As eye care physicians, we often encounter corneal infections in our patients. Fortunately, most of these infections are mild, respond quickly to standard topical antibiotic treatment alone, and resolve without significant corneal scarring or decreased vision. In those infections that are more severe, however, the risk of visually significant scarring is substantial.
The corneal damage that leads to the scarring can result from both the actual infection and the body's inflammatory response to it. Topical steroids have been used, in conjunction with topical antibiotics, to mitigate the inflammatory response in hopes of minimizing corneal scarring and ideally improving the final visual outcome. As some inflammatory response is usually beneficial in combatting infections, however, suppressing it may have unintended consequences, including worsening infection and corneal melting.
In an attempt to determine the effect of steroids in culture-positive bacterial keratitis, a group of researchers from Australia conducted a review of all eligible patients treated for this infection at their institution between 1999 and 2015.[1]Among other factors, researchers compared visual outcomes in groups who received high-, medium-, and low-dose steroids, as well as no steroids. Their results indicated that very good outcomes can be achieved with the use of high-dose steroid treatment, which they define as
