From the Guidelines
The safest topical steroid to use around the eye is loteprednol etabonate, as it has a greatly reduced risk of causing increased intraocular pressure and cataract formation compared to other ocular corticosteroids. This is based on the most recent and highest quality study available, which highlights the importance of using topical corticosteroids with caution around the eyes due to the potential for serious side effects 1.
When using topical steroids around the eyes, it is essential to use them sparingly and for short durations, typically 5-7 days maximum, to minimize the risk of complications. Applying a thin layer to the affected area 1-2 times daily is recommended, and care should be taken to avoid getting the medication directly into the eye itself. The eyelid skin is much thinner than skin elsewhere on the body, making it more susceptible to steroid side effects like skin thinning, increased intraocular pressure, and cataract formation.
Some key points to consider when using topical steroids around the eyes include:
- Using low-potency options, such as loteprednol etabonate, to minimize the risk of side effects
- Applying the medication sparingly and for short durations
- Avoiding getting the medication directly into the eye itself
- Monitoring for signs of increased intraocular pressure and cataract formation
- Consulting with a healthcare provider if symptoms persist beyond a week of treatment
It is also important to note that prescription steroid eye drops specifically formulated for ophthalmic use may be more appropriate for certain eye conditions, but these should only be used under medical supervision 1. Additionally, topical corticosteroids should be tapered once inflammation is controlled, and patients should be monitored regularly for signs of complications 1.
In terms of specific medications, loteprednol etabonate 0.5% suspension or gel has been shown to be effective in reducing ocular irritation symptoms and corneal fluorescein staining, with a lower risk of increased intraocular pressure and cataract formation compared to other corticosteroids 1. However, it is essential to use these medications under the guidance of a healthcare provider and to follow their recommended treatment plan.
From the FDA Drug Label
Loteprednol etabonate ophthalmic suspension is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe The incidence of patients with clinically significant increases in IOP (≥10 mmHg) was 1% with loteprednol etabonate and 6% with prednisolone acetate 1% 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 safest topical steroid to use around the eye is loteprednol etabonate, as it has a lower incidence of increasing intraocular pressure (IOP) compared to other steroids like prednisolone acetate 1% 2. However, it is essential to use it with caution and under the guidance of a healthcare professional, as prolonged use of corticosteroids can still result in adverse effects such as glaucoma and cataract formation 2. Key considerations for using loteprednol etabonate around the eye include:
- Monitoring for increases in IOP
- Avoiding use in patients with a history of herpes simplex or other viral infections
- Using with caution in patients with glaucoma or thinning of the cornea or sclera
- Potential delay in healing and increase in bleb formation after cataract surgery 2, 2
From the Research
Safest Topical Steroid to Use Around the Eye
- The safest topical steroid to use around the eye is loteprednol etabonate, as it has a high therapeutic index and a lower risk of increasing intraocular pressure compared to other topical corticosteroids 3, 4.
- Loteprednol etabonate is an ester corticosteroid that is rapidly de-esterified to inactive metabolites, which may contribute to its improved safety profile 3.
- Studies have shown that loteprednol etabonate is effective in treating ocular inflammatory conditions, including giant papillary conjunctivitis, seasonal allergic conjunctivitis, and uveitis, with a lower risk of side effects compared to other topical corticosteroids 3, 5.
- Topical corticosteroids, in general, can increase the risk of intraocular pressure elevation, cataract formation, and decreased resistance to infection, but loteprednol etabonate may have a lower risk of these side effects due to its unique mechanism of action 6, 7.
- The use of topical corticosteroids, including loteprednol etabonate, should be carefully monitored and used for the shortest duration necessary to achieve the desired therapeutic effect, in order to minimize the risk of side effects 5, 7.