Maximum Duration for Prednisolone Eye Drops

Prednisolone eye drops should be used as short-term therapy for no longer than 3 months due to the risk of developing glaucoma and cataracts. 1

Recommended Duration Guidelines

Topical glucocorticoids such as prednisolone acetate 1% should be used for short-term therapy (≤3 months) with the goal of discontinuing use due to potential ocular complications 1
Prolonged use of topical steroids increases the risk for elevated intraocular pressure (IOP) and cataract formation, with risk increasing with greater frequency of drops per day and longer duration of therapy 1
For conditions requiring ongoing topical glucocorticoids beyond 3 months, systemic therapy should be considered to allow tapering of the topical steroids 1

Using ≥2 drops/day of topical glucocorticoids is a strong risk factor for IOP elevation, with risk increasing with greater number of drops per day 1
Using ≥4 drops daily of prednisolone increases the risk of developing cataracts compared to ≤3 drops daily 1
Long-term use (beyond 3 months) significantly increases the risk of both glaucoma and cataracts 1

For conditions like juvenile idiopathic arthritis-associated uveitis, if a patient requires 1-2 drops/day of prednisolone acetate 1% for 2-3 months, systemic therapy should be considered to allow tapering of the topical steroids 1
Initial treatment may require more frequent dosing (such as hourly), but should be tapered as soon as inflammation is controlled 1, 2
Tapering schedules should be determined based on the clinical response and the underlying condition being treated 1

Preservative-free formulations may be preferred to reduce ocular surface toxicity, especially if longer treatment is necessary 2
For conditions requiring long-term anti-inflammatory control (such as after penetrating keratoplasty), switching to a lower-potency steroid like 0.1% fluorometholone may allow for safer extended use 3
For dry eye disease, the evidence regarding long-term safety is very uncertain, and short courses (less than 4 weeks) are generally recommended 4

Regular monitoring for elevated IOP and cataract formation is essential when using prednisolone eye drops, especially when treatment extends beyond a few weeks 1
Close follow-up with an ophthalmologist is necessary for patients requiring even low-dose prednisolone (1-2 drops/day) for extended periods 1
Patients should be evaluated for signs of ocular surface toxicity, which can occur with preserved formulations 2

Continuing topical steroids beyond 3 months without considering alternative therapies or systemic treatment 1
Failing to monitor for IOP elevation and cataract formation during treatment 1
Using higher doses than necessary (≥4 drops daily), which significantly increases the risk of complications 1
Not tapering the dose as inflammation resolves 1, 2