What is a safe steroid to use on the eyelids?

From the Guidelines

For treating eyelid inflammation, loteprednol etabonate 0.25% is considered a safe steroid to use on the eyelids, as it has a reduced risk of causing increased intraocular pressure compared to other ocular corticosteroids, as noted in 1. This medication should be applied sparingly, typically a small amount to the affected area 1-2 times daily for a limited period, such as 5-7 days, to minimize the risk of side effects. It's essential to use loteprednol etabonate under medical supervision, as prolonged steroid use near the eyes can potentially lead to complications such as glaucoma, cataracts, or thinning of the eyelid skin, as mentioned in 1. Some key points to consider when using loteprednol etabonate on the eyelids include:

• Applying the medication sparingly to avoid excessive absorption
• Limiting the treatment duration to minimize the risk of side effects
• Monitoring for signs of increased intraocular pressure or other complications
• Consulting an eye care professional if symptoms persist or worsen, as advised in the example answer The use of loteprednol etabonate is supported by studies, such as the one mentioned in 1, which highlights the importance of careful consideration when selecting a steroid for use on the eyelids, due to the thin skin in this area, which allows for greater absorption and increased risk of side effects.

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

• Loteprednol etabonate is a safe steroid to use on the eyelids, as it is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral conjunctiva, which includes the eyelids 2.
• It is less likely to cause an increase in intraocular pressure (IOP) compared to other steroids like prednisolone acetate 1%.
• However, it is essential to use loteprednol etabonate under the guidance of a healthcare professional and follow their instructions carefully to minimize potential side effects.

From the Research

Safe Steroids for Eyelid Use

There are several studies that have investigated the safety of using steroids on the eyelids.

• The use of topical hydrocortisone on the eyelids has been associated with complications such as atrophy and telangiectasia, particularly with long-term application 3.
• Topical tacrolimus has been shown to be effective in treating atopic eyelid disease, with substantial improvement in eyelid induration, erythema, and eczematous changes within 1 to 3 weeks of treatment 4, 5.
• Tacrolimus may be a safer alternative to topical corticosteroids for the treatment of atopic eyelid disease, as it does not appear to increase intraocular pressure (IOP) 5.
• The penetration of fluticasone propionate ointment into eyelid skin has been studied, and it was found that only very small amounts of the drug penetrate the skin, suggesting that it may be a safer option for the treatment of eyelid dermatoses 6.
• Topical corticosteroids are generally recommended for short-term use only, due to the risks associated with long-term use, such as increased IOP, glaucoma, and cataracts 7.

Key Findings

• Topical tacrolimus is a safe and effective treatment for atopic eyelid disease 4, 5.
• Fluticasone propionate ointment may be a safer option for the treatment of eyelid dermatoses due to its low penetration into the skin 6.
• Topical corticosteroids should be used with caution and for short-term periods only, due to the risks associated with long-term use 3, 7.