Precautions on the use of steroid eyedrops & ointment
In response to the recent newspaper reports on the “use of steroid eyedrops after cataract surgery and stroke”, the College of Ophthalmologists of Hong Kong, The Hong Kong Ophthalmological Society and The Hong Kong Association of Private Eye Surgeons hope to provide some evidence-based information to the public and reserve the right to investigate relevant reports.
The use of topical steroid medication (eyedrops and/or ointment) after cataract surgery is considered a standard treatment and is also recommended by all international guidelines. Topical steroid medication is essential to control the intraocular inflammation that occurs after surgery, and can reduce or prevent corneal edema, macular edema and intraocular pressure spikes. If untreated, these conditions could lead to irreversible damage in vision. The usual duration of topical steroid treatment is few weeks, but the duration may be lengthened or shortened depending on the recovery progress after surgery.
Apart from cataract surgery, topical steroid medication is also prescribed after most other eye surgeries, including but not limited to, glaucoma surgery, corneal surgery, vitreoretinal surgery and refractive surgery. In addition, steroid is also commonly prescribed in the management of various eye inflammatory diseases, such as uveitis, keratitis, dry eye disease and inflammation of the eyelid areas.
However, the College, the Society and the Association would like to emphasize that topical steroid is a prescription medication, and should only be used under the supervision of ophthalmologist. All patients should return for regular follow-up appointment so that the ophthalmologist could monitor for any potential side-effects of topical steroid medication, such as steroid-induced glaucoma.
Elevation in serum glucose level is a common side effect after systemic steroid treatment via the oral or intravenous route. For steroid eyedrop, because it is only being applied topically, the systemic body absorption is minimal. However, if prolonged treatment with steroid eyedrop is necessary, a small amount of medication could still be absorbed and could enter the systemic blood stream. A literature review showed that the serum blood glucose level in diabetic patients could be increased if steroid eyedrops were used for several weeks or more. In diabetic patients, if topical steroid is intensively applied (for instance, every two-hourly) for a prolonged period, it also led to a slight increase in blood glucose levels that did not reach clinically significant levels or cause any severe systemic side effects or strokes during the study period. The serum glucose level returned to baseline when topical steroid medications were stopped. In addition, after a person has applied any eyedrops into the eye, the recommended technique is to close the eye, and then gently press (with own finger) on the area between the nasal bridge and inner corner of the eye. This manoeuvre can further reduce the amount of medication being systemically absorbed via the nasolacrimal duct.
Most patients receiving cataract surgery are in the older age group. Hypertension, diabetes and hyperlipidemia, being the main risk factors for cerebrovascular events (strokes), are also more prevalent in this age group. Besides, the stress when one undergoes any type of surgery can also elevate the blood pressure and serum glucose level transiently. Therefore, we would want to remind all patients who are going to receive eye surgery that one should first achieve good control of their medical conditions including hypertension and diabetes. If such control is known to be poor, one should first consult their physician to optimize the conditions, and consult their ophthalmologist regarding the risks of surgery, before proceeding.
2021.05.25 Version 1