The corticosteroids have come to be widely used in ophthalmology since the introduction of cortisone and adrenocorticotropic hormone (ACTH) in 1949. Although the glucocorticoids are given by the ophthalmologist for their anti-inflammatory effect, they produce many other side effects.
The indications, contraindications of systemic therapy were listed.
There is no good evidence that, given in full therapeutic dose, the anti-inflammatory activity of one particular corticosteroid is better than another.
The major considerations in the choice of the drug are the side effects and the cost to the patient.
Although prednisone and prednisolone cause sodium retention, these are clearly the drug of choice.
If sodium retention becomes a factor, switching to dexamethasone is indicated. Dexamethasone stimulates the appetite considerably, and excessive weight gain may result.
Triamcinolone, on the other hand, depresses the appetite and is the drug of choice when sodium retention and increased appetite present problems.
In several regimens of therapy, the following three are considered best. The first is the divided daily dose, usually four times a day. Next is the single daily dosage, taken in the morning.
An every-other-day dosage is advocated in long-term therapy.
For the most part in ophthalmic diseases a single daily dose is the preferable treatment.
Usual starting therapeutic dosage and average maintenance doses were tabled.
The most common side effects of corticosteroid therapy were listed.
The other considerations in systemic therapy were described.
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