Why use steroids in endophthalmitis?
Ophthalmologists often consider the use of steroids in endophthalmitis treatment. Steroids reduce inflammation in endophthalmitis. The decrease in inflammation helps improve comfort and potentially reduces inflammatory tissue damage, such as scarring. Although it is key to treat with appropriate antibiotics for infectious endophthalmitis, topical steroids (steroid eye drops) are included in the therapeutic regimen. The physician orders the steroid eye drops frequently at the onset and monitors inflammation and eye pressure to determine the best treatment schedule.
What is the role of intravitreal steroid injections?
The role of intravitreal steroids (dexamethasone) is controversial. In a recent review and meta-analysis of endophthalmitis, there was no added benefit with the use of intravitreal dexamethasone. The reason for lack of benefit may include the short half-life of intravitreal dexamethasone (<3 hours). Nonetheless, there may be benefit derived from the use of intravitreal dexamethasone in severe bacterial infections such as those caused by Bacillus species.
What about other ways to give steroids?
In select cases there may also be a role for periocular or systemic steroids for a more prolonged steroid effect. Periocular steroids require an injection next to the eye. My preferred technique is a subtenant’s injection as described by Nozik because it is fairly pain-free. Systemic steroids are given as a pill. There are potential side-effects to the use of steroids. With steroid injections come the risk of elevation of eye pressure, which may cause glaucoma. Many side effects may occur with steroid pills including depression, high blood sugar, weight gain, brittle bones, acne, stomach ulcers, and others. Usually side-effects are preventable or treatable. The final decision of how and when to use steroids lies with the treating physician based on the circumstances of the case.
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