Topical Steroids in Management of Dry Eye Disease
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CORNEA (T YAMAGUCHI, SECTION EDITOR)
Topical Steroids in Management of Dry Eye Disease Hayley Favre 1 & Sejal Lahoti 1 & Nasser Issa 1 & Daniel A. Johnson 1 & Ahmad Kheirkhah 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To review current literature on the use of topical steroids for treatment of both aqueous-deficient and evaporative subtypes of dry eye disease (DED). Recent Findings Recent studies have shown that topical steroids are effective for the treatment of patients with moderate or severe DED who have failed to respond to more conservative measures. These medications are useful for patients with both aqueous-deficient and evaporative subtypes of DED. Although topical steroids are often used for a short period of time, patients with chronic ocular surface inflammation can benefit from long-term treatment. For this, low-potency steroids, such as loteprednol or fluorometholone, would be reasonable due to their reduced risk for increasing intraocular pressure. Topical steroids have proven beneficial in conjunction with other anti-inflammatory medications such as topical calcineurin inhibitors. Summary As inflammation plays an important role in pathogenesis of DED, topical steroids may be considered for patients with refractory disease. Keywords Topical steroids . Cornea . Dry eye disease
Introduction Dry eye disease (DED) is one of the most common reasons for patients to see eye care providers [1]. It is estimated that the worldwide prevalence of DED is between 5 and 34%, with an increased prevalence in the elderly and women [2–4]. DED can be associated with ocular symptoms of irritation, hyperemia, eye fatigue, and vision changes and can significantly affect a patient’s quality of life [5••]. Two major subclassifications of DED are aqueousdeficient dry eye (ADDE) and evaporative dry eye (EDE). Pathophysiologically, DED is a multifactorial disorder caused by disruption in the homeostasis of the tear film. This loss of homeostasis is due to tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities [5••, 6••]. The resultant stress and damage on corneal epithelial cells lead to a cycle of ocular This article is part of the Topical Collection on Cornea * Ahmad Kheirkhah [email protected] 1
Department of Ophthalmology, Long School of Medicine, University of Texas Health San Antonio, Medical Arts and Research Center, 8300 Floyd Curl Dr., San Antonio, TX 78229, USA
surface disruption and thus further stimulation of the inflammatory cascade [6••]. Due to the significant role of inflammation in the pathogenesis of DED, anti-inflammatory medications are commonly used for its treatment. Various anti-inflammatory medications have been employed for this purpose, including topical steroids, topical calcineurin inhibitors, topical lymphocyte function-associated antigen-1 blocker, oral antibiotics such as tetracyclines or macrolides, and both topical and oral omega 3 fatty acids. This article will review the current litera
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