Topical steroids in ophthalmology. Part 2. Comparative analysis, safety, and clinical guidelines

Topical steroids are a cornerstone in the management of inflammatory diseases of the anterior segment of the eye, providing potent anti-inflammatory and immunosuppressive effects. The first part of the review [ROJ. 2026; 19 (2): 192–202] presents a comprehensive comparative analysis of the pharmacokinetics of key steroids used in ophthalmology practice — prednisolone, dexamethasone, fluorometholone, hydrocortisone, loteprednol, and difluprednate. At the same time, their use is associated with a potential risk of developing serious adverse reactions, including ocular hypertension, cataracts, delayed reparative processes, and suppression of local immunity. Therefore, the choice of the optimal drug requires a balanced assessment of the expected therapeutic efficacy and safety profile depending on the specific clinical situation. Part 2 of the review focuses on comparing the clinical efficacy of the above-mentioned steroids, assessing the associated risks, and analyzing the pathogenetic mechanisms of their development, primarily steroid-induced ocular hypertension. Differentiated approaches to prescribing are discussed, considering the pharmacological properties of drugs, the localization and severity of the inflammatory process, as well as individual risk factors for the patient.

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