Can mometasone furoate (corticosteroid) cream be used around the eyes?

Can Mometasone Furoate Cream Be Used Around the Eyes?

No, mometasone furoate cream should not be used around the eyes due to the risk of serious ocular complications including increased intraocular pressure, glaucoma, and cataracts.

FDA Labeling and Direct Contraindications

The FDA-approved labeling for mometasone furoate topical products explicitly states: "FOR DERMATOLOGIC USE ONLY—NOT FOR OPHTHALMIC USE" and instructs to "AVOID CONTACT WITH THE EYES" 1. This is a clear regulatory prohibition against periocular application.

Specific Ocular Risks with Periocular Corticosteroid Use

The American Academy of Dermatology guidelines specifically warn that increased intraocular pressure, glaucoma, and cataracts have been reported with use around the eye 2. These are not theoretical risks but documented adverse events that can result in permanent vision loss.

• Long-term topical corticosteroid use near the eyes requires consideration of regular ophthalmic monitoring, though the American Academy of Otolaryngology notes that long-term intranasal steroid use has not been shown to increase risk of lens opacity or elevated intraocular pressure 2
• The distinction is critical: intranasal use is different from direct periocular application where drug concentration and ocular exposure are substantially higher 2

Anatomical Considerations for Steroid-Sensitive Sites

The face and periocular area are classified as steroid-sensitive sites where local cutaneous side effects occur more frequently 2. The American Academy of Dermatology explicitly recommends avoiding application of mometasone furoate on the face unless specifically directed by a physician 3.

• The periocular skin is particularly thin and has enhanced corticosteroid absorption compared to other body sites 2
• Even high-potency corticosteroids like mometasone furoate (Class III) carry increased risk of skin atrophy at these sensitive locations 3

Clinical Context: When Periocular Steroids Might Be Considered

While the general answer is "no," there are specific clinical scenarios where ophthalmologists may use corticosteroids periocularly:

• Infantile hemangiomas: High-potency topical corticosteroids (including topical clobetasol propionate) have been used for periocular hemangiomas with good efficacy and no significant adverse effects in initial reports, though this requires ophthalmologic supervision 2
• Corneal inflammation: Topical corticosteroids are used to reduce intraocular and corneal inflammation, but intraocular pressure and cataract formation must be monitored with long-term use 2

These applications are under direct ophthalmologic care, not general dermatologic use.

Safer Alternatives for Periocular Dermatologic Conditions

For inflammatory dermatologic conditions near the eyes:

• Lower potency corticosteroids may be considered with extreme caution and ophthalmologic consultation 2
• Non-steroidal alternatives such as tacrolimus or pimecrolimus (calcineurin inhibitors) may be safer options for periocular inflammatory conditions, though these also require careful consideration 2
• Emollients alone should be tried first for mild conditions 2

Monitoring Requirements If Periocular Use Is Unavoidable

If a physician determines periocular corticosteroid use is necessary despite the risks:

• Regular ophthalmic examinations to monitor for increased intraocular pressure, glaucoma, and cataracts are essential 2
• Treatment duration should be minimized (typically 2-4 weeks maximum for high-potency agents) 2, 3
• Patients must be counseled to avoid direct eye contact and report any visual changes immediately 1

Patient Education Points

Patients must understand:

• This medication should not be used on the face, underarms, or groin areas unless directed by the physician 1
• Avoid contact with the eyes 1
• Report any signs of local adverse reactions to their physician 1
• If no improvement is seen within 2 weeks, contact the physician 1