Corticosteroids in the management of herpetic eye disease

The discriminate use of topically applied corticosteroids to modify or abolish the inflammatory response in herpetic stromal keratitis, has, as its objectives, the prevention of visual loss from corneal scarring and disorganization and a lessening of the morbidity associated with this disese. Steroids may be expected to have a profound anti-inflammatory effect in antibody-complement mediated inflammation and are effective in delayed hypersensitivity as in homograft rejection. The equally profound effect of pharmacological vasoconstriction may enable steroids to impede both afferent and efferent pathways in an immunological reflex arc, and they may be expected to reduce inflammation of nonimmunogenic origin. The adverse effects of the misapplication of these potent drugs in herpetic keratitis, in terms of an increase in the rate of complications and in the severity and morbidity of the disease, should be emphasized again.