STEROIDS

STEROIDS

 

Mechanism Of Action :

  • Potent anti-inflammatory – inhibit first step in LOX & COX pathway – inhibits Leukotrienes & Prostaglandins synthesis.
  • Decrease permeability of blood ocular barrier – vaso constriction – prevents chemotaxis of inflammatory agents – decrease in inflammatory edema.

 

INDICATION :

  • TOPICAL :
    1. Uveitis ( iritis, iridocyclitis & choroiditis )
    2. Scleritis
    3. Vernal kerato-conjunctivitis
    4. Allergic keratitis
    5. Phlyectenular kerato-conjunctivitis
    6. Post – operative : after intra-ocular surgeries viz Cataract Surgery, anti-glaucoma surgery, keratoplasty, Retinal surgery.

 

  • SYSTEMIC :
    1. Posterior uveitis
    2. VIRAL KERATITIS : only if STROMAL KERATITIS. If epithelial punctuate lesions are present, s/o SPK – Superficial Punctate Keratitis, steroids are contra-indicated
    3. Sympathetic Ophthalmitis
    4. Vogt-Koyonagi-Harada syndrome
    5. Papillitis / Optic neuritis ( ONTT trial )
    6. Retrobulbar neuritis
    7. AION : Anterior Ischemic Optic Neuropathy
    8. Episcleritis
    9. Malignant Exophthalmos
    10. Orbital Pseudotumours
    11. Orbital Lymphangioma

 

SIDE EFFECTS :

  • OCULAR :
    1. Posterior Sub capsular Cataract – d/t systemic (oral ) steroids especially in children with Nephrotic syndrome / Ashthma
    2. Glaucoma – d/t long term Steroid drops (Steroid responder / steroid induced glaucoma )
    3. Dry Eye
    4. Predisposition to infection

 

  • SYSTEMIC :
    1. Gastritis : hence steroids always given with RANITIDINE.
    2. Hypertension
    3. Aggravation of Diabetes Mellitus : to be avoided / used cautiously in DM patients
    4. Reactivation of Tuberculosis
    5. HPA axis suppression : seen if Oral steroids taken daily for more than 14 days.