What are ophthalmic corticosteroids and how do they work?
Ophthalmic corticosteroids are potent anti-inflammatory medications that suppress inflammation in the eye. Several corticosteroids are used in the treatment of eye inflammations. Corticosteroids prevent inflammation by inhibiting the release of inflammatory proteins by immune cells, and relieve symptoms such as pain, redness and swelling.
Corticosteroids are thought to work by activating an enzyme known as lipocortin which inhibits phospholipase A2, an enzyme that plays an important role in initiating inflammation. Phospholipase A2 enables the synthesis of inflammatory substances such as leukotrienes and prostaglandins.
Corticosteroids inhibit inflammatory responses to injury or infection in the eye, such as:
- Tissue swelling due to fluid collection (edema)
- Migration of immune cells (leukocytes) to the inflammation site
- Release of inflammatory proteins (cytokines) by immune cells
- Blood vessel (capillary) dilation
- Leakage of inflammatory substances from capillaries
- Deposition of fibrin, a substance that helps form clots
- Scar formation
Corticosteroids are also used in combination with other medications such as antivirals and antibiotics to suppress inflammation caused by infections.
How are ophthalmic corticosteroids used?
Ophthalmic corticosteroids are administered in various ways as follows:
- Solutions, suspensions, gels or ointments that are used as topical applications in the eye.
- Injectable solutions that are injected into the eye
- Biodegradable implants or inserts placed into the eye, which release measured amounts of medication slowly over a period of time
Ophthalmic corticosteroids are used to control inflammation in the following eye conditions:
- Postoperative inflammation: Inflammation that can occur after surgical procedures in the eye
- Macular edema: Swelling in the macula, the central part of the retina
- Diabetic macular edema: Macular edema that occurs due to diabetes
- Noninfectious uveitis: Inflammation of the uvea, part of the middle layer of the eye
- Ocular inflammation: Inflammatory eye conditions such as:
- Conjunctivitis: Inflammation of conjunctiva, the clear membrane that covers the eye and the inner surface of the eyelids
- Keratitis: Inflammation of the cornea
- Iritis: inflammations of the iris
- Corneal injury: Inflammation from injuries to the eye from:
- Chemical burns
- Foreign body
- Radiation
- Thermal burns
- Seasonal allergic conjunctivitis: Conjunctivitis from seasonal allergies
- Dry eye disease: A condition with insufficient tears and lubrication in the eyes, resulting in symptoms such as burning and irritation
- Ocular inflammation/infection: Inflammation that occurs with infections, treated in combination with antibacterial or antiviral drugs
- Ophthalmic disease: Inflammation from eye diseases such as:
- Sympathetic ophthalmia: Inflammation in both eyes following injury to one eye
- Temporal arteritis: Inflammation of the artery that supplies blood to the eyes
- Visualization during vitrectomy: To facilitate visualizing the inside of the eye during surgical procedure to remove a part or whole of the vitreous (a clear gel-like fluid that fills the eyeball). Vitrectomy is a part of many surgical procedures in the eye.
What are the side effects of ophthalmic corticosteroids?
Side effects of ophthalmic corticosteroid are primarily ocular, and systemic side effects are minimal. Side effects of ophthalmic corticosteroids may include the following:
- Ocular side effects
- Increase in pressure inside the eye (intraocular pressure)
- Corneal edema
- Inflammation of the iris (iritis)
- Inflammation of the iris and the ciliary muscle in the eye (iridocyclitis)
- Inflammation of the uvea (uveitis)
- Anterior chamber inflammation (inflammation of uvea, iris and ciliary muscle, also known as anterior uveitis)
- Inflammation of the choroid, a layer in the eye (choroiditis)
- Conjunctival hemorrhage
- Loss of endothelial cells in the cornea
- Blepharitis (inflammation of the eyelids)
- Eye pain, burning and stinging
- Macular edema (swelling of the macula)
- Cystoid macular edema (thickening of macula)
- Macular degeneration (maculopathy)
- Macular fibrosis (scar tissue formation in macula)
- Dry eyes
- Irritation and foreign body sensation
- Ocular inflammation
- Ocular hyperemia (dilation of blood vessels in the eye)
- Eye swelling
- Posterior capsule opacification (opacity of the posterior side of the clear membrane that encapsulates the lens)
- Blurred vision
- Double vision (diplopia)
- Reduced visual acuity
- Defects in visual field
- Difficulty in focusing
- Flashes of light in the vision (photopsia)
- Vitreous floaters (myodesopsia)
- Vitreous detachment
- Vitreous hemorrhage
- Vitreous opacity or haze
- Vitreitis (inflammation of the vitreous)
- Light sensitivity
- Conjunctival hyperemia (dilation of blood vessels in the conjunctiva)
- Conjunctival edema
- Inflammation of the conjunctiva (conjunctivitis)
- Inflammation of cornea and conjunctiva (keratoconjunctivitis)
- Bumps (papillae) in the conjunctiva
- Cataract formation
- Open-angle glaucoma (a disease that damages the optic nerve, usually characterized by high intraocular pressure)
- Optic nerve damage
- Corneal edema
- Corneal damage, erosion or ulcers
- Corneal inflammation (keratitis)
- Punctate keratitis (inflammation of cornea in a pinpoint pattern)
- Eye watering and/or discharge
- Eye itching (pruritus)
- Eyelid margin crusting
- Redness of eyelids
- Eyelid edema
- Dilation of the pupils (mydriasis)
- Droopy eyelids (ptosis)
- Delayed wound healing after surgery
- Secondary ocular infection
- Perforation of the eyeball globe
- Adhesions in iris
- Bulging of the eye (exophthalmos)
- Injection site hemorrhage in the case of intraocular injections
- Optic disc vascular disorder (disease of blood vessels that supply to the disc at the back of the eye where the optic nerve connects to the retina)
- Rarely, blindness from intravitreal or intraocular injections
- Ocular side effects specific to implants:
- Device misplacement or dislocation
- Eye tissue injury from the device
- Endophthalmitis (inflammation of the interior eye cavities)
- Decrease in intraocular pressure (hypotony) due to vitreous leakage
- Retinal detachment
- Retinal hemorrhage
- Hyphema (pooling of blood in the anterior eye chamber between the cornea and the lens)
- Optic atrophy (death of nerve cells in the retina)
- Fluid leakage from retina (retinal exudate)
- Anterior chamber cell (leakage of cells into aqueous humor, the clear liquid that fills the space between the cornea and lens)
- Anterior chamber flare (an optical phenomenon)
- Systemic side effects
- Headache
- Brow ache
- Nasopharyngitis (inflammation of the nasal passage and pharynx)
- Anemia
- High blood pressure (hypertension)
- Renal failure
- Pneumonia
- Allergies
- Rash
- Superinfection (herpes simplex virus)
- Hypercorticoidism, rare (excessive secretion of hormones by adrenal cortex)
Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.
What are names of some ophthalmic corticosteroid drugs?
Generic and brand names of some ophthalmic antiviral drugs include:
- Dexamethasone ophthalmic (Maxidex)
- Dexamethasone ophthalmic insert (Dextenza)
- Dexamethasone intraocular (Dexycu)
- Dexamethasone intravitreal implant (Ozurdex)
- Difluprednate ophthalmic (Durezol)
- Fluocinolone acetonide intravitreal implant (Retisert, Iluvien, Yutiq)
- Prednisolone acetate ophthalmic (Pred Forte, Pred Mild, Omnipred)
- Loteprednol etabonate ophthalmic (Alrex, Lotemax, Inveltys, Lotemax SM, Eysuvis)
- Neomycin/polymyxin B/hydrocortisone/bacitracin ophthalmic
- Triamcinolone intravitreal (Triesence)
- Triamcinolone suprachoroidal (pending FDA approval)
