-

cortisol Najeeb .

STEROIDS ←
④ ④ Gyeong;
① SHORT-ACTING -
(teh Ll2hm )

used to treat ocular inflammation Hydrocortisone i

20mg
o
- . i

② INTERMEDIATE
ACING (ther -
36hm )
-
ra o A
phospholipid
-
.
-

Prednisone 4 0.8 5
my
-
o

Plotz I corticosteroids .
Methyl Bred . 5 o -
5 4
mg
u Triamcinolone 5 o u
AA ng
oDeHaawrt 3- y O G
g, mg
WX
③ WEEING ( th > 36 hours )
Cox
d
Dexamethasone
Yr : :?I7hg
°

NSAIDs -0-1 LT Cee , Dy ,

obemmema.me
Ey
M
PG LT Broncho combichin
Thromboxane ↳ ( T By
Az chemotaxis .

① ① Putz

migration of neutrophils
into to
② ① .
Ecf ,
and adherence

vascular endothelium .

interfere
③ ① macrophage of inflammation
access to site .

activity and ⑥se of Band T lymphocyte no .

c- lymphocyte
,

⑨ ②se capillary permeability

.

⑤ ② se fibroblast proliferation
and
quantity of collagen deposit .

measure of the activity

in terms
of amount
# Potency →

required to produce an effect of given intensity

.

( Drugs i high potency give response at low concentration)

→

H MODERATE LOW

• Prednisone acetate o Rim exo cone o Med M some

prednisone phosphate o
Dexamethasone phosphate of me alcohol
o

u
Difluprednate
u
FML acetate o
Hydrocortisone
• Dexamethasone acetate
o
loteprednole o cortisone
-

efficacy -→ maximum effect a

drug can produce .

Bioavailibiity →
Depends on
availability to penetrate cornea

# corneal epi
Solubility
.

uu csrtiaymii
-

Acetate phosphate
Hydrophilic
lipophilic
-

form
-

solution
form
.

and ointment
-

suspension .
.
zy his .
effective
'

'

Belter penetration .

gf corneal epi →
Phosphate form
contact time effective
longer intact more
- .

Better used in keratitis

-
E epithelium
n

Routes
- of delivery
-

Eto , ETD
"
Topical -

Retiro bulbar
opeuioculauin-jechn-subconjgsub.tn
on ,

0.1mL )
pdexa.IO -4mg in

Jntrauibaf Implant ↳ 02uRDe*

'

•
Ivy
- .

,
Ointment
0.7mg Solution suspension
Oral Parental a
Systemic .

unuefeiinigost
made
of
-

oflipid
o
made
-

water
.

made of
-
-

bare Soluble base like PETROLATUM

soluble -

ACETATE
like Phosphine
PREDMISOWNE Prolonged
-

small particles
Doesn't require
-

# contact time ,
-

of Hydrocortisone
's
analogue shaving of the
drug Mms good for night
.

syn .

in WL -
DE SAC
-
, time

anti-inflammatory
.

-
.

resulting
in
prolonged
wniautime Tired
←
acetate and phosphate form
higher penetration
.

- -

( 0.125% , 1% ) CI %) -

↳ t
Need to shak-ewell-tomvmmt.fm
th 18 36 hours
reffing
-

④ doesn't
-

: -

cone to
drug rapidly
.

corneal tear
enhance its the pre
film so despite
anti inft effect
,

contact time,
prolonged
-
. .

is available
lending
than suspension for
penetration .

BEST -
GOOD
GOOD
-

-
 DEXAMETHASONE
# -

resemble cortisol
structurally
- .

available in o
usurp enrich form
-
and O -

Kinmen t form .

the 3- 6
days
-

30 mins and peaks btw 90 Iso mins

-

Ein
.

Reaches aqueous
.

int aqueous humor )

-

( shows resistance to Penicillin after penetration

into and aqueous humor
-
Ointment has lower penetration cornea

as
compared toeyedroops .

High propensity ⑨
to IOP
-
vehicle → cyclodextrine ( improves corneal penetration ) a
.

WTEPREDNOL
Cat wth position )
of
#

instead ketone group

-
Esler based steroid ( has ester
bond protein that
) ketone group forms covalent
I lens are
-

l-
so

in steroid induced
cataract .

found in AC and on ocular surface .

esterase
by
em
deactivated
Rapidly
.

( totem ax ) ; Elo I
-

suspension
-
o g .

o s t
Elo
.
-
-

Gel , cells
-

(Avex)
- ,

o -
sit .
. .

El D)
'
not much used and not efficacious .

( and o 25 I
-

o l 't
FMI
-
-
-
.

-
Relatively weaker c. s .

-
ten complications
penetration be used for longer pd of time .

-
lens , can .

- concentrates in corneal epithelium .

m
-
Anti in fl potency : 40 .

TOC =
tho ④ top dtt steroid I diagnosed Glaucoma .
 MED R 't SOME
I T

sign derivative of progesterone

.
←
.

- weakest ophthalmic steroid .

-
minimal ④ top → but caution e steroid responders

BETAMET HAS ONE

effect 28 hours
-

and th 36 72 hours anti in fin →

Et D and Elo
- -
:
-

-
O -

l 't
.
-
-

ointment form and

available in 0-5 I
-

I I 3- I
HYDROCORTISONE
-

- . . .

,
.

e -

used
it .
Et D form .

-
1st c. s .
to be .

-
tr,
za
8 -
12 hours .

oh , csewRomt .

I O 51
Anti in Hm potency 1.1. w/ w
-
-
.
- .

wlw
--

Uses afw in Hms Knob conf sic ca

Dry
. .

① lids contact
Atopic
] dermatitis → ocular cicatricial

,
pemphigoid
/
squamous
chemical blepharitis .

bums
CI eine )
allergic conjunctivitis
② conjunctiva
→

diluted Predco -
121 . or o 010 I
-
-

.
deca )
use
.
-

Fml ) pulse therapy

potency Clotepredl
as .

or low
Hb
4- 8 timed day tapering → .

. Luke , atopic , giant papillary phylectanular conj ) .

.

viral
cutaneous conf . lesion
-
mu w

'
chemical burns .
③ conga
-
Cle in active epithelial keratitis .

Severe in
flm - diluted .

( l lo)
-

- dexa .
BD TDS . .

given I antiviral Tx

-
H2O keratitis .

-
ocular
pemphigus .

chemical it pred acetate (2 hourly 10lb )

injury
- -
. .
.

-
keratitis .

Moorenis ulcer -
relent
-÷#

Inflammatory peripheral ulcerative keratitis

-

-
Autoimmune .

-
keratitis .

marginal comeal -

infiltrates .

after dacoit
Immune reaction
keratopathy
-

Khan
.

for corneal graft rejection

-
-
.

fire
^
endo .
epi
-
.

4 times I
every hourly day
(severe rejection -
iv.
methylpred .
+ I
hourly topical)
Acute uveitis
④ Ung -
non -

granulomatous ant .

hourly 1 day
Topical pred
- .
acetate 17 .
I -
G .

in intermediate Post uveitis

effective
a
Not much
.

- .

scleritis
⑧ Sclera g
.

Epi scleritis .
 51£ : -

* steroid induced glaucoma

* cataract formation
* Delayed wound healing
-

Epithelial
breakdown to
geographical ulcer . * ⑤ guscep to .

infection
-

⑦ IOP .

20 odnflammation
muwpolysachridogis
.

-
-
steroid induced glaucoma
-

dpen L
type
→ causes

in TM .

⑥ ag outflow ;.
most IOP return to ① after withdraw of steroids .

( 31 .
cases were observed to be irreversible -
so not to be used in I
degree
steroid responder )
relative of POAG , prev .

prednisone
-

Highest risk of ⑨ top → Dexamethasone , difluprednate ,

then .

)
M
edrysonl
-

loteprednol ten likely to cause 9 top .

Fml

and Beckler
Skroidrespndeei
- Acc .
to
Asmaly .

-
4 times
3 times
administration
cis frog of .

6 wks
4 wks
cir) Duration

Ciii ) Parameter
change in top final IOP

low resp .
26 < 20

Inter resp . G -
12 20 -
So

high resp .

gig
731
 cataract
-
formation
-

Psc ④ i
long term steroid .

Intra withal implant

.
-

multiple intrawit injection

.
.

dose duration
depends upon
!
-
and

75%Dctwmgbfgylmdaygepmd.deuelopspsc.TT
.

'

Jb is
'

progressive and irreversible .

1471mL Gmt)
#
penioeulausu-jetion-ge.ae =

song , sme

① Sub ate -
phosphate salt

② Sub tenon route → chronic Post uveitis

,
.

, Dme .

T ant
( post
-
-

capsule-extenn.cn -

Space Mw lemon 's capsule

and sclera .

sub tenon 's route pt is not a steroid

( Before giving by
ensure - .

responder ) Pt should be
→ . topical steroids on
for 4 week

to
for glaucoma appear .
 In trauitreal
Injection →
-
more
targeted delivery
controlled and consistent
-
-

3.5 -
4mm from limbus . -

by pars blood ocular barrier

.

on few temporally Cd )
systemic toxicity
-
-

① Dexa=→ the 3- 4 hours ,

o -

1mL

② Triamcino lone →

longer teh
-

O
5mg 12mg injection of long line uomglmloeespeaely
-

or
-
.

detectable after 3 months .

effect upto 6 months .

is oietinotoxic
-
Non -
toxic to retina but its vehicle benzyl alcohol .

more -
Cme there occurs because of bheakdown of Blood retinal barrier .

to edema mediated VEGF

leading by .

and cytokines and

steroids → -0 u eat
growth factors .

&

regulate endothelial cell tight junction .

① pg , a release → localreduction
of inflammatory mediators .

uses →

-1 .
me →

and macular
VEGF ) (d) vascular
permeability
( anti PG anti anti
-

edema .

2 .
Stein Ilm and ERM
during HR
surgery
.

Dexa
3 .
Post op . endophlhalmitis →

0.9mg .
 off . label um -

-1
wet AR MD
.

2 . PDR
3. venous occlusion
4 .
pseudo phatic macular edema .

5 .
Proliferative vitro
retinopathy
.

Complications
=
→

i . Subway: n'ge
2 .
④ top
3- Traumatic cataract

tiger
4 . vitreous
. RD
systemics -

Read nisolone Dera

µf①
-
MK used oral steroids →
-
-
-

' ml
-

single dose
early morning .

② 9mg Iml
.
ABF E antacid ( PPI BBF )
-

HPA oucis
supremum
→

Hypothalamus

÷÷÷l
I can

of dit feedback
Systemic suppression HPA axis
steroid 72 weeks
-
•

mech .

adreno cortical
Sudden acute deficiency
stoppage precipitates
.
o

I
done
tapering should be .

Huck
u ; 940
my 1day
→
by 10mg 1day every
Cd) .

Huck
Cii ) 40 20mg I day → Cd) by 5 mglday every
- .

Huck
long day
1 Cd) by 25mg 1day every
→
Ciii ) 20 -
.

t yuck
day (d)by t 2.5mg 1day every
-

Civ) 1 -
ing
-

i o
.

-
Pulse therapy
=

limp (intravenous methyl Pred )

-

.
.

Igm#y or
250mg 6th
hourly 1day
a
zedo.gs
f-Ib oral Bredn isotone
=

used : .
I Optic neuritis '

rejection
.

Severe corneal
graft
.

2.

3. Symp . Ophthalmitis
uveitis
post
sight threatening
. .

4 .
Severe

Monitor -

B1 RBI
.
&iwh