|Year : 1983 | Volume
| Issue : 4 | Page : 413-415
Steroid addction : A complication of use and abuse of steroids in herpes simplex keratitis
IS Jain, Amod Gupta, MR Dogra
Department of Ophthalmology, Postgraduate Institute of Medical Education Chandigarh, India
I S Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain I S, Gupta A, Dogra M R. Steroid addction : A complication of use and abuse of steroids in herpes simplex keratitis. Indian J Ophthalmol 1983;31:413-5
|How to cite this URL:|
Jain I S, Gupta A, Dogra M R. Steroid addction : A complication of use and abuse of steroids in herpes simplex keratitis. Indian J Ophthalmol [serial online] 1983 [cited 2020 Jun 1];31:413-5. Available from: http://www.ijo.in/text.asp?1983/31/4/413/27568
Herpes simplex virus (HSV) is said to be most frequent cause of corneal blindness in western countries. In our country not much attention has been said to HSV keratrtis due to widely prevalent malnutrition, trachoma and other external ocular diseases. With the changing socioeconomic conditions, a change in the pattern of corneal blindness is emerging in our part of country. HSV keratitis now accounts for more than 50% of all corneal affections (unpublished data) and 0.57% of all ophthalmic oat patients. Many of these patients are first seen by generai practitioner and exposed to topical or systemic steroids. It is well established that unjudicious use of steroids in HSV keratitis may lead to severe ocular complications. In this study we have outlined various indications, and complication of use and abuse of steroids in HSV keraritis,
| Materials and methods|| |
194 patients of herpes simplex ocular disease who attended the corneal clinic of the department of Ophthalmology, PGIMER, Chandigarh during the period from January 1977 to July 1982, were the subject of this study. The criteria for diagnosing HSV keratitis were mainly clinical history of keratitis in the past. number of recurrences and history of previous treatment were noted.
Visual acuity recording fluorescein staining of corneal lesions and biomicroscopic examination in each patient was done.
| Observations|| |
There were 156 men and 38 women. Of these 123 (63.4%) patients were seen between the age of 21 and 40 years. 136 patients were affected in one eye and 58 in both eyes. Thus a total of 252 eyes were available for the study. Various corneal lesions seen in these eyes are shown in [Table - 1]. Nearly one third of the eyes had healed lesions of HSV keratitis.
Use and Abuse of steroids
114 of the 252 eyes had been exposed to steroids. 35 of these had been treated elsewhere and steroids had been misused. In 23 of these 35 eyes there was a change in the ulcer pattern [Table - 2], non healing ulcer in 8 eyes and four eyes had perforation of globe. 17 eyes developed steroids dependence and bad to be put on diluted steroids in order to control keratitis in this group. In 79 eyes use of the topical steroids was indicated due to keratouveitis or stromal keratitis without epithelial involvement. Most frequent complication noted in this group was corneal thinning in 8 eyes [Table - 3]. Four eyes in the former and 16 eyes in the latter group become addicted to the use of topical steroids and developed recurrence whenever steroids were stopped.
Recurrent HSV Keratitis
126 eyes had recurrent HSV keratitis [Table - 4]. Nearly 3/4th of the eyes with multiple recurrences had been exposed to steroids or had to be put on steroids subsequently [Table - 4]. 63.8% of the eyes treated with steroids had either stromal keratitis or keratouveitis [Table - 5].
Complications like deeper infiltration, secondary infection, and perforation due to use of steroids were almost universal in the group of recurrent epithelial lesions and epithelial lesions with stromal infiltration [Table - 6]. Incontrast none of the eyes in recurrent HSV keratitis not exposed to steroids developed any of these complications. 9 eyes of 83 recurrent HSV keratitis exposed to steroids became steroid addict.
| Discussion|| |
HSV keratitis in emerging as one of the commonest cause of blindness in our part of the country. Hence we wish to emphasize the magnitude of problems posed by use and abuse of steroids in the management of these cases. Use of topical or systemic steroids in epithelial lesions of HSV keratitis is absolutely contraindicated as we found that complication rate was universal in this group. Role of steroids in epithelial lesions with stromal infiltration is controversial. Exposure to steroids may lead to deeper infiltration keratolysis, perforation and steroids addiction. However experimental evidence has been presented that diluted topical steroids can be safely administered under cover of antiviral therapy for such cases.
Topical steroid in dilution are mostly used for stromal keratitis and keratouveitis, where the improvement in keratitis and visual acuity is tremendous. However steroids addiction is seen frequently in these eyes and they have to be kept on titrated strength of steroids for several months to years.
| Summary|| |
In a study of 194 patients (252 eyes) of HSV keratitis over a period of 52 years seen in the Corneal Clinic, we found misuse of steroids in 35 eyes which led to serious ocular complications like non-healing ulcers, perforation and superadded infections. In 79 eyes of keratouveitis and stromal keratitis, use of topical steroids lead to complications like stromal thinning (8 eyes) and steroid addiction (16 eyes). In recurrent HSV keratitis, none of the eyes not-exposed to steroids developed any of these complications.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]