For 50 years, the debate for and against the use of topical steroids in the treatment of bacterial keratitis has raged. Today it is as controversial as ever. Kirk Wilhelmus, MD, has advanced the subject and helped me with this article by doing an excellent literature review of the subject in his article “Indecision About Corticosteroids for Bacterial Keratitis: An Evidence-Based Update.”1 I still agree with the quotation he cites by Thygeson, published originally in 1953, that “great care should be examined in the use of cortisone and hydrocortisone in central corneal ulcers and that bacteriologic diagnosis should be made before employment of these hormones.”1(p839) Evidence and experience suggest that even after the results of cultures and sensitivities are known, one should be especially cautious in the use of topical steroids in the treatment of Pseudomonas aeruginosa. I think the anti-inflammatory effects of antibiotics (a phrase I learned from Jules Baum, MD, when I was a corneal fellow) are frequently sufficient in the treatment of bacterial corneal ulcers.
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