Topical and subconjunctival corticosteroids are one of the most effective and compelling treatment options in ocular inflammatory diseases. A systematic review of literature indexed by Ovid MEDLINE & EMBASE was performed up to December 2008. There are few studies on their aqueous penetration in human subjects. In this review article we discussed the penetration of different ocular corticosteroids into human aqueous humour along with the therapeutic implications on management of ocular surface diseases, immune related corneal diseases, anterior uveitis and postoperative anti inflammatory use. In the context of the paucity of well-constructed, prospective clinical trials comparing the efficacy of different corticosteroids, it provides guiding principles for the use of topical corticosteroids. Dexamethasone alcohol 1% and prednisolone acetate 1% are potent corticosteroids but the latter achieves the highest aqueous concentration within 2 hours and maintains higher levels for 24 hours. Subconjunctival corticosteroids provide very high concentrations in the aqueous which maintain higher concentrations for longer periods.
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