Daily use of steroid drops increases risk for ocular hypertension

Excerpted from page 52 of the July/August 2017 edition of AOA Focus.

"The dose makes the poison" goes the old phrase, credited to Paracelsus, a 16th century Swiss physician and scientist who is considered the founder of toxicology. A recent study in the journal Ophthalmologyis more proof of the wisdom of these words.

Researchers combed through the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, which spans 28 years and several thousand patients, to identify risk factors of ocular hypertension in adults with noninfectious uveitis. One highly significant factor discovered was the use of medicinal corticosteroid drops.

Uveitis is an inflammation of the uvea, the middle layer of the eye. A number of eye diseases or trauma can cause it. A common treatment for uveitis is a corticosteroid drop applied to the eye every one to two hours. This study found that even one drop a day may double the risk of ocular hypertension.

"It's been known for years that steroids can elevate intraocular pressure, especially in what are called steroid responders," says Daniel Bintz, O.D., past chair and current member of the AOA's Health Promotions Committee, who has a private practice in Elk City, Oklahoma. "If the pressure does go up with steroid use, we sometimes add a temporary glaucoma drop, and it resolves nicely in a short amount of time. The uveitis patients I have treated over the years typically respond very well when it is needed."

Modifying risk

Uveitis patients typically use corticosteroid drops for up to one to two months, a duration that is short enough not to cause issues in the majority of patients, says Dr. Bintz.

However, monitoring the intraocular pressure of the patient is essential, and a backup plan for treating stubborn uveitis without steroids should be at the ready.

"Nonsteroidal anti-inflammatory meds can be necessary," says Dr. Bintz. "They don't have the 'punch' of a steroid but also don't have the side effects."

While the study indicated that several things can increase the risk of ocular hypertension, corticosteroid drops were not only one of the most significant factors in a patient's eye history, but also stood out as an easily modified risk. The authors of the study indicate that corticosteroids are best used sparingly when treating inflammation, and should be monitored closely for indications requiring an increase or decrease in strength and/or duration of the steroid.

"Steroids can be a double-edged sword," says Dr. Bintz, echoing Paracelsus' thoughts on the dual nature of medicine as poison. "They can be an amazing wonder drug or an epic fail if not respected for what they can and cannot do."