Corticosteroids with anti-infectives show promise for acute conjunctivitis

This review article explores the effectiveness of topical corticosteroids, alone or combined with anti-infectives/antibiotics, for the treatment of acute infectious conjunctivitis.

Study design

The authors examined published literature and relevant treatment guidelines concerning topical steroid use in infectious conjunctivitis.

Outcomes

Topical corticosteroids can help alleviate symptoms and reduce scaring in infectious conjunctivitis. Historically, caution has been advised when using steroids because of the potential to prolong infection, worsen or activate herpes epithelial keratitis and increase IOP. Combination drops, which include corticosteroid and povidone-iodine, may help treat both inflammatory and infectious components of conjunctivitis. Several combination drops are under development and have been studied in randomized placebo-controlled trials with no harm or serious complications and no signs of herpes virus activation. Studies evaluating these combination drops show reduction of viral titers, reduced duration of viral shedding and effective killing of all bacteria, Candida and Fusarium isolates.

Limitations

Future randomized clinical trials are needed to study the effectiveness and safety of steroids in conjunctivitis treatment.

Clinical significance

There is evidence that low-dose, short-term corticosteroid use is well tolerated and can be used in combination with antibiotics, anti-infectives or antiseptics to address the infectious and inflammatory components of conjunctivitis. The perceived risks of these medications are not supported by high-quality evidence in the literature.