What is the use of corticosteroid (cortisone) eye drops?

From the Guidelines

Cortisone eye drops should be reserved for severe symptoms of allergic conjunctivitis and used under the supervision of an ophthalmologist due to the risk of vision-threatening side effects, as indicated in the study by 1. When considering the use of cortisone eye drops, it is essential to weigh the benefits against the potential risks, including increased intraocular pressure, cataract formation, and secondary infections.

• The study by 1 highlights the importance of using corticosteroid eye drops, such as loteprednol etabonate, with caution and only for temporary relief of symptoms and signs of seasonal allergic conjunctivitis.
• Another study by 1 discusses the use of topical corticosteroids, such as prednisolone or dexamethasone, as first-line treatments for acute and chronic anterior uveitis, but also notes the increased risk of cataract formation and glaucoma with prolonged use.
• The use of corticosteroid eye drops should be limited to the lowest effective dose and for the shortest duration necessary to control symptoms, as recommended by 1.
• Patients using corticosteroid eye drops should be closely monitored for signs of increased intraocular pressure, cataract formation, and secondary infections, and should follow their doctor's instructions precisely regarding dosage and duration.
• If symptoms persist or worsen, patients should contact their eye doctor immediately, as indicated in the study by 1.
• In general, corticosteroid eye drops are effective in reducing inflammation and relieving symptoms of allergic conjunctivitis and uveitis, but their use requires careful consideration of the potential risks and benefits, as discussed in the studies by 1 and 1.

From the FDA Drug Label

WARNINGS Prolonged use of corticosteroids may result in posterior subcapsular cataract formation and may increase intraocular pressure in susceptible individuals, resulting in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. ADVERSE REACTIONS The following adverse reactions have been identified during use of prednisolone acetate ophthalmic suspension 1%. Because reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure Adverse reactions include elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage, posterior subcapsular cataract formation, and delayed wound healing.

The cortisone eye drop, specifically prednisolone acetate ophthalmic suspension 1%, has several potential adverse reactions and warnings, including:

• Elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage
• Posterior subcapsular cataract formation
• Delayed wound healing
• Secondary ocular infection (bacterial, fungal, and viral) These reactions are reported in the context of prolonged use of corticosteroids 2 and are also listed as adverse reactions in the drug label 2.

From the Research

Cortisone Eye Drops

• Corticosteroids, such as cortisone, are a powerful class of medications used to treat uveitis, characterized by intraocular inflammation involving the uveal tract 3.
• They can be given systemically or locally, in the form of topical drops, periocular injection, intravitreal suspension, or intravitreal implant 3.
• Topically administered corticosteroids are typically indicated for the treatment of anterior uveitis, whereas periocular or intravitreal agents are employed most often in the management of intermediate or posterior intraocular inflammation 4.

Safety and Efficacy

• Corticosteroids can have serious side effects, whether localized to the eye (such as cataract and elevated intraocular pressure) or systemic (such as osteonecrosis and adrenal insufficiency) 3.
• Loteprednol etabonate, a topical ophthalmic corticosteroid, has been shown to have a low propensity to elevate intraocular pressure, regardless of formulation, dosage regimen, or treatment duration 5.
• The cumulative proportion of patients exhibiting clinically significant IOP increases was 0.8% (14/1725 subjects) in studies evaluating short-term loteprednol etabonate treatment and 1.5% (21/1386 subjects) in long-term studies 5.

Treatment of Ocular Inflammatory Conditions

• Corticosteroids are an effective short-term treatment option for seasonal allergic conjunctivitis (SAC) and have been used successfully to treat ocular inflammation 6.
• Loteprednol etabonate has been designed to be rapidly converted to an inactive, nontoxic metabolite, thus minimizing adverse effects, and is currently the only ophthalmic corticosteroid specifically developed for and approved by the Food and Drug Administration for treatment of SAC 6.
• Loteprednol etabonate is also effective in the treatment of postoperative ocular inflammation and relieves ocular surface and lacrimal gland inflammation associated with dry eye 7.