Caution: steroids

2 August 2023
Summer 2023

Kathy Oxtoby looks at the intended and adverse effects of corticosteroids, the common concerns patients have, and how to manage a steroid response.

Domains covered

Communication Clinical practice Specialty CPD (IP)

Optometrists will often see patients who are taking prescribed corticosteroids, used primarily in the treatment of various autoimmune and inflammatory conditions (NHS, 2023). Steroids work by mimicking the effect of cortisol, a natural steroid hormone released by the adrenal glands, to reduce inflammation and the activity of the immune system, mediate the body’s stress response and regulate metabolism. Cortisol is a glucocorticoid, and because glucocorticoid receptors are present in almost all bodily tissues, cortisol is able to affect nearly every organ system – nervous, immune, cardiovascular, respiratory, reproductive, musculoskeletal and integumentary (Thau et al, 2022).

As steroids are used to treat a range of conditions, from multiple sclerosis to hay fever (NHS, 2023), their dose and duration can vary widely. “Steroids’ potency ranges from low to high, with different indications depending on the diagnosis and severity of the condition,” says Dr Anna Kwartz MCOptom, an optometrist at Stockport NHS Foundation Trust. This means it is hard to define a “typical dose”.

While steroids are often used to treat acute conditions, they may also be used long term in some chronic conditions or given to people as an ongoing low-maintenance dose. It is normally recommended that steroids are tapered to prevent rebound inflammation – for example, when they have been prescribed for anterior uveitis (COptom, 2021; Royal College of General Practitioners (RCGP), 2016).

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