mdwannabe
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I think there is evidence that supports use of CS in all the choices, in certain conditions. Though decrs dose in Ren Insuf and Peptic ulc.
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| lucky
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ocular herpes?
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| mdwannabe
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no...as far as I know it is indicated for Herps. To dampen inflam react, coz most of damage to vision is from inflam and scarring.
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| ELM
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Lucky tell us why! 8)
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| lucky
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whats the correct answer elm. i didnt go thru all the option s just clicked herpes on a hunch[a very bad habit of mine]
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| lucky
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but i think that steroids will aggravate an ocular ulcer instead of helping any
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| ELM
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Use of CS in ocular herpes zoster helps to disseminate the HSV infection.
Also pregnancy tend to help local herpes infection to spread into systems!......
generally any cause of inmmunosuppression helps dissemination of this virus!
Ok we are done with this...ready for the next? 8)
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| mdwannabe
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I have read several papers on use of steroids in occular herps, some time back, there was no mention of dessemination. Plz provide the source.
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| lucky
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i don't think steroids are indicated for infections, inflammation yes, but infection no.
steroids are immunosuppresive and will slow down the body 's natural defences trying to contain the infectious process and will disseminate it instead.
i hope this explains a little of it.[ i'm awful with reasoning.]
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| mdwannabe
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in my understanding, most damage in optic infections, is from overly aggressive immune response, not the infection per se.
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| Alina T
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hey md, i have jump in and say that according to my knowledge corticosteriods are contraindicated in herpes ocular infections, for the reason lucky stated above. i cant provide a handy refference for that, except for my medschool books and professors. but i remember them stressing this out a lot! (its pretty fresh in my memory, as i had opht last semester :wink: )
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| ELM
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Uuups i thought we was done with this ...guess we wasn't soorryy.....Lucky's reasoning is perfectly legitimate for systemic use of CS ....... but for topical use of CS in ocular Herpes infection is it causes dendritic keratitis --> could potentially cause perforation of the cornea since it's readily absorbed across inflamed mucous membranes and skin.
(2004 CMDT ......HSInfection and HZInfection, Katzung and Trevor's last edition Pharm)
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| Dot
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Accord to HEDs[herpatic eye disease study] CS use with antiviral drop is the most effective of t/t.
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| mdwannabe
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Thank you Dot! So I was not dreaming! :-)
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| ELM
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Sure you doctors or doctors wanna be .....give it to your patients and you will get sued badly for purposely making innocent people blind! Treat the patiens by THE standart!!!
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| mdwannabe
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that is if you are treating STANDART patients. However, in real world...well, I guess we are not talking about real world here.. now do we???
As far as law goes.. if you can prove the rationale behind treatment, that is based upon published work, it is rather tough to pin blame on you.
Here are just some resourses:
http://www.revoptom.com/handbook/SECT1F.HTM
http://www.nei.nih.gov/neitrials/static/study37.a...
http://www.aafp.org/afp/20000415/2437.html
....Corticosteroids
Orally administered corticosteroids are commonly used in the treatment of herpes zoster, even though clinical trials have shown variable results. Prednisone used in conjunction with acyclovir has been shown to reduce the pain associated with herpes zoster.15 The likely mechanism involves decreasing the degree of neuritis caused by active infection and, possibly, decreasing residual damage to affected nerves
http://www.emedicine.com/OPH/topic256.htm
I hope that proves my point.
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| ELM
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You can show endless recent studies...but Harrison's and CMDT says (which i thought it's the current standart) ... big no-no on this!!!......you tell me what we are talking about???
PS: the last stusy from above....i see lot's of negatives on CS Tx...huh?
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| mdwannabe
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whatever dear...I am just providing info.
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| Dot
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I m explaining the t/t of ocular herpes.Though epithelial keratitis can be t/t with dedebriment+antiviral drops like acyclovir 5 times a day.And topical steroid is contraindicated if virus is still multiplying which is very common in Herpes simp epithelial keratitis.
But in case of STROMAL ULCER The t/t is Combination of Topical steroida+topical antiviral+cycloplegics.This t/t accord to HEDS study is better than any other t/t especially if stromal ulcer is not acomp with epithelial ulcer.
Though oral steroiid i crneal ulcer is of little help but in case of iridocyclitis if added to the topical antiviral nd top steroid regime is of great help in t/t.
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| asekra2001
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I think lucky and alina are right. I have seen russian and indian literature in which it is written clearly that corticosteroids are contraindicated in ocular herpes. The reason was not given. But I think that due to it's immunosupressive quality it will exacerbate the lesion, moreover it's antiinflammatory property will not do any good to the lesion, so their is no point in using this drug.
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| Drmos
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d, can be die for ocular herpes with the use of CS, peptic ulcer is a relative contraindication, you can add by IV.
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| mikyro
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An absolute contraindication to CS therapy...
a.Pregnancy
b.Peptic ulcer
b.Diverticulosis
c.Renal insuff
d.Ocular herpes
I had such a test on the exam - a young female with ocular herpes.
Guys, never give steroids in such cases or when you are undecided. Let the opthalmologist take this decision. This is serious. You may do worse than better.
Answer: D
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