Use of Topical Steroids in Conjunctivitis: A Review of the Evidence

Abstract

Purpose: Conjunctivitis, or inflammation of the conjunctiva, is a common condition that can be caused by infectious (eg, bacterial or viral infections) and noninfectious (eg, allergy) etiologies. Treatment involves diagnosis of the underlying cause and use of appropriate therapies. A broad-spectrum therapy that can address multiple etiologies, and also the accompanying inflammation, would be very useful. In this review, we discuss the usefulness of topical ophthalmic corticosteroids and ophthalmic formulations that combine corticosteroids with anti-infectives/antibiotics for treating acute infectious conjunctivitis. Methods: A review of the published literature and relevant treatment guidelines. Results: Topical corticosteroids are useful in treating ocular inflammation, but most treatment guidelines recommend steroid use generally in severe cases of conjunctivitis. This is partly due to risks associated with steroid use. These risks include potential for prolonging adenoviral infections and potentiating/worsening herpes simplex virus infections, increased intraocular pressure, glaucoma, and cataracts. Most of these perceived risks are not, however, supported by high-quality clinical data. They are also associated with long-term steroid uses that are dissimilar to applications for infectious conjunctivitis. Clinical data show that ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well tolerated when used for short-term treatment (≤2 weeks). Conclusions: Corticosteroids, in combination with anti-infectives, could be a promising treatment option for acute conjunctivitis subject to development of further evidence on their effectiveness and safety in conjunctivitis treatment.

The role of ozonized oil and a combination of tobramycin/dexamethasone eye drops in the treatment of viral conjunctivitis: a randomized clinical trial

“…The use of the steroid in viral inflammations of the ocular surface does not agree with all the authors in fear of possible side effects such as cataract and glaucoma. Holland et al underlines that the perceived risks associated with short-term corticosteroid use in the treatment of ocular surface infections (increased IOP, prolonged viral shedding, and HSV reactivation) is not supported by high-quality evidence in the literature [32]. However, it should not be forgotten that without the addition of a anti-viral agent can increase the duration of viral shedding and prolong the infectivity of the patients [12].…”

Increased Risk of Ocular Hypertension in Patients with Cushing’s Disease: An Underestimated Comorbidity

“…Secondary glaucoma was usually caused by trauma, in ammation, or external glucocorticoid usage 20 . Previous studies suggested that externally applied corticosteroids increase the intraocular pressure in one-third of the general population [5][6][7][8] . The proposed mechanism of corticosteroid-induced glaucoma includes morphological and functional changes in the trabecular meshwork system and is similar to the pathogenesis of primary open-angle glaucoma 21 .…”

“…As the largest tertiary pituitary center in South China, we encountered many patients who had glaucoma surgeries performed and then referred to our center for endocrine evaluation. It was well known that systemic steroid was a signi cant risk factor for increased intraocular pressure (IOP) 5,6 , and the incidence may rise to 30-40% of the general population due to topical or systemic glucocorticoids usage 7,8 . However, only several case reports and two cohort studies [9][10][11] investigated the association between increased IOP and endogenous hypercortisolemia.…”

A drug safety surveillance study of a ciprofloxacin / dexamethasone ophthalmic fixed combination in Peruvian population

“…[4] There are different combinations of antibiotic/steroid ophthalmic medications available for the treatment of ocular infections that have been used for several years. [7] The concomitant use of antibiotics and steroids gained relevance due to the negative effects produced by the severe inflammation caused by ocular infections. [8] The ophthalmic solution containing ciprofloxacin 0.3% / dexamethasone 0.1%, is a combination of a fluoroquinolone, an antibiotic that inhibits bacterial DNA synthesis through its action on topoisomerase II and topoisomerase IV, and a corticosteroid that suppresses inflammation by inhibiting the production of multiple inflammatory cytokines.…”