Systemic Corticosteroids in the Treatment of Uveitis

  • Sarju S. Patel
  • Abhiniti Mittal


Corticosteroids are still the mainstay in the treatment of uveitis due to their potent anti-inflammatory and immunosuppressant mechanisms. Various forms and routes of administration exist, each with its own positive and negative attributes. Due to the diverse function of gluco- and mineralocorticoids in the body, synthetic corticosteroids always come with adverse effects. Treating physicians must be aware of all the potential effects of these medications and provide adequate counseling and monitoring when treating their patients.


Corticosteroids Glucocorticoids Steroids Uveitis Cushing’s syndrome Diabetes/hyperglycemia Osteoporosis Hypercoagulability 


  1. 1.
    Gordon DM. Prednisone and prednisolone in ocular disease. Am J Ophthalmol. 1956;41(4):593–600.CrossRefGoogle Scholar
  2. 2.
    Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011;335(1):2–13. Scholar
  3. 3.
    Smoak KA, Cidlowski JA. Mechanisms of glucocorticoid receptor signaling during inflammation. Mech Ageing Dev. 2004;125:697–706.CrossRefGoogle Scholar
  4. 4.
    Newton R, Holden NS. Separating transrepression and transactivation: a distressing divorce for the glucocorticoid receptor? Mol Pharmacol. 2007;72:799–809.CrossRefGoogle Scholar
  5. 5.
    Matyszak MK, Citterio S, Rescigno M, et al. Differential effects of corticosteroids during different stages of dendritic cell maturation. Eur J Immunol. 2000;30:1233–42.CrossRefGoogle Scholar
  6. 6.
    Newton R, Seybold J, Kuitert LME, Bergmann M, Barnes PJ. Repression of cyclooxygenase-2 and prostaglandin E2 release by dexamethasone occurs by transcriptional and post-transcriptional mechanisms involving loss of polyadenylated mRNA. J Biol Chem. 1998;273:32312–21.CrossRefGoogle Scholar
  7. 7.
    Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30. Scholar
  8. 8.
    Babu K, Mahendradas P. Medical management of uveitis – current trends. Indian J Ophthalmol. 2013;61(6):277–83. Scholar
  9. 9.
    Movahedi M, Costello R, Lunt M, Pye SR, Sergeant JC, Dixon WG. Oral glucocorticoid therapy and all-cause and cause-specific mortality in patients with rheumatoid arthritis: a retrospective cohort study. Eur J Epidemiol. 2016;31(10):1045–55. Scholar
  10. 10.
    Wasko MC, Dasgupta A, Sears GI, Fries JF, Ward MM. Prednisone use and risk of mortality in patients with rheumatoid arthritis: Moderation by use of disease-modifying anti-rheumatic drugs. Arthritis Care Res. 2016;68(5):706–10. Scholar
  11. 11.
    Lewis JD, Scott FI, Brensinger CM, et al. Increased mortality rates with prolonged corticosteroid therapy when compared with antitumor necrosis factor-α-directed therapy for inflammatory bowel disease. Am J Gastroenterol. 2018;113(3):405–17. Scholar
  12. 12.
    Waljee AK, Rogers MA, Lin P, Singal AG, Stein JD, Marks RM, Ayanian JZ, Nallamothu BK. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415. Scholar
  13. 13.
    Dekkers OM, Horvath-Puho E, Jorgensen JO, Cannegieter SC, Ehrenstein V, Vandenbroucke JP, Pereira AM, Sorensen HT. Multi-system morbidity and mortality in Cushing’s syndrome: a cohort study. J Clin Endocrinol Metab. 2013;98:2277–84.CrossRefGoogle Scholar
  14. 14.
    Coelho MC, Santos CV, Vieira Neto L, Gadelha MR. Adverse effects of glucocorticoids: coagulopathy. Eur J Endocrinol. 2015;173:M11–21.CrossRefGoogle Scholar
  15. 15.
    Kok C, Sambrook PN. Secondary osteoporosis in patients with an osteoporotic fracture. Best Pract Res Clin Rheumatol. 2009;23:769–79.CrossRefGoogle Scholar
  16. 16.
    Briot K, Roux C. Glucocorticoid-induced osteoporosis. RMD Open. 2015;1:e000014. Scholar
  17. 17.
    Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W, Curtis JR, Furst DE, McMahaon M, Parker NM, Volkmann E, Saag KG. American College of Rhematology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res. 2010;62(11):1515–26.CrossRefGoogle Scholar
  18. 18.
    Tamez-Pérez HE, Quintanilla-Flores DL, Rodríguez-Gutiérrez R, González-González JG, Tamez-Peña AL. Steroid hyperglycemia: prevalence, early detection and therapeutic recommendations: a narrative review. World J Diabetes. 2015;6(8):1073–81. Scholar
  19. 19.
    Gulliford MC, Charlton J, Latinovic R. Risk of diabetes associated with prescribed glucocorticoids in a large population. Diabetes Care. 2006;29:2728–9.CrossRefGoogle Scholar
  20. 20.
    Perez A, Jansen-Chaparro S, Saigi I, Bernal-Lopez MR, Miñambres I, Gomez-Huelgas R. Glucocorticoid-induced hyperglycemia. J Diabetes. 2014;6:9–20.CrossRefGoogle Scholar
  21. 21.
    Ruzzin J, Wagman AS, Jensen J. Glucocorticoid-induced insulin resistance in skeletal muscles: defects in insulin signalling and the effects of a selective glycogen synthase kinase-3 inhibitor. Diabetologia. 2005;48:2119–30.CrossRefGoogle Scholar
  22. 22.
    Trence DL. Management of patients on chronic glucocorticoid therapy: an endocrine perspective. Prim Care. 2003;30:593–605.CrossRefGoogle Scholar
  23. 23.
    Hirsch IB, Paauw DS. Diabetes management in special situations. Endocrinol Metab Clin N Am. 1997;26:631–45.CrossRefGoogle Scholar
  24. 24.
    Nieman LK. Cushing’s syndrome: update on signs, symptoms and biochemical screening. Eur J Endocrinol. 2015;173:M33–8.CrossRefGoogle Scholar
  25. 25.
    Drozdowicz LB, Bostwick JM. Psychiatric adverse effects of pediatric corticosteroid use. Mayo Clin Proc. 2014;89(6):817–34.CrossRefGoogle Scholar
  26. 26.
    Geer EB, Islam J, Buettner C. Mechanisms of glucocorticoid-induced insulin resistance: focus on adipose tissue function and lipid metabolism. Endocrinol Metab Clin N Am. 2014;43(1):75–102.CrossRefGoogle Scholar
  27. 27.
    Etxabe J, Vazquez JA. Morbidity and mortality in Cushing’s disease: an epidemiological approach. Clin Endocrinol. 1994;40(4):479–84.CrossRefGoogle Scholar
  28. 28.
    Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of corticosteroid use. Rheum Dis Clin N Am. 2016;42(1):157–76.CrossRefGoogle Scholar
  29. 29.
    Ferrau F, Korbonits M. Metabolic comorbidities in Cushing’s syndrome. Eur J Endocrinol. 2015;173(4):M133–57.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sarju S. Patel
    • 1
  • Abhiniti Mittal
    • 2
  1. 1.Uveitis and Ocular Immunology, Retinal Consultants Inc.SacramentoUSA
  2. 2.New York Medical College - MS3ValhallaUSA

Personalised recommendations