Steroid induced ocular hypertension and glaucoma

During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every six hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenal cortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenal cortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.

Diagnosis of reactive arthritis (including the condition formerly called Reiter’s syndrome) is mainly clinical.  There are no validated diagnostic criteria, however some guidance for diagnosis is available. [18, 19, 20, 10]   In 1995, the Third International Workshop on Reactive Arthritis established criteria for diagnosing reactive arthritis.  The main criteria involve the pattern of joint involvement and the timing of the onset of the condition (such as soon after an infection).  Diagnosis of Reiter’s syndrome has essentially been replaced with diagnosis of the broader category in which it resides:  Reactive Arthritis.

The battle is long. The MERSI experience suggests that at least 2 years on immunomodulatory agents is necessary. The idea is to allow the patient’s immune system to re-learn how to behave itself properly instead of being hyperactive, inappropriate, or aggressive. Immunomodulation suppresses this over activity and inappropriateness, making (artificially) the immune system behave more normally. The goal of such treatment is not to over-suppress the immune system as is sometimes required in treating transplant or cancer patients; rather, the immune system is modulated, re-regulated, until it stops attacking the eye(s). Are there risks to this strategy? Sure. Are the risks worth taking? In the MERSI experience, absolutely. Because the risks are small and manageable if the medications are prescribed and monitored by an expert in these matters, and the benefits are enormous, . preservation of sight and prevention of blindness for the rest of one’s life. Chronic steroid use ALWAYS causes damage. This is why doctors advocate getting away from that plan of treatment, and moving on to non-steroidal agents.

* Malignant Melanoma: This is another form of skin cancer often observed by optometrists. Malignant melanomas can appear in the choroid, the iris or even the conjunctiva. Malignant means that the tumor has the potential to metastasize. Melanoma shows that it arises from the pigmented cells of the eye. Because the choroid has the highest blood flow of any structure in the body and is considered part of the uveal tract, which also includes the iris and sclera, these tumors can often be aggressive. In fact, malignant melanomas of the choroid are the most common intraocular malignancy present. 17

Steroid induced ocular hypertension and glaucoma

steroid induced ocular hypertension and glaucoma

* Malignant Melanoma: This is another form of skin cancer often observed by optometrists. Malignant melanomas can appear in the choroid, the iris or even the conjunctiva. Malignant means that the tumor has the potential to metastasize. Melanoma shows that it arises from the pigmented cells of the eye. Because the choroid has the highest blood flow of any structure in the body and is considered part of the uveal tract, which also includes the iris and sclera, these tumors can often be aggressive. In fact, malignant melanomas of the choroid are the most common intraocular malignancy present. 17

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