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Corticosteroid — Periocular or Intravitreal Injection Pregnancy: Avoid — corticosteroids affect fetal development

Triamcinolone Acetonide (Intravitreal / Periocular)

Brand names: Kenalog, Triesence (preservative-free — intravitreal)

Adult dose

Dose: Intravitreal: 4 mg in 0.1 mL; Periocular (posterior sub-Tenon): 40 mg in 1 mL
Route: Intravitreal injection or posterior sub-Tenon injection
Frequency: Single injection; repeat at 3–4 months as required
Max: 4 mg per intravitreal injection; 40 mg per periocular injection
Use preservative-free preparation (Triesence) for intravitreal injection — Kenalog contains benzyl alcohol which is toxic to retinal cells. Sub-Tenon injection is preferred in phakic patients to reduce cataract risk. Duration: 3–4 months (shorter than Ozurdex).

Paediatric dose

Route:
Specialist paediatric ophthalmology guidance required — used in paediatric uveitis and cystoid macular oedema

Dose adjustments

Renal

No systemic adjustment — intravitreal/periocular use

Hepatic

No adjustment

Clinical pearls

  • CRITICAL formulation difference: Kenalog (triamcinolone for intramuscular/intra-articular use) contains benzyl alcohol preservative — benzyl alcohol is directly retinotoxic; NEVER inject Kenalog intravitreally; ONLY use Triesence (preservative-free ophthalmic formulation) for intravitreal injection
  • Pseudoendophthalmitis: triamcinolone crystals in vitreous can appear as white vitreous opacification mimicking endophthalmitis — distinguishing features: no anterior chamber cells/flare, no pain, no hypopyon, no systemic inflammation; resolves spontaneously
  • IOP elevation: mandatory IOP check at week 8; topical IOP-lowering drugs started if IOP >25 mmHg; surgical IOP-lowering may be required in steroid responders (genetic predisposition to trabecular meshwork steroid response)
  • Sub-Tenon vs intravitreal: posterior sub-Tenon injection provides periocular drug delivery without entering the eye — avoids endophthalmitis risk and cataract risk; IOP elevation still occurs; used for non-infectious posterior uveitis and CME
  • Superseded in many indications: intravitreal triamcinolone has largely been replaced by Ozurdex (biodegradable implant) for sustained release with better safety profile and NICE approval

Contraindications

  • Active ocular or periocular infection
  • Glaucoma with poor IOP control
  • Benzyl alcohol preparation (Kenalog) for INTRAVITREAL use — CRITICAL: use only preservative-free Triesence for intravitreal injection
  • Phakic patient (cataract risk — relative; consider Ozurdex instead)

Side effects

  • IOP elevation — common (30–50%); monitor at 8 weeks
  • Cataract formation in phakic eyes
  • Steroid-induced glaucoma — irreversible optic nerve damage if untreated
  • Endophthalmitis (injection risk)
  • Pseudoendophthalmitis (sterile): triamcinolone crystals in vitreous — white floaters mimicking endophthalmitis; differentiate by absence of hypopyon and absence of pain/inflammation signs

Interactions

  • No clinically significant systemic drug interactions

Monitoring

  • IOP at week 8 and monthly
  • Lens status (cataract)
  • OCT — retinal thickness
  • Visual acuity
  • Signs of endophthalmitis post-injection

Reference: BNFc; BNF 90; NICE TA229; RCOphth Uveitis Guidelines; SPC Triesence; SPC Kenalog. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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