Inflammation, Immunity & Allergy

Ocular Corticosteroids and NSAIDs: Powerful, and Not Without Cost

Inflammation is the eye's answer to almost every insult — a bruised iris after surgery, an allergic surface, a graft the body is trying to reject. Two drug families quiet it: corticosteroids, the broad and mighty suppressor of the whole inflammatory cascade, and NSAIDs, the narrower blocker of a single pathway. Steroids can rescue a sight-threatening uveitis in days. But left running, the same drops can silently raise the pressure until the optic nerve is gone, cloud the lens, and — most dangerously — turn a herpes ulcer into a corneal perforation. Knowing when to reach for which, and what each one costs, is the heart of ocular anti-inflammatory therapy.

Uveitis: Steroids, Steroid-Sparing Agents and Biologics

Uveitis is where the eye stops being an isolated organ and becomes a window onto the whole body. The inflammation you see through the slit lamp is often the visible edge of a systemic disease — a spondyloarthropathy, sarcoid, Behçet's, a childhood arthritis — or a hidden infection wearing the same mask. The pharmacology climbs a familiar ladder: corticosteroids first, then steroid-sparing immunosuppressants, then biologics. But every rung carries one non-negotiable rule: prove it isn't an infection before you switch off the immune system, or you can blind the eye you meant to save.

Ocular Allergy: Calming the Itchy, Watery Eye

There is one symptom that gives allergy away, and it is not redness or watering — it is the itch. A patient who wants to rub their eyes is telling you histamine is loose on the surface of the eye. Behind that itch sits a single busy cell, the mast cell, and almost every drug we reach for is aimed at it: block the histamine it releases, or stop it releasing anything at all. Get the itch right and you have understood ocular allergy; miss it, and you will treat a gritty dry eye or a painful infection as if it were hay fever.