What is the prescription guideline for dexamethasone (corticosteroid) eye drops for the treatment of conjunctivitis?

From the Guidelines

For conjunctivitis, I recommend dexamethasone ophthalmic solution 0.1% with a typical dosing of 1-2 drops into the affected eye(s) four times daily, as supported by the most recent study 1.

Treatment Considerations

When prescribing dexamethasone eye drops for conjunctivitis, it is essential to consider the type of conjunctivitis, as dexamethasone should only be used for inflammatory or allergic conjunctivitis, not bacterial or viral infections unless combined with appropriate antimicrobials 1.

• The treatment duration is usually 5-7 days, though this may be extended to 10-14 days for more severe cases.
• Always complete the full course even if symptoms improve.
• Before application, wash hands thoroughly, tilt the head back, pull down the lower eyelid to form a pocket, instill the drops, close eyes gently for 1-2 minutes, and apply gentle pressure to the inner corner of the eye to prevent systemic absorption.

Important Cautions

Dexamethasone is a potent corticosteroid that reduces inflammation by inhibiting inflammatory mediators and stabilizing cell membranes. However, prolonged use increases the risk of increased intraocular pressure, cataract formation, and opportunistic infections 1.

• If symptoms worsen or don't improve within 48 hours, discontinue use and seek medical attention.
• Patients with adenoviral conjunctivitis who are being treated with corticosteroids require close follow-up, as administration of topical corticosteroids may lead to prolonged viral shedding 1.

Follow-up and Monitoring

Patients who are prescribed prolonged topical corticosteroids should be monitored by periodically measuring IOP and pupillary dilation to evaluate for glaucoma and cataract 1.

• Topical corticosteroids should be tapered once inflammation is controlled.
• Patients who are not treated with topical corticosteroids should be instructed to return for follow-up if they continue to experience symptoms of red eye, pain, or decreased vision after 2 to 3 weeks.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION The duration of treatment will vary with the type of lesion and may extend from a few days to several weeks, according to therapeutic response. Eye: Instill one or two drops of solution into the conjunctival sac every hour during the day and every two hours during the night as initial therapy. When a favorable response is observed, reduce dosage to one drop every four hours. Later, further reduction in dosage to one drop three or four times daily may suffice to control symptoms.

To prescribe dexamethasone eye drops for conjunctivitis, the recommended dosage is:

• Initial therapy: 1-2 drops into the conjunctival sac every hour during the day and every 2 hours during the night
• Maintenance therapy:
  • Reduce to 1 drop every 4 hours when a favorable response is observed
  • Further reduction to 1 drop 3-4 times daily may be sufficient to control symptoms, as needed 2

From the Research

Prescribing Dexamethasone Eye Drops for Conjunctivitis

• Dexamethasone is a topical corticosteroid that can be used to treat conjunctivitis, but its use is generally recommended in severe cases due to potential risks such as prolonging adenoviral infections and potentiating/worsening herpes simplex virus infections, increased intraocular pressure, glaucoma, and cataracts 3.
• However, clinical data show that ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well tolerated when used for short-term treatment (≤2 weeks) 3.
• The treatment of conjunctivitis depends on the underlying cause, and a thorough medical and ophthalmic history should be obtained, along with a thorough physical examination 4.
• Viral conjunctivitis is the most common overall cause of conjunctivitis and usually does not require treatment, while bacterial conjunctivitis can be treated with topical antibiotics to decrease the duration of the infection and allow earlier return to school or work 5.
• Allergic conjunctivitis can be treated with topical antihistamines and mast cell inhibitors, and itching is the most consistent sign in allergic conjunctivitis 5.

Considerations for Prescribing Dexamethasone Eye Drops

• The use of topical corticosteroids like dexamethasone should be carefully considered due to potential risks, and treatment guidelines recommend steroid use generally in severe cases of conjunctivitis 3.
• Long-term usage of eye drops with preservatives can lead to toxic conjunctivitis, and patients with conjunctival irritation and discharge should be evaluated for this condition 4.
• Effective management of conjunctivitis includes timely diagnosis, appropriate differentiation of the various etiologies, and appropriate treatment, and patients should be educated on the self-limiting nature of the condition to increase compliance with conservative treatment 6.