Steroid induced glaucoma may develop after application of steroid preparations applied to the skin of the eyelids. This elevation occurs most frequently with chronic use, such as in patients with atopic dermatitis. Close IOP monitoring of these patients is essential and consideration of a non-steroidal topical medication, such as tacrolimus and pimecrolimus, should be considered as an alternative. Elevation in intraocular pressure has also been noted with application of steroids on skin that was not periocular, either from ocular contamination or systemic absorption.  Patients should be advised to wash their hands after applying dermatologic steroids or to use gloves.
Now you understand what you need to do and how you need to do it, but you still don’t have the proper doses or full time frame for your post cycle therapy treatment and that’s the final point of our discussion. While Nolvadex and Clomid can work equally as well, they will only work equally as well if they are dosed properly. This is where many fail when they use Clomid as Nolvadex is much stronger on a per milligram basis. For example, with 40mg of Nolvadex, for Clomid to match it you need 150mg. As for hCG dosing, 500iu to 1,000iu per day every day for 10 straight days is your plan and implemented precisely as discussed above. Once the hCG therapy is complete, you will start your Nolvadex therapy at 40mg per day or Clomid at 150mg per day; whichever you choose, you will continue it for two weeks. Once the two weeks is complete, you will complete two more weeks this time with a Nolvadex dosing at 20mg per day or a Clomid dosing at 100mg per day. No, you’re not done yet, you will complete one more week at 10mg per day for Nolvadex or 50mg per day with Clomid and add in an additional week at the same dose if you feel it is necessary.
Guidance on prescribing topical steroids reminds practitioners to prescribe the least strong steroid which is effective for the least possible length of time. A balance must be struck between efficacy and reducing adverse effects. Education is crucial to maximise efficacy and reduce adverse effects. Use of printed information may be helpful (including detail of how to use emollients and topical steroids) and education involving practice nurses to help improve efficacy of treatments and information for patients. Examples can be obtained from the British Association of Dermatologists and the National Eczema Society.