye care provider are essential to monitor these symptoms and adjust treatment as necessary.

5. Healing of Epithelial Cells: If the intraocular pressure is successfully lowered, it is possible for the corneal epithelial cells to heal over time. The cornea has a remarkable ability to regenerate, but the extent of recovery can depend on the severity of the damage and the underlying cause. Regular monitoring and appropriate management of IOP are critical to facilitate healing.

6. Corneal Edema and Glaucoma: If corneal edema is related to elevated IOP due to glaucoma, lowering the pressure may help alleviate the edema. However, the recovery process can vary among individuals. It is essential to maintain regular follow-ups with your ophthalmologist to assess the condition of your cornea and ensure that your glaucoma is well-managed.

In conclusion, while steroids can be effective in managing inflammation and other ocular conditions, their long-term use requires careful monitoring due to the risk of complications such as glaucoma. It is vital to maintain open communication with your healthcare providers, adhere to prescribed treatments, and report any new or worsening symptoms promptly. Regular eye examinations will help ensure that any potential issues are identified and managed early, promoting better overall eye health.

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