Ophthalmic Corticosteroids
Key Points
- Dexamethasone and prednisolone are key topical agents for ocular inflammatory conditions.
- Extended therapy can increase IOP and glaucoma risk and may cause cataract or optic-nerve damage.
- Ocular corticosteroids are contraindicated in active viral, fungal, and selected mycobacterial eye infections.
- Dexamethasone formulations may contain sulfites that can trigger severe reactions in sulfite-sensitive clients.
- Teaching should emphasize contamination prevention, safe ambulation with transient blurry vision, and prescriber-directed taper plans.
Class Overview
Topical ocular corticosteroids suppress inflammatory responses from allergic, chemical, immune, or postoperative causes. They are commonly used for conjunctivitis, iritis, uveitis, and selected burn or trauma pathways when infection contraindications are excluded.
Common Agents and Typical Dosing
| Drug | Typical Adult Ophthalmic Dosing Pattern | Notes |
|---|---|---|
| Dexamethasone (drops/ointment/insert formulations) | Initial high-frequency dosing (often q1h daytime, q2h nighttime), then taper by response | More potent and longer duration than prednisolone |
| Prednisolone sodium phosphate 1% | 1-2 drops q1h while awake and q2h at night initially, then taper to q4h and then 3-4 times daily | Duration varies from days to weeks by response |
Adverse Effects and Contraindications
- Blurred vision, photophobia, ocular irritation/dryness
- Increased IOP and glaucoma risk (especially with prolonged use)
- Cataract formation and optic-nerve injury risk
- Secondary infection risk and worsening of existing ocular infection
Contraindication examples:
- Acute superficial herpes simplex keratitis
- Fungal ocular disease
- Acute infectious varicella-stage eye disease
- Viral corneal/conjunctival disease
- Ocular tuberculosis
- Advanced glaucoma
Nursing Assessment and Interventions
- Assess therapeutic response: reduced pain, redness, and irritation.
- Monitor for warning signs: increasing pain, drainage, persistent blurred vision, headache, or light sensitivity.
- Ensure safe ambulation and environment while vision is transiently blurred.
- Verify administration technique and contamination prevention.
- For treatment longer than about 10 days, ensure routine IOP monitoring is performed.
Client Education
- Follow taper instructions exactly; abrupt or overly rapid reduction can cause rebound problems.
- Report severe fatigue, dizziness, visual change, infection signs, or worsening symptoms promptly.
- Use sunglasses for photophobia outdoors when needed.
- Avoid contact lenses for at least about 15 minutes after instillation.
- Avoid driving or hazardous activities until vision clears.
Related Concepts
- ophthalmic-medication-administration - Route technique and contamination prevention.
- ophthalmic-antibiotics - Combination anti-infective pathways and contamination-control overlap.
- ophthalmic-immunosuppressants - Steroid-sparing and concurrent immunomodulator safety context.
- ophthalmic-nonsteroidal-anti-inflammatories - Additive delayed-healing risk when combined.