12.6  Systemic Steroids

Y (Why Have the Procedure)

“You have: Giant cell arteritis, optic neuritis, severe non-infectious uveitis, inflammatory orbit disease etc. You need to be on steroids to suppress your immune system which is contributing to this disease. If left untreated this condition can lead to vision loss or blindness.”


  • Prevent vision loss

It is important to exclude infectious causes that may worsen if left untreated in an immunosuppressed or diabetic patient e.g. tuberculosis, syphilis, fungal infections. However, in the setting of potentially blinding conditions (e.g. GCA), do not delay initiating steroid use while awaiting tissue confirmation of diagnosis.

M (Mechanism, What is the Procedure)

“Systemic steroids can be given”:

  • “In a vein” (intravenous e.g. methylprednisolone)
  • “As tablets” (oral e.g. prednisone)

Consider additional treatment of oral proton pump inhibitor and calcium / vitamin D supplementation. Long term steroid treatment should involve collaborative care with a patient’s GP / Rheumatologist / Immunologist / Endocrinologist as appropriate.

C (Complications)

Significant systemic side effects are associated with systemic steroids and are largely dose related. Side effects / complications can be severe, especially in patients that need long term treatment:


  1. Cataract
  2. Glaucoma
  3. Central serous chorioretinopathy


  1. Acute
    1. Immunocompromise (dependant on dose, duration and other medications)
    2. Altered mood (mania / psychosis / anxiety)
    3. Increased appetite
    4. HT
    5. Diabetes
    6. Gastritis or gastric ulcer
  2. Chronic
    1. Weight gain, cushingoid appearance (Truncal obesity, buffalo hump, “moon facies”)
    2. Osteoporosis, osteonecrosis (especially femoral head and knees)
    3. Diffuse myopathy (mainly upper and lower limbs)
    4. Growth deceleration (in children)
    5. Bruising (ecchymosis), skin thinning, hirsutism, acne
    6. Adrenal insufficiency (if rapid wean of long-term steroid)


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