Pred Forte (Prednisolone Acetate 1%) Dosing
The FDA-approved dosing for Pred Forte is 1-2 drops into the affected eye 2-4 times daily, with frequency potentially increased to every 1-2 hours during the initial 24-48 hours for severe inflammation, followed by tapering as inflammation resolves. 1
Initial Dosing for Active Inflammation
- Start with 1-2 drops in the conjunctival sac 2-4 times daily for most inflammatory conditions 1
- During the first 24-48 hours, dosing frequency may be increased if necessary to control severe inflammation 1
- For active uveitis, frequent topical glucocorticoids should be used initially to control inflammation, followed by rapid tapering once anterior chamber cellular reaction is controlled 2
Maintenance and Tapering Strategy
- Taper to the lowest effective dose as soon as inflammation is controlled 2
- The goal is to reduce to 1-2 drops per day or less within the first few weeks of treatment 2
- Do not discontinue therapy prematurely—if signs and symptoms fail to improve after 2 days, re-evaluate the patient 1
Critical Duration Limits
- Maximum duration should not exceed 3 months due to significant risk of elevated intraocular pressure (IOP) and cataract formation 3, 4
- If patients still require 1-2 drops/day after 3 months, strongly consider adding systemic immunomodulatory therapy to allow discontinuation of topical steroids 2, 3
Dose-Related Risk Thresholds
- Using ≥2 drops/day is a strong risk factor for IOP elevation, with risk increasing proportionally with higher frequency 2, 3, 4
- Using ≥4 drops/day significantly increases cataract risk compared to ≤3 drops daily 2, 3
- Keep dosing at ≤3 drops daily whenever possible to minimize complications 2
Monitoring Requirements
- Check IOP regularly during treatment, especially when extending beyond a few weeks 3, 4, 5
- Monitor within 1 month after each change in topical glucocorticoid dosing 2
- Examine for cataract formation during ongoing treatment 3, 4
- Recent research shows cumulative risk of steroid-induced ocular hypertension reaches 29% at 1 year and 49% at 10 years with long-term prednisolone acetate 1% use 6
Common Pitfalls to Avoid
- Never continue beyond 3 months without considering systemic alternatives or accepting the substantially elevated risk of glaucoma and cataracts 3, 4
- Never use in viral corneal diseases (especially herpetic keratitis), mycobacterial infections, or fungal eye diseases—this is an absolute contraindication 5
- Never fail to taper—abrupt discontinuation after prolonged use can cause rebound inflammation 2
- Never use ≥4 drops daily for extended periods due to dramatically increased complication rates 2, 3
Alternative Considerations
- For conditions requiring lower IOP risk, consider switching to loteprednol etabonate or fluorometholone, which have better safety profiles for long-term use 4, 7
- Prednisolone acetate 1% is preferred over difluprednate due to difluprednate's increased risk of steroid-induced IOP elevation and cataract formation 2