CORTICOSTEROIDS

 The corticosteroids reduce the inflammatory responses of the ocular tissues by:

                                               👉Decreasing capillary permeability,

                                               👉Limiting exudation and 

                                               👉Inhibiting the formation of new vessels and granulation tissue.

They inhibit the cyclooxygenase and lipoxygenase pathways by inhibiting phospholipase A2, thereby inhibiting the release of arachidonic acid. 

All corticosteroids are prepared as ketone-based formulations except loteprednol which is prepared as an ester-based formulation. 

They stay within the tissue more with good therapeutic effects and at the same time with more toxicity. Whereas, enzymatic degradation occurs quickly with loteprednol, and it is less potent with less toxicity.

                                                     USES

1. Sterile ocular inflammations:-

👉disciform keratitis

👉episcleritis, 

👉scleritis, 

👉uveitis, 

👉optic neuritis, 

👉chemical injury,

👉local wound healing.

2. Allergic problems:-

👉phlycten, 

👉seasonal allergic conjunctivitis, 

👉contact dermatitis, 

👉vernal keratoconjunctivitis, 

👉allergic blepharoconjunctivitis,

3. Postoperative:-

👉cataract surgery, 

👉keratoplasty, 

👉vitrectomy, 

👉trabeculectomy

4. Miscellaneous:-

👉pseudotumor of the orbit, 

👉graft rejection, 

👉endocrine exophthalmos

👉temporal arteritis, 

👉post-herpetic neuralgia.

Preparation and Mode of Administration:

Three types—topical, periocular, and intraocular

Topical Preparation:-

           Mostly available as drops and also as an ointment, sometimes with some antibiotic combination in India. 

👉Hydrocortisone acetate: 0.5% 

👉Prednisolone acetate: 1.0% 

👉Dexamethasone phosphate: 0.1% 

👉Betamethasone: 0.5% 

👉Fluorometholone: 0.1% 

👉Loteprednol etabonate: 0.5% and 0.2% 

👉Difluprednate: 0.05% (a precursor for prednisolone).

Periocular 

a. Subconjunctival: Mainly, injection of dexamethasone and in combination with gentamycin—after intraocular surgeries—like cataract, keratoplasty, etc.; in anterior uveitis—only dexamethasone.

b. Posterior sub-Tenon’s: Inj. Triamcinolone as in postoperative cystoid macular edema (CME); chronic uveitis, etc.

c. Peribulbar: As in optic neuritis; thyroid ophthalmopathy, etc.

                                                               

Intraocular

A. Intravitreal injection: Triamcinolone acetonide 4 mg/0.1 mL is useful in uveitic CME, exudative AMD, DME, and PDR. 

B. Sustained-release intravitreal drug delivery: Fluocinolone, dexamethasone, a combination of dexamethasone and cyclosporine.

                                                 SYSTEMIC

Two types are oral and intravenous. 

Oral: Prednisone is the most commonly used oral corticosteroid.

         The initial dose is 1–1.5 mg/kg/day and the maximum adult dose is 60–90 mg/kg/day. The maintenance dose is 10 mg/kg/day. Tapering is done based on the response by every 1-2 weeks.

Calcium and vitamin D supplements may be needed.

oral methylprednisolone or betamethasone may be used in some cases.

                                                            INTRAVENOUS

Methylprednisolone:- this is given in optic neuritis, acute graft rejection, Vogt-Koyanagi harada syndrome, sympathetic ophthalmia, thyroid ophthalmopathy etc.

😨😨 SIDE EFFECTS:-

OCULAR:

• Increased risk of superinfection either with fungus, bacteria, or HSV.
• Steroid-induced glaucoma: it is due to reduced aqueous outflow & occurs more with dexamethasone followed by difluprednisolone.
• fluorometholone & loteprednol have little effect on intraocular pressure although they are less potent.
• Steroid induced cataract: it is mainly posterior subcapsular cataract (more often following systemic use of steroids). 
• Delayed wound healing.
• Mydriasis- dilation of the pupil of the eye. 
• Corneal melting due to increased collagenase activity.
• Transient ptosis & occasionally transient myopia.
• Papilledema due to pseudotumor cerebri. 

                                                SYSTEMIC

• Peptic ulceration.
• Generalized edema due to sodium & electrolyte imbalance.
• Cusing appearance.
• Increased severity of diabetes.
• Osteoporosis
• Mental changes.
• Benign intracranial hypertension.

                                                         CONTRAINDICATED

• Herpes simplex epithelial keratitis.
• Cataract
• Fungal keratitis
• Bacterial keratitis
• Glaucoma

            HYDROCORTISONE ACETATE 0.5% 

Is a steroid which works by blocking the production of certain chemical messengers in the body that causes inflammation ( redness & swelling) & allergies.

Used in eye disorder & allergies.

                            PREDNISOLONE ACETATE 1% 

Is a steroid group medicine ketone-based formulation more potent & more toxic.

USE:- 

👉used in the treatment of redness & swelling in eye, caused by infection or allergy, rheumatic disorder in eyes.

👉It provides relief from redness itching & soreness by stopping the release of substance in the body that cause inflammation.

           =) Uveitis

           =) Episcleritis

           =) Scleritis

           =) Chemical injury

           =) After surgery

SIDE EFFECTS:- 

👉 Burning sensation

👉 Eye irritation

👉 Watery eyes

👉 Blurred vision

👉 Reduction in bone density

👉 Increased IOP

           NO.                  BRAND NAME.                                       COMPANY.

                     01.                       Predmet 1%                                         sun pharma

                     02.                       Predsol                                                 Entod pharma   

                     03.                       Predone.                                              Cipla

                     04.                       Preadforte.                                          Allergen

                     05.                       Pesilone 1%                                         Ajanta

                     06.                       Monopred 1%                                      optho pharma

ANTIBIOTICS+ STEROIDS:- 

 MOXIFLOXACIN + PREADNISOLONE ACETATE 1% 

    1. APDROPS-PD

    2. Occumox P

    3. 4 Quin PD

        DEXAMETHASONE PHOSPHATE 0.1% 

Is used for inflammatory conditions & autoimmune conditions.

HOW WORKS? 

Dexamethasone is a steroid which works by blocking the production of certain chemical messengers in the body that cause inflammation redness and swelling and allergies.

SIDE EFFECTS:- 

⭕Burning sensation

⭕Irritation

⭕Itching

⭕Redness

⭕Increased IOP

It is available in market combination with antibiotics. 

BRAND NAME:-

1. CIPLOX-D

2. MOXICIP-D

3. MOXIMAX-D

4. VIGADEXA

5. MILFLOXDEX 

6. MOSI-D

7. MOXIBLU-D

8. APDROPS-DM

9. TOBA -DM

10. MOXIFORD-D

11. 4 QUIN-D

12. VIGOQUIN-DX

                   FLUROMETHOLONE 0.1% 

Used in the treatment of redness and swelling in the eyes.

HOW WORKS? 

          flurometholone 0.1% is a steroid. It works by blocking the release of certain chemical messengers ( prostaglandins) that cause redness & swelling in the eyes. 

SIDE EFFECTS:- 

👉 Increased IOP

👉 Itching

👉 Discomfort

👉 Dry eyes

                 BRAND                                                          COMPANY

                  FML                                                                Allergen

                  Flurisone                                                       Microlabs

                  Flosoft                                                           Cipla

                  Flomon                                                          FDC Ltd

                  Flarex                                                             Alcon laboratories

                  Fluocin                                                           Sunways India Pvt.Ltd

           LOTEPREADNOL- ETABONATE 0.5%

used in the treatment of redness & swelling in eye, caused by infection or allergy, rheumatic disorder in eyes.

👉It provides relief from redness itching & soreness by stopping the release of substance in the body that cause inflammation.

           =) Uveitis

           =) Episcleritis

           =) Scleritis

           =) Chemical injury

           =) After surgery

HOW IT WORKS?

        =}is a steroid which works by blocking the production of certain chemical messengers in the body that cause inflammation redness and swelling and allergies.

SIDE EFFECTS:- 

 ⭕ Foreign body sensation

 ⭕ Increased IOP

 ⭕ Dry eyes

 ⭕ Corneal defect

 ⭕ Eye itching

                BRAND NAME                                  COMPANY

              LOTEPREAD 0.5%                             SUN PHARMA

              LOTEPREAD LS 0.2%                        SUN PHARMA

              LOTEL GEL 0.3%                                AJANTA PHARMA

              LOTEL GEL 0.5%                                AJANTA PHARMA

              L-PREAD                                              ALLERGAN INDIA Pvt.

              Loteflam                                              CIPLA Ltd. 

              Etapred LS                                           Sunways India Pvt. 

                      DIFLUPREDNATE (0.05%)

Is used in the treatment of post-operative eye pain & inflammation. It is used to prevent and treat inflammation and associated symptoms following eye surgery. Post-infections swelling & pain of the eyes.

HOW IT WORKS? 

       Is a topical steroid, it works by stopping the release of certain natural substance in the eyes that are responsible for pain & inflammation (redness and swelling).

SIDE EFFECTS:- 

👉Eye pain

👉Corneal edema

👉Photophobia

👉Anterior chamber inflammation

👉Conjunctival edema

👉Eyelids inflammation

Posterior capsular opacification

                BRAND NAME                                     COMPANY

               ENPRED                                             ENTOD PHARMACEUTICAL

               FLUPRED                                           SUN PHARMACEUTICAL

               DURONET                                          SUNWAYS INDIA PVT.

               UVEFROST                                         LUPIN LTD.

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THANK YOU

RAIN HEALTH CARE

@ESSENTIALS OF OPHTHALMOLOGY