Corticosteroid Use in Glaucoma Patients

Clinical Decision Algorithm

Short-term bridging therapy (≤3 months) with systemic prednisone may be considered for specific inflammatory conditions, such as vision-threatening uveitis, with intensive IOP monitoring, as recommended by the American College of Rheumatology 1, 2, 3
The American Academy of Ophthalmology suggests that the risk-benefit ratio must strongly favor treatment, such as in vision-threatening uveitis or systemic inflammatory conditions, when considering systemic prednisone use 4

If topical corticosteroid eye drops are necessary, they should be limited to ≤3 months with the goal of discontinuation due to risk of glaucoma and cataracts, as recommended by the American College of Rheumatology 1, 2, 3
Consider alternative immunosuppressive agents, such as methotrexate or biologics, for conditions requiring long-term anti-inflammatory therapy, as suggested by the American Academy of Ophthalmology 4
Loteprednol etabonate and fluorometholone phosphate have more favorable safety profiles for minimizing IOP elevation, according to the American Academy of Ophthalmology 5

In juvenile idiopathic arthritis-associated uveitis, topical glucocorticoids, such as prednisolone acetate 1%, should be used short-term with systemic therapy added if control requires >1-2 drops/day for 2-3 months, as recommended by the American College of Rheumatology 1, 2, 3