Ophthalmic Steroids Overview

Ophthalmic Steroids

• Prednisolone (1%, 0.125%):

  • Common ophthalmic steroid
  • Available as acetate and phosphate bases
  • Ocular Applications:
    • Anterior uveitis (phosphate base not recommended)
    • Ocular surface disease (acetate/phosphate base usable)
    • Post-op cataract surgery
    • Adenoviral keratitis (used to mask symptoms, not for antiviral treatment)
  • Problem: Rebound effect
  • Combination: Used in combination with antibiotics (e.g., Tobradex) for sterile ulcers
  • Important Distinction: Subepithelial infiltrate vs infectious ulcer (size and inflammation differences)
  • Side Effect: Increased intraocular pressure (IOP) is a key concern
  • Special Considerations: Not for long-term use due to IOP increase
  • Related Formulations: PredForte and Pred-Forte (different uses for specific conditions)

• Loteprednol (0.5%, 0.2%):

  • Little or no effect on IOP (always monitor)
  • Lower concentrations for anti-allergic use
  • Ocular Applications:
    • Chronic adenoviral keratitis
    • Thygeson's keratitis
    • Vernal keratoconjunctivitis (type 4 situations)
    • Pingueculitis (tear film instability and dry spots)
    • Corneal dulling
  • Mechanism of Pingueculitis Inflammation: Dryness of pinguecula, affecting tear coverage, causing dry spots.
  • Important Distinction (Pterygium vs. Pinguecula): Pterygium invades the cornea

• Rimexolone 1% ophthalmic suspension:

  • Little effect on IOP.
  • No longer in market due to lack of effectiveness in post-op cataract surgery

• Fluorometholone (FML):

  • Alcohol and acetate base suspensions (0.1% and 0.25%, and 0.1% ointment)
  • Alcohol base has higher bioavailability.
  • Ocular Applications: Long-term treatment for chronic conditions mentioned.
  • Considerations: Episcleritis (not best for nodular type), unpredictable success, idiopathic (underlying autoimmune disease possible).

• Difluprednate (Durezol 0.5%):

  • Indications: Post-op inflammation/pain, Anterior uveitis (short-term treatment protocols)
  • Important Note: Requires tapering treatment plan (starts with QID)
  • Side Effects: Increased IOP, corneal edema, pain, photophobia, cataract formation in prolonged use.
  • Contraindications: Ocular fungal, viral, or mycobacterial infection (applies to all steroids)

• Ophthalmic Non-steroidal Anti-inflammatory Agents (NSAIDs):

• Diclofenac (Voltaren 0.1%):

  • Post-op cataract surgery (not primary use).
  • Can cause corneal melting, so not for inflammation.
  • Potential for chronic use side effects: aspirin derivatives and delays in cell migration/ulceration
  • Important Note: corneal melting is a serious concern with chronic NSAID use

• Ketorolac (Acular 0.5%):

  • Primarily to manage pain, not inflammation.
  • Ocular Applications: Pain management (corneal refractive surgery, allergic conjunctivitis).

Key Considerations for Steroid Use

• Careful Monitoring: Close monitoring of IOP is crucial with any steroid.
• Purpose: Steroids are strong meds that help reduce inflammation but may have side effects - using the proper dosage and frequency is important.
• Uveitis Treatment: Strong uveitis requires aggressive, high-frequency early treatment with tapering strategies.
• Non-Steroid Use: NSAIDs are often supplemental pain relief measures with limited inflammatory benefits and potential issues

This quiz covers the essential information about ophthalmic steroids, focusing on prednisolone and loteprednol. It includes their applications, effects, and important distinctions in ocular use. Perfect for students and professionals in the medical field, this quiz helps reinforce understanding of steroid usage in ophthalmology.