Short-term steroid use helps heal ocular surface before refractive surgery

Short-term use of topical steroids used in conjunction with other long-term therapies can help heal the ocular surface in patients considering refractive surgery, said Deepinder K. Dhaliwal, MD, of the University of Pittsburgh School of Medicine.

"Steroids reduce inflammation by increasing production of protein that inhibits phospholipase A and block production and release of cytokines," she said.

For patients with a compromised ocular surface, Dr. Dhaliwal described a typical treatment regimen including steroid drops q.i.d., which is reduced by a weekly taper of one drop per week, and concomitant cyclosporine 0.05% (Restasis, Allergan) b.i.d. She also starts thermal eyelid massage for meibomian gland dysfunction. Dr. Dhaliwal will consider omega-3 fatty acids p.o. or low-dose doxycycline (20 to 50 mg b.i.d.).

When choosing which steroid to use, physicians should be aware that the older ketone steroids such as prednisolone and dexamethasone can increase IOP and cause cataracts. Dr. Dhaliwah suggests loteprednol etabonate 0.5% or 0.2% or fluorometholone 0.1% because of their safety profile.

"After 1 month, I re-evaluate the patient and if the ocular surface is crystal clear, I will proceed with refractive surgery," she said. "If there are persistent signs or symptoms of ocular surface compromise, I consider punctal plugs if there is aqueous deficiency."

She warned surgeons of the contraindications to steroid use, including a history of HSV dendritic keratitis or contact lens-related keratitis.