Side effects of topical ophthalmic therapy with anti-inflammatory steroids and β-blockers

Anti-inflammatory corticosteroids and β-blockers remain two of the most widely prescribed classes of drugs in ophthalmology despite their well-known ocular and systemic side effects. For corticosteroids, studies of ocular drug levels and corneal anti-inflammatory assays have been used to compare the currently available therapeutic choices. The safety and efficacy of different corticosteroid formulations are being explored, including direct injection of corticosteroids into the vitreous and other locations, and the use of collagen-shield drug delivery approaches. With the demonstration of effective antimicrobials for herpes keratitis, the clinical requirement for corticosteroids is being examined because of the concern for steroid complications. For ophthalmic β-blockers, adverse systemic side effects and possible ocular complications remain important issues. Different doses and formulations of β-blockers have been assessed, with lower-dose regimens and combinations of antiglaucoma agents under evaluation as means of maximizing efficacy while minimizing complications. Useful quantitative data regarding the potential of ophthalmic β-blockers for producing systemic side effects have been provided by β1- and β1-adrenergic receptor binding assays, whereas different mechanisms appear to be required to explain intraocular pressure effects. Additional laboratory and clinical evaluations should help in making rational therapeutic choices and in designing new products.