Antiinflammatory Drugs and the

Local steroids are widely used in the treatment of eye disease; systemic steroids are not used unless the sight of the eye is threatened. It must be remembered that systemic steroids give the patient a sense of well-being, which might give a false impression of the real benefit obtained. Furthermore, systemic steroids can have serious and life-threatening side effects, such as vertebral collapse through osteoporosis and perforated gastric ulcer (Figure 24.1).

Local steroids should also be applied with caution, and it is a good rule always to have a specific reason for giving them. That is to say,they should not be prescribed just to make red eyes turn white without a clear diagnosis. The reasons for this are two-fold: first, local steroids enhance the multiplication of viruses, especially herpes simplex; and second, they can cause glaucoma in certain predisposed individuals. In such individuals, the instillation of one drop of steroid can cause a temporary rise of intraocular pressure. The most potent steroid in this respect is dexam-ethasone, followed by betamethasone, pred-nisolone and hydrocortisone. It has been claimed that rimexolone, clobetasone and fluorometho-lone are relatively safe in this respect.

Recently, a number of nonsteroidal anti-inflammatory drugs (NSAIDs) have been made available in topical form (diclofenac [Voltarol

Steroids give a patient a feeling of well-being.

Figure 24.1. There might be a false impression of the real benefit obtained. O

Steroids give a patient a feeling of well-being.

Figure 24.1. There might be a false impression of the real benefit obtained. O

Ophtha], ketorolac [Acular] and flurbiprofen [Ocufen]) to reduce our dependence on topical steroids. They have been shown to be of use in the treatment of postcataract surgery inflammation and in reducing the pain after excimer laser surgery and corneal abrasions.

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