Objective:

To critically synthesize current clinical and translational evidence on the interaction between stress-related endocrine responses and glucocorticoid therapy in ophthalmology.

Approach:

• Literature Search: A structured literature search was conducted using PubMed, Scopus, and Web of Science to identify peer-reviewed studies published between January 2013 and May 2025, resulting in 35 studies included in the final synthesis.

Key Findings:

• Activation of the HPA axis and sympathetic nervous system influences ocular homeostasis, including intraocular pressure regulation, inflammatory signaling, vascular permeability, and neurodegenerative pathways.
• Stress-related neuroendocrine dysregulation is associated with ocular disorders such as glaucoma, ocular surface disease, and central serous chorioretinopathy.
• Glucocorticoids are essential for managing inflammatory ocular diseases but can lead to adverse effects like ocular hypertension and cataract formation.
• Emerging concepts include chronobiology and advanced corticosteroid delivery systems aimed at optimizing treatment efficacy while minimizing treatment-related complications.

Interpretation:

The findings support an integrated model of ocular disease susceptibility influenced by neuroendocrine, inflammatory, vascular, and psychosocial factors.

Limitations:

• Existing evidence is fragmented across experimental, clinical, and translational studies, limiting direct comparison and generalizability.
• Current data largely derive from observational cohorts and preclinical models.

Conclusion:

Greater recognition of stress as a modifiable contributor to ocular health may facilitate the development of more individualized and multidisciplinary approaches to ophthalmic care.