Prednisone Eye Drops for Ocular Inflammation
Prednisolone acetate 1% (not prednisone) is the gold standard topical corticosteroid for ocular inflammation, dosed initially at 2 drops four times daily for most conditions, with frequency adjusted based on severity. 1
Critical Clarification: Prednisolone vs. Prednisone
- Prednisone is NOT available as an eye drop formulation - the correct ophthalmic corticosteroid is prednisolone acetate 1%, which has superior corneal penetration and extensive clinical experience 2, 3
- Prednisolone acetate 1% is conditionally recommended over difluprednate by the American College of Rheumatology for active chronic anterior uveitis 2
Standard Dosing Regimen
Initial Dosing Based on Severity
- Acute severe inflammation: Start every 1-2 hours while awake, then taper based on clinical response 3
- Moderate inflammation: Begin with 4-6 times daily 3
- Standard postoperative/mild inflammation: 2 drops four times daily 1
Duration and Tapering
- Maximum duration: Topical glucocorticoids should be used for short-term therapy ≤3 months 2, 4
- Taper gradually by decreasing frequency of applications in chronic conditions 1
- Never discontinue abruptly after prolonged use to prevent rebound inflammation 3
Critical Monitoring Requirements
Patients require close ophthalmologic follow-up to prevent vision-threatening complications:
- During dose changes: Examine within 1 month after each change in topical glucocorticoid dosing 2, 3
- On stable therapy: Examine no less frequently than every 3 months 2, 3
- Check intraocular pressure (IOP) at every visit - elevated IOP is the most common complication 3, 4
When to Add Systemic Therapy
If patients require ≥1-2 drops/day of prednisolone acetate 1% for ≥3 months to maintain control, systemic therapy should be added to allow tapering of topical steroids 2, 4
This threshold exists because prolonged topical steroid use significantly increases risk of:
- Glaucoma/elevated IOP (especially with ≥2 drops/day) 3, 4
- Cataract formation (especially with ≥4 drops/day) 4
Alternative Corticosteroid Options
- Loteprednol 0.5%: Recommended for conditions requiring prolonged anti-inflammatory therapy due to lower rates of IOP elevation (0.8% short-term, 1.5% long-term) and cataract formation 3
- Difluprednate 0.05%: More potent but has increased risk of corticosteroid-induced IOP elevation and cataract formation compared to prednisolone acetate 1% 2, 5
Common Pitfalls to Avoid
- Never use topical corticosteroids alone for posterior uveitis or retinal vasculitis - these conditions require systemic immunosuppression 3
- Avoid prolonged monotherapy beyond 3 months if requiring ≥1-2 drops daily without addressing underlying inflammation with systemic therapy 3, 4
- Do not use higher doses than necessary (≥4 drops daily significantly increases complication risk) 4
- Always use concomitant anti-infective agents in cases of bacterial infections 1
- Re-evaluate patients if signs and symptoms fail to improve after 2 days 1