Hydrocortisone is a common, over-the-counter corticosteroid medication used to reduce inflammation, itching, and redness associated with minor skin irritations, eczema, and rashes. While generally safe when applied topically to the skin, the eye is a highly sensitive organ that reacts negatively to the introduction of non-ophthalmic substances. Accidental contact of hydrocortisone cream or ointment with the ocular surface presents an immediate concern due to both the physical nature of the formulation and the pharmacological action of the steroid compound itself, necessitating rapid first aid and professional medical follow-up.
Immediate Symptoms of Ocular Exposure
Upon accidental contact with hydrocortisone cream, the eye typically reacts with an immediate, sharp stinging or burning sensation. This acute discomfort is primarily caused by the non-medicinal components, such as the cream base, preservatives, and other inactive chemical irritants. The physical presence of the thick, non-sterile ointment or cream on the corneal and conjunctival surfaces acts as a foreign body.
This foreign body sensation triggers a reflex called lacrimation, resulting in an immediate and excessive production of tears as the eye attempts to flush out the substance. The conjunctiva, the clear membrane covering the white of the eye, rapidly becomes inflamed and congested, leading to a bloodshot or intensely red appearance. Vision may temporarily become blurred or cloudy due to the oily or creamy residue coating the cornea.
The initial symptoms are generally transient, meaning they subside relatively quickly once the bulk of the irritating substance is removed from the eye’s surface. However, the intensity of the initial irritation should not be mistaken for the total extent of potential injury. The immediate effects are mostly an inflammatory response to the physical and chemical irritants, which is distinct from the delayed, more serious risks posed by the corticosteroid absorption.
Essential First Aid Actions
Immediate and thorough rinsing is the most important action following accidental hydrocortisone exposure. The goal is to flush out the physical substance and minimize the contact time of the chemical irritants and the steroid compound with the ocular tissues. The eye must be flushed continuously for a minimum of 15 to 20 minutes using a gentle stream of clean, lukewarm tap water or saline solution.
During the rinsing process, hold the eyelid open, ensuring the water flows directly over the eyeball and underneath the upper and lower lids to dislodge any trapped cream residue. If contact lenses are worn, remove them immediately, as they can trap the substance against the cornea. The lenses should not be reinserted.
The eye must not be rubbed, as this action can scratch the cornea or spread the irritating substance further across the ocular surface. After 15 to 20 minutes of irrigation, a medical evaluation is required, even if the eye feels better. If intense pain persists, vision remains significantly blurred, or the exposure involved a high-strength prescription steroid, seek emergency medical attention immediately without stopping the irrigation process.
Delayed Risks and When to Seek Medical Attention
Even after successful initial first aid, hydrocortisone exposure carries delayed risks because the steroid compound can be absorbed by the eye’s internal structures. A significant concern is the potential for an increase in intraocular pressure (IOP). Steroids can alter the outflow pathways of the aqueous humor, the fluid that maintains eye pressure.
This increased resistance to fluid drainage can lead to ocular hypertension, which, if sustained, results in steroid-induced glaucoma. Glaucoma damages the optic nerve, leading to irreversible vision loss, and often progresses without noticeable symptoms until the damage is extensive. The risk is related to the potency of the steroid and the duration of exposure, and individuals with pre-existing open-angle glaucoma are genetically more susceptible.
Another long-term concern is the accelerated formation of cataracts, specifically posterior subcapsular cataracts. Corticosteroid exposure is associated with changes that can lead to the clouding of the lens. This risk is typically associated with prolonged or repeated steroid use, but any exposure warrants monitoring.
Hydrocortisone acts as an immunosuppressant, which can compromise the eye’s natural defenses. The suppression of the local immune response increases the eye’s vulnerability to opportunistic infections, such as bacterial, fungal, or viral keratitis. A viral infection like herpes simplex can worsen significantly under the influence of steroids. Any persistent symptoms like light sensitivity, visible abrasions, or a continued change in vision after the initial 24 hours necessitate an immediate examination by an ophthalmologist or optometrist.