Steroid drops can be brilliant for dry eye inflammation. But I'm one of the rare people they don't suit, and my eye pressure paid the price. Here's honestly what happened, why steroids get used in the first place, and the gentler one I use now.
Steroid eye drops come up a lot with dry eye, and they can be genuinely brilliant, because they bring down inflammation fast. My experience with them was a bit more dramatic than most, so let me explain what they're for, and then what happened to me.
Two reasons, really. The first is simple: dry eye is largely an inflammatory condition, and steroids are powerful anti-inflammatories that work quickly, so a short course can calm an angry, flaring eye when nothing else is touching it.
The second is the one that surprised me, and it answers a question a lot of people have. Steroids are often used to settle the eye down before, or alongside, starting a drop like iKervis (ciclosporin). Ciclosporin is slow, it can take months to work, and it stings. So a steroid calms the inflammation quickly and makes the ciclosporin easier to tolerate while it slowly builds up. So if you've been given a steroid to "prepare" your eyes for iKervis, that makes complete sense: it's a recognised way of doing it.
Here's the thing you have to respect about steroid eye drops. In a small number of people, they push up the pressure inside the eye. Most people aren't affected, but some are, and they're called "steroid responders." It matters because sustained high eye pressure can, over time, lead to glaucoma. That's why anyone on steroid drops should have their eye pressure checked, usually a couple of weeks in.
So, Dr Tam prescribed me steroid drops and had me back two weeks later to check my pressure (and for my IPL anyway). And my pressure had gone up through the roof. "Stop the steroids immediately," was the verdict.
Which is a real blow with dry eye, because that fast anti-inflammatory power is so useful, and now one of the most helpful tools was off the table for me. He told me he'd worked there ten years and seen only a handful of steroid responders, maybe four, in all that time. I just rolled my eyes: of course that would be me. He said, "you don't seem shocked," and I wasn't. If there's a more awkward way for my eyes to behave, they'll find it.
There's a happier ending, though. More recently, Mr Matheson prescribed me Softacort, a "soft" steroid (hydrocortisone) that barely penetrates the eye, so it carries far less risk of raising pressure. And it does the same helpful job: calming inflammation and settling my eyes, including when I'm starting or restarting ciclosporin. I've been okay on it.
But, and this really matters, it is not zero risk. I've seen other people online whose pressure rose on Softacort too, so being a "soft" steroid does not mean you can skip the checks. If you're on it, you still need your eye pressure monitored, because that glaucoma risk from sustained high pressure is the whole reason to be careful. Please don't skip that.
Steroid drops are a really useful part of the dry eye toolkit, and for most people they're fine and effective, especially as a way to settle the eye before a slow drop like ciclosporin. Just treat them with respect: they're not something to keep using indefinitely without supervision, and whatever steroid you're on, get your eye pressure checked. If you happen to be a responder like me, there are gentler options, and it's not the end of the road.
More of my journey: My iKervis experience → · How I got diagnosed → · My IPL experience → · My punctal plugs →