Corticosteroid eye drops are commonly prescribed to manage inflammation, swelling, and pain following eye surgery, or for conditions like uveitis and severe allergic conjunctivitis. These medications contain potent anti-inflammatory compounds that primarily work locally in the eye to reduce the body’s immune response. However, even this localized treatment can lead to systemic side effects, including feelings of anxiety, agitation, and nervousness. The possibility of mood changes like anxiety is a valid concern for patients using these topical drops.
Systemic Absorption of Ocular Medications
The eye is connected to the body’s general circulation, allowing some medication to enter the bloodstream. When a drop is placed on the eye’s surface, only a small fraction is absorbed by the corneal and conjunctival tissues. The majority of the liquid volume quickly drains away through the tear drainage system.
This drainage moves the medication through the nasolacrimal duct, which connects the eye to the nasal cavity. Once in the nasal passage, the drug is readily absorbed by the highly vascularized nasal mucosa. This direct absorption bypasses the liver’s first-pass metabolism, meaning the drug enters the systemic circulation in a potent, unchanged form. Although the amount absorbed systemically is often small, it can be enough to exert effects on sensitive systems, like the brain and endocrine glands.
How Corticosteroids Influence Mood and Anxiety
The anxiety side effect occurs because the steroid compounds in the eye drops are synthetic versions of cortisol, a hormone naturally produced by the adrenal glands. Once absorbed into the bloodstream, these synthetic steroids interfere with the Hypothalamic-Pituitary-Adrenal (HPA) axis, the body’s central stress response system. The presence of exogenous steroids disrupts the HPA axis’s balance in regulating stress hormones.
The synthetic corticosteroids bind to glucocorticoid receptors (GRs) found throughout the body, including in brain regions that regulate mood and emotion, such as the amygdala and hippocampus. Activating these receptors alters the balance of neurotransmitters, specifically influencing gamma-aminobutyric acid (GABA), a primary inhibitory neurotransmitter.
An imbalance in the GABA system is closely linked to increased feelings of anxiety and agitation. Interference with the HPA axis can also suppress the body’s natural cortisol production, leading to adrenal suppression associated with psychiatric symptoms. The resulting chemical shifts in the brain manifest psychologically as heightened anxiety and nervousness.
Recognizing the Spectrum of Psychological Side Effects
Anxiety is the most reported mood change, but corticosteroids can trigger a broader range of psychological and behavioral symptoms known as steroid-induced psychiatric symptoms. These effects can appear within days of starting the medication.
Beyond general anxiety, patients may experience nervousness, agitation, or a feeling of being constantly “on edge.” Sleep disturbances are also a common complaint, including difficulty falling or staying asleep, or a reduced need for sleep, which further exacerbates mood instability.
Less common, but documented, effects include significant mood swings, irritability, or, in rare cases, more severe symptoms like mania or psychosis. Patients should recognize that these changes are a physical response to the medication.
Patient Consultation and Management Steps
If a patient suspects their steroid eye drops are causing anxiety or other mood changes, the immediate action is to contact the prescribing ophthalmologist. It is important not to stop the medication suddenly, as this interrupts the treatment of the eye condition and can potentially cause withdrawal symptoms. The prescribing physician will evaluate the severity of the symptoms, determine the next steps, and may adjust the dosage or frequency of the drops. The physician may also ask about the timing of the symptoms, pre-existing mental health conditions, and the specific dosage and duration of the treatment.
A common mitigation strategy is teaching the patient how to perform punctual occlusion. This involves pressing lightly on the inner corner of the eyelid for one to two minutes immediately after administering the drop. This simple technique temporarily blocks the nasolacrimal duct, reducing the amount of medication draining into the nasal passage and limiting systemic absorption. In some cases, switching to a different type of steroid eye drop with a lower systemic absorption profile may be considered.