Synopsis
Prescribe and review ocular corticosteroids only for an established indication, recognise infection and pressure-related hazards, and give a clear administration, taper and urgent-reassessment plan.
- Ocular corticosteroids can be valuable for established inflammatory disease, but redness alone is not an adequate prescribing indication.
- Steroids can worsen or mask infection, including epithelial herpes simplex and fungal or amoebic corneal disease.
- Pressure elevation may be asymptomatic; symptom improvement does not remove the need for ophthalmic monitoring.
Key red flags
An undiagnosed red eye, corneal epithelial lesion or suspected microbial infection requires examination before steroid treatment is considered.
Investigation priorities
Confirm the indication and identify relevant infection or tissue damage.
Management branches
A clinician is considering ocular steroid initiation, renewal or a change in frequency.
- Confirm the examined diagnosis, corneal status, infection assessment and relevant history such as glaucoma or a previous steroid response.
- Select the appropriate preparation and record eye, concentration, dose, duration, intended taper and the service responsible for review.
Key medicines
Prednisolone acetate 1% suspension, Pred ForteFor a confirmed steroid-responsive indication, the adult SmPC dose is one to two drops two to four times daily; the initial 24 to 48 hours may use two drops hourly. The ophthalmologist determines the indication-specific duration and taper.
Dexamethasone 0.1% suspension, MaxidexFor severe inflammation under ophthalmic supervision, the SmPC permits one to two drops every 30 to 60 minutes until a satisfactory response occurs, then reduction towards one drop every four hours. Subsequent duration and taper follow the specialist examination.