This medicine works in a similar way to a hormone produced by the body. It has powerful anti- inflammatory properties.
When inflammation is severe and especially when a patient has posterior uveitis, steroid tablets (Prednisolone), can be taken to quell the inflammation. A high dose is given to begin with and once the inflammation is controlled, the dose is lowered slowly to a level where inflammation remains controlled.
If this dose is still too high to be taken for a sustained period of time, one or more immunosuppressants may be added to it. While on high dose steroid, patients are monitored for side effects such as weight gain, stomach upset, raised blood pressure, development of diabetes, infections and disturbances of mood – highs and lows.
When steroid tablets are taken long term, there are other side effects such as the formation of cataracts, raised intraocular pressure, the thinning of skin and bones, and women may be troubled by excess hair.
Particular care should be paid to children whose skeletal structure is still developing. For this reason, many specialists will omit this ‘rung’ in the step ladder approach to treatment, and advise moving straight on to an immunosuppressant drug such as Methotrexate.
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In some types of uveitis it is necessary to bring inflammation to a halt rapidly. In eye centres where a rheumatology department works in tandem with the eye clinic, patients may be given intravenous steroid immediately if it is needed. This may take the form of a single pulse, or three pulses may be needed over the course of a week.
Side effects are similar to high dose oral steroid, but there is less of a problem with weight gain. Some patients given steroid through IV require this treatment for their systemic disease, as well as their uveitis. IV steroid may be given just before eye surgery to provide anti- inflammatory cover post operatively.
These injections place steroid where it is needed – in the eye, and systemic side effects are vastly reduced. The injections are usually given if only one eye requires treatment. The effect of the injection lasts for up to four months depending on the type given.
Patients are monitored for raised intraocular pressure in the weeks and months to follow. Should vision blur for short periods of time, it is essential that the patient returns to the eye clinic to have ocular pressure checked. An injection around, or into the eye is a scary thought, but most patients experience mild discomfort only and these injections hurt less than those given by dentists.
The patient lies down and a local anaesthetic is given first. The whole process is less traumatic than the time spent worrying about it before hand. If you are worried about flinching away from an approaching needle, you probably won’t even see it coming, since most doctors instruct you to look at something which diverts your gaze.
Children tend to be given this procedure under general anaesthetic.
Some doctors use an alternative method of getting steroid into the eye. The eye is numbed, a small nick is made to the surface and the steroid enters through that without being injected. After the injection, there may be some soreness and discomfort and it may be some time before sight improves, although if the injection works, most patients see a benefit within a week.
Again, this places steroid into the eye. An implant is surgically placed in the eye and this releases the drug for around two years or so. These implants, like Retisert, are useful when uveitis is posterior and the patient has no systemic disease which requires the use of immunosuppression therapies. The side effects include the formation of cataracts and the risk of raised intraocular pressure.
- Everything you want to know about corticosteroid, written by EU uveitis specialists and patients (PDF, 1.5MB)