Introduction: Corticosteroids are widely utilized for systemic and inflammatory conditions. They come in several different types of formation including intravenous, oral, and topical. Systemically absorbed corticosteroids are known to have several adverse effects that are discussed below but ophthalmic formulations are known to primarily only have local adverse effects.
Case: We present a case of a 48-year-old female presenting to her gynecologist with recurrent vulvovaginal candidiasis while on long term use of prednisolone-acetate 1% ophthalmic drops. Once these drops were discontinued and the patient was switched to ketorolac drops, the patients' recurrent vulvovaginal candidiasis resolved.
Conclusion: This case highlights the potential systemic absorption ophthalmic corticosteroids drops may have along with the argument further investigation should be made to investigate the potential of these effects.
Corticosteroids when administered systemically via intravenous or oral route have an established adverse effect profile that includes adrenal suppression, increased risk of infections, steroid induced myopathy, slowed wound healing, cataracts, hyperglycemia, formation of ulcers, increased risk of osteoporosis, psychosis, leukocytosis, and Cushing syndrome [1]. In contrast, topical corticosteroids such as ophthalmic preparations are believed to have fewer adverse effects which include increased intraocular pressure, cataract formation, secondary eye infections, and corneal ulcers [2].
A 48-year-old female with a medical history of rheumatoid arthritis and iritis presented with recurrent vulvovaginal candidiasis. In June of 2021, the patient was prescribed prednisolone acetate 1% ophthalmic drops for management of iritis. The following year in March, the patient the presented to her obstetrician-gynecologist with recurrent vulvovaginal candidiasis. The patient was evaluated by her OBGYN; once via telehealth and once in office. The patient was then started on Diflucan and was instructed to make a follow up appointment with her ophthalmologist.
The patient followed up with ophthalmology in April where the decision was made to discontinue the prednisolone acetate 1% and change to ketorolac ophthalmic drops. Following this change, the patient no longer experienced her recurrent vulvovaginal candidiasis episodes. Thus, it was deemed the patient's ophthalmic corticosteroid drops were the cause of her recurrent vulvovaginal candidiasis [3].
We felt this case demonstrated the possible association between ophthalmic glucocorticoid drops and vulvovaginal candidiasis along with the potential systemic adverse effects topical corticosteroids may have. Furthermore, an argument can be made that her long-term use of the prednisolone acetate ophthalmic drops lead to an increased risk of infections via potentially getting systemically absorbed through the conjunctival vessels leading to her becoming more susceptible to vulvovaginal candidiasis infections.
This case allows clinicians to be aware of the potential link between long-term ophthalmic glucocorticoid drops and recurrent vulvovaginal candidiasis. This case also could help warrant the argument to further investigate other cases where patients may be experiencing other systemic adverse effects when using long term ophthalmic glucocorticoid drops.
It is our belief that long-term ophthalmic glucocorticoid drops have the potential of having not only local adverse effects but also systemic adverse effects. This case highlights the potential for secondary complications from ophthalmic glucocorticoid drops such as vulvovaginal candidiasis. Awareness of this can improve clinical management and potentially help aid in the etiology of patient's symptoms who are on long-term ophthalmic glucocorticoid drops. Further research is warranted to better define the risk of long-term ophthalmic glucocorticoid drops.