During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every six hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenal cortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenal cortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.
It is urged that patients receiving steroid therapy, either systemically or locally to the eye, be examined periodically for possible elevations in intraocular pressure. Patients who have a family history or previous diagnosis of open-angle glaucoma should be observed more frequently  . Refractive surgeries should not be considered when IOP is poorly controlled. Provider must recognize that the interface fluid characteristic of post-refractive surgery steroid-induced glaucoma leads to inaccurately low central applanation tonometry measurements and obscures the diagnosis of steroid-induced glaucoma. Measurements of central cornea should be confirmed with those obtained from the cornea peripheral—preferably temporal rather than nasal--to the flap using Tono-Pen, pneumotonometery, or applanation tonometer [3,11,12]    .
An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (., myasthenia gravis ), or in patients receiving concomitant therapy with neuromuscular blocking drugs (., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis . Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.