Should I give ocular steroids just in case?
Q I have had two patients, one with (unexplained) uveitis and one with severe allergic conjunctivitis. Both have been given steroids in the past and want to have scripts 'just in case' when they travel. I have been reluctant to prescribe.
A One of the 'rules' of ophthalmology is patients should not have ocular steroids unless they have been examined and can be followed up with slit lamp examination. This is because the diagnosis may have changed – for example, instead of idiopathic uveitis they have developed a herpes simplex keratitis – and because even in the short-term topical steroids can cause side-effects such as raised intraocular pressure (IOP).
Although fluoromethalone has a slightly lower propensity to raise the IOP, in reality it has the same adverse effect profile as the other steroids, so it is better to regard all of them with caution.
But in the real world it would not be unreasonable to let certain patients have steroids just in case: for example, if a patient is travelling to a country where it is likely to be difficult for them to access ophthalmic services (or medications) and the patient has a history of relapsing/remitting idiopathic uveitis or allergic conjunctivitis which has been treated with topical steroids in the past without adverse effects.
It is important for these patients to know that not treating their inflammation for 24 hours is unlikely to do them harm and in countries with easy access to health services they may not need to take the precaution of having their own steroids.
Dr Scott Fraser is consultant ophthalmologist at
Sunderland Eye Infirmary