From the Guidelines
Ocular steroid drops commonly used in ophthalmology include loteprednol etabonate 0.5% (Lotemax) as a preferred option due to its beneficial effects on symptoms and conjunctival hyperemia findings with minimal side effects 1.
Overview of Ocular Steroid Drops
These medications are prescribed to reduce inflammation in various eye conditions. The use of ocular steroids can decrease ocular irritation symptoms, decrease corneal fluorescein staining, and improve filamentary keratitis 1.
Commonly Used Ocular Steroid Drops
- Loteprednol etabonate 0.5% (Lotemax) is highlighted for its effectiveness in improving patients’ symptoms and conjunctival hyperemia findings without further beneficial effects or increase in side-effect profile beyond 2 weeks of use 1.
- Other options, though not as prominently featured in the most recent evidence, include prednisolone acetate, dexamethasone, fluorometholone, and difluprednate, which are used for various inflammatory conditions of the eye.
Considerations for Use
- Monitoring for Adverse Effects: Patients prescribed corticosteroids for dry eye should be monitored for adverse effects such as increased intraocular pressure and cataract formation 1.
- Duration and Dosage: Low-dose topical corticosteroid therapy can be used at infrequent intervals for short periods, typically several weeks, to suppress ocular surface inflammation 1.
- Supervision: These medications should only be used under ophthalmological supervision due to the potential for serious complications with prolonged use, including glaucoma and opportunistic infections.
Evidence Basis
The recommendation for loteprednol etabonate 0.5% (Lotemax) is based on a prospective randomized study showing its beneficial effects on symptoms and conjunctival hyperemia findings in patients with dry eye syndrome 1. This study supports the use of loteprednol etabonate as a preferred ocular steroid drop due to its efficacy and safety profile.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Corticosteroids inhibit the inflammatory response to a variety of inciting agents and probably delay or slow healing. Loteprednol etabonate is structurally similar to other corticosteroids. WARNINGS: FOR TOPICAL OPHTHALMIC USE. Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision, and in posterior subcapsular cataract formation.
The following are examples of ocular steroid drops:
From the Research
Ocular Steroid Drops
Characteristics of Loteprednol Etabonate
- High therapeutic index 4
- Rapid de-esterification to inactive metabolites 4
- Low risk of inducing clinically significant increases in intraocular pressure 5, 7, 8
- Effective in treating various ocular inflammatory conditions, including giant papillary conjunctivitis, seasonal allergic conjunctivitis, uveitis, and postoperative ocular inflammation 4, 5, 6
Comparison with Other Steroid Drops
- Non-inferior to dexamethasone 0.1%/tobramycin 0.3% in treating blepharokeratoconjunctivitis 7
- Similar efficacy to prednisolone acetate suspension 1% in treating inflammation after cataract surgery in children 8