5 · Factors delaying or impairing healing
Topical corticosteroids — dual role
Review — modulators of corneal healing › 5 · Factors delaying or impairing healing › Topical corticosteroids — dual role
Topical corticosteroids — dual role
Prednisolone acetate 1 %, dexamethasone 0,1 %, loteprednol 0,5 %, fluorometholone, difluprednate
Oxford I–II
Negative (epithelium/melting)
Strong (both effects)
Present · established
Mechanism (dual)Benefit: ↓phospholipase A2 → ↓prostaglandins/leukotrienes; ↓inflammatory infiltrate, cytokines, neovascularization and keratocyte fibrosis (↓haze). Downside: inhibit keratocyte proliferation and collagen synthesis → ↓wound tensile strength; delay epithelial migration; potentiate collagenolytic melting (keratolysis) and perforation, especially over a defect or a "dry"/inflamed cornea; mask/worsen infection (bacterial, HSV, fungal, Acanthamoeba); ↑IOP, cataract.
ContextAfter epithelial healing: control of postoperative inflammation, immune keratitis, ↓haze/scarring (adjunct after antibiotics in bacterial keratitis, cf. SCUT). Avoid in active melting, an uncovered infectious ulcer, or a large fresh defect.
Route & dosageTopical; prednisolone acetate 1 % every 1–6 hours in a tapering schedule; loteprednol/FML (lower IOP risk) for maintenance. Taper cautiously.
Level of evidenceOxford I–II (anti-inflammatory efficacy — SCUT; delayed healing/↓wound strength — experimental studies + melting case series) · Scale: Strong for both aspects.
| FDA / EU MA | Approved; generics widely available (France/Asia/USA). Loteprednol/difluprednate are widely marketed. |
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Key studies: "Effect of topical corticosteroids on corneal wound strength," Am J Ophthalmol — PMID 5715619; corticosteroids and epithelial healing (classic) — PMID 6896993; corticosteroids in infectious keratitis (2021 review) — PMID 34448619.
See also: Gabison E. “Corneal wound-healing agents”. In: SFO 2023 Report — Médicaments et biothérapies en ophtalmologie, chapter 21. Full text, open access (in French).