Steroid-related mechanisms in ocular health and disease: therapeutic effects, adverse events, and stress-related modulators. A narrative literature overview.

This narrative overview examines the interplay between stress-related neuroendocrine dysregulation, glucocorticoid signaling, and ocular health, with particular emphasis on their roles in ocular disease pathophysiology and clinical management. A structured literature search was conducted using PubMed, Scopus, and Web of Science to identify English-language peer-reviewed studies published between January 2013 and May 2025. Additional records were identified through manual screening of reference lists. Following title, abstract, and full-text evaluation according to predefined eligibility criteria, 35 studies were included in the final narrative synthesis. The available evidence indicates that activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system influence key biological processes involved in ocular homeostasis, including intraocular pressure regulation, inflammatory signaling, vascular permeability, and neurodegenerative pathways. Stress-related neuroendocrine dysregulation has been associated with several ocular disorders, particularly glaucoma, ocular surface disease, and central serous chorioretinopathy (CSC). At the same time, glucocorticoids remain indispensable therapeutic agents for the management of inflammatory and immune-mediated ocular diseases, although their use may be accompanied by adverse effects such as ocular hypertension, glaucoma, cataract formation, delayed wound healing, and increased susceptibility to infection. The review further highlights emerging concepts related to chronobiology, advanced corticosteroid delivery systems, and personalized treatment approaches aimed at optimizing therapeutic efficacy while minimizing treatment-related complications. Collectively, the findings support an integrated model in which neuroendocrine, inflammatory, vascular, and psychosocial factors interact to influence ocular disease susceptibility, progression, and treatment outcomes. Greater recognition of stress as a modifiable contributor to ocular health may facilitate the development of more individualized and multidisciplinary approaches to ophthalmic care.