Final answer:
The primary concern when administering IV steroids is to avoid vision loss by rapidly reducing inflammation and preventing optic nerve damage, especially in conditions like Graves' Disease. Other considerations include preventing glaucoma, minimizing side effects, and promoting healing.
Step-by-step explanation:
The most important concern of an ophthalmologist when prescribing IV steroids to a 35-year-old female with symptoms such as grittiness, redness, proptosis, and a relative afferent pupillary defect (RAPD) is avoiding vision loss. These symptoms may indicate a serious underlying condition like Graves' Disease, which can cause inflammation and other issues leading to vision impairment. IV steroids are used to rapidly reduce inflammation and prevent further damage to the optic nerve, which can result in irreversible vision loss if not treated promptly.
The ophthalmologist must also consider preventing intraocular pressure elevation, minimizing side effects, and promoting healing, but the immediate threat to the patient's vision is often the most critical factor influencing treatment decisions. Monitoring for glaucoma is also key for patients over 40 or those at risk due to the potential for increased intraocular pressure.