Corticosteroids

Corticosteroids (often just called "steroids") are powerful anti-inflammatory medications widely used in ophthalmology and neurology. They work by suppressing the immune system's inflammatory response.

Types of Corticosteroids

Systemic (Whole Body)

Oral

• Prednisone—most common oral steroid
• Dexamethasone
• Prednisolone

Intravenous

• Methylprednisolone (Solu-Medrol)
• Used for severe inflammation
• See IV Steroids

Ophthalmic (Eye)

Eye drops

• Prednisolone acetate
• Dexamethasone
• Loteprednol
• Difluprednate

Injections

• Periocular (around the eye)
• Intravitreal (inside the eye)

Common Uses in Neuro-Ophthalmology

Optic Neuritis

• IV steroids speed recovery
• Optic neuritis treatment
• High-dose pulse therapy typical

Giant Cell Arteritis

• High-dose steroids urgently
• Prevents blindness in other eye
• See Giant Cell Arteritis

Thyroid Eye Disease

• Active inflammatory phase
• IV steroids often preferred
• See Thyroid Eye Disease

Myasthenia Gravis

• Part of treatment regimen
• Often combined with other immunosuppressants
• See Myasthenia Gravis

Other Conditions

• Optic perineuritis
• NMO attacks
• Inflammatory orbital disease
• Uveitis

How They Work

Corticosteroids:

• Enter cells and bind to receptors
• Alter gene expression
• Reduce production of inflammatory chemicals
• Suppress immune cell activity
• Decrease swelling and redness

Dosing

High-Dose IV Pulse

• Methylprednisolone 1000mg daily for 3-5 days
• Used for acute severe inflammation
• Usually followed by oral taper

Moderate-High Oral Dose

• Prednisone 40-80mg daily
• Gradually tapered over weeks to months
• Typical for conditions requiring prolonged treatment

Low-Dose Maintenance

• Prednisone 5-10mg daily
• Long-term for chronic conditions
• Goal is lowest effective dose

Eye Drops

• Frequency varies by condition
• May be hourly initially for severe inflammation
• Gradually tapered

Side Effects

Short-Term (More Common)

• Increased appetite and weight gain
• Mood changes, insomnia
• Elevated blood sugar
• Fluid retention
• Increased blood pressure

Long-Term (With Prolonged Use)

• Osteoporosis (bone thinning)
• Cataracts
• Glaucoma
• Adrenal suppression
• Easy bruising
• Skin thinning
• Increased infection risk
• Weight gain (central obesity)
• Muscle weakness

Eye-Specific (Drops or Systemic)

• Increased eye pressure (glaucoma)
• Cataract formation
• Delayed wound healing
• Increased infection risk

Tapering

Why Tapering Is Necessary

Long-term steroid use suppresses your body's natural cortisol production. Stopping suddenly can cause:

• Fatigue
• Weakness
• Low blood pressure
• Adrenal crisis (rarely, dangerous)

How to Taper

• Gradual dose reduction over weeks to months
• Slower taper for longer treatment courses
• Follow your doctor's specific instructions
• Never stop abruptly without medical guidance

Monitoring

During Treatment

• Blood pressure
• Blood sugar
• Weight
• Eye pressure (if on eye drops or long-term systemic)
• Bone density (DEXA scan for long-term use)
• Signs of infection

Preventive Measures

For prolonged use:

• Calcium and vitamin D supplementation
• Consider bone-protective medication
• Regular eye exams
• Diabetes screening
• Vaccinations (but avoid live vaccines)

Interactions

• Diabetes medications (may need adjustment)
• Blood thinners
• NSAIDs (increased GI risk)
• Live vaccines (avoid during treatment)
• Many other medications—inform all your doctors

Special Considerations

Pregnancy

• Some steroids safer than others
• Discuss with your doctor
• Benefits may outweigh risks in some situations

Diabetes

• Steroids raise blood sugar
• May need medication adjustment
• More frequent monitoring needed

Prior Infections

• Can reactivate tuberculosis, hepatitis
• Screening may be needed before starting

Frequently Asked Questions

Are these the same as anabolic steroids?

No. Corticosteroids are anti-inflammatory medications. Anabolic steroids are muscle-building hormones sometimes abused by athletes. Different drugs with different purposes.

Why do I feel so much better on steroids?

Steroids rapidly reduce inflammation and can also cause euphoria. This is why it's important to taper slowly—both to avoid adrenal insufficiency and to prevent symptom rebound.

Can I take steroids long-term?

Sometimes necessary, but goal is usually to use the lowest dose for the shortest time. Long-term use increases side effect risk.

What if I miss a dose?

Take it as soon as you remember, unless it's almost time for your next dose. Don't double up. Call your doctor if you're unsure.