Topical Steroids in Ophthalmology www company com Corticosteroid

Topical Steroids in Ophthalmology www. company. com

Corticosteroid Action Corticosteroids are the workhorses of ophthalmic care when it comes to decreasing ocular inflammation. Whether the cause is mechanical, infective, chemical, or others, the actions of these therapeutics are the same. www. company. com

Corticosteroids are related to and mimic substances produced by our own bodies. These substances have many action and control functions, only one of which is reduction of inflammation. www. company. com

Corticosteroids affect the production of proteins, leukotrienes, and prostaglandins— all of which create various parts of the inflammatory response; decreasing dilation and permeability of blood vessels, thereby reducing the redness and swelling. www. company. com

They also decrease white blood cell proliferation, mast cell degranulation, and histamine release. Corticosteroid use can also lead to an increase in corneal thickness, mydriasis, and ptosis. As with systemic use, topical corticosteroid therapy should not be used alone in cases of acute infection. www. company. com

The anti-inflammatory properties will reduce associated symptoms, giving the appearance (to both doctor and patient) that the condition is resolving. In actuality, the drug is masking and aiding the progress of the underlying disease. In particular, corticosteroids should be used with caution when treating patients with a history of herpes simplex keratitis. www. company. com

These drugs can induce recurrences or exacerbate an existing episode. Lastly, some commercial preparations contain sulfites. Certain patients have a known sensitivity to these compounds. Therefore, care must be exercised when choosing therapeutic. www. company. com

Topical Corticosteroids Topical administration is commonly the route of choice for ocular disorders. Most ocular inflammation manifests itself in the anterior segment of the eye: the conjunctiva, cornea, anterior chamber, and anterior uveal tract. In addition, topical administration decreases potential risks and side effects associated with these drugs. www. company. com

In topical form, corticosteroids are the mainstay of therapy for inflammation involving the anterior segment of the eye. In addition to use after cataract or refractive surgery, there are many other uses for these agents. Topical corticosteroids work best in cases of acute inflammation and less well for chronic diseases. They have little, if any, effect on degenerative diseases. www. company. com

Topical ophthalmic corticosteroids are available for administration as suspensions, solutions, and ointmaents. In some types, suspensions are more effective than solutions. Ointments are the least effective. Though they increase contact time with the ocular surface, ointments seem to bind the drug, decreasing availability for its intended use. www. company. com

Each steroid base, such as prednisolone or dexamethasone, may be available in more than 1 form; for example, dexamethasone is available as dexamethasone alcohol or dexamethasone sodium phosphate. The alcohol or phosphate form is known as its derivative. The derivative of the corticosteroid has an important role in both its overall effect and its vehicle. www. company. com

In therapeutic mixtures, acetate and alcohol formulations will form suspensions, while phosphate preparations will remain true solutions. Furthermore, given the same corticosteroid base, acetate preparations have more anti-inflammatory activity than alcohols; phosphate preparations are yet less effective. The choice of which steroid to use is made weighing the relative cost, convenience, safety, and effectiveness of the available corticosteroids against the patient’s condition and need for treatment. www. company. com

Frequency of application may be as often as every hour to once a day, depending on the type, location, severity, and course of the inflammatory condition. Therapy should be started quickly and aggressively enough to suppress the inflammation. Once the inflammation is quelled, tapering should begin. www. company. com

Normally, it is not necessary to taper after topical ocular therapy unless the duration of treatment exceeds 2 or 3 weeks or the inflammation was severe. In these cases, the physician may prefer to use a short tapering period: 4 times per day for 4 days, 3 times per day for 3 days, and so on www. company. com

until discontinuing the medication entirely. If used long-term or with recurrent disease, slower tapering is necessary (decreasing by only 1 drop per week or slower). Patients must always be cautioned of the dangers of discontinuing corticosteroids on their own accord. www. company. com

Prednisolone acetate 1%, is considered the standard by which all other topical ocular corticosteroids are compared. This suspension crosses the cornea more easily and has the greatest efficacy when compared to all other available ophthalmic agents. As such, it is more likely to elevate IOP and have greater side effects than its weaker counterparts. www. company. com

For this reason, most practitioners either use weaker prednisolone 0. 12% or 0. 125% suspensions or totally shun this agent when treating mild cases of inflammation. Prednisolone sodium phosphate solutions are also available. They are marketed as solutions in 1% and 0. 125% concentrations. Prednisolone is not available as an ophthalmic ointment. www. company. com

Fluorometholone alcohol is available as both a suspension and an ointment. Marketed in a 0. 1% concentration as both a suspension and ointment, and as a 0. 25% suspension, this relatively weaker corticosteroid is used primarily in the treatment of mild to moderate forms of chronic inflammation (usually allergic conjunctivitis). www. company. com

It lacks the efficacy to be used satisfactorily in cases of uveitis. The benefit derived from these medications is the decreased risk of unwanted complications, such as IOP rise. A more recent introduction to therapeutic arsenal has been the addition of fluorometholone acetate suspension in a 0. 1% concentration. www. company. com

While fluorometholone has less tendency to increase intraocular pressure than other steroids, physicians are not nearly as comfortable using it long-term as with the ester -based loteprednol. fluorometholone 0. 25% is not recommended because fluorometholone 0. 1% represents the top of the dose response curve—meaning that the 0. 25% formulation is no more efficacious than the 0. 1%. Moreover, the 0. 25% concentration has a greater tendency to raise IOP. www. company. com

Due to its acetate formulation, movement across the cornea is much improved, increasing its effectiveness. Studies indicate that it approaches the efficacy of prednisolone acetate but is less likely to cause IOP rise. www. company. com

It may be the treatment of choice in those patients with a history of pressure rise due to corticosteroid therapy or previously diagnosed glaucoma. Of course, all of the corticosteroids are capable of increasing IOP, and patients on long-term therapy (even those on “safer” medications) must have their IOPs measured regularly. www. company. com

Dexamethasone is a potent corticosteroid available as a 0. 1% sodium phosphate solution and a 0. 1% suspension. It is also available as a 0. 05% ophthalmic ointment. www. company. com

Dexamethasone is very effective in reducing ocular inflammation, but it has the propensity to increase IOP more than any other topical ophthalmic corticosteroid. For this reason, it is usually limited to short course therapy or as an alternative when other corticosteroids are not available. www. company. com

When applied at bedtime dexamethasone ointment is very useful for nighttime coverage in cases of uveitis. Combined with an antibiotic, it is also popular for the reduction of inflammation after cataract or refractive surgery. www. company. com

Rimexolone 1% ophthalmic suspension is indicated for use postoperatively and in cases of anterior segment inflammation. The main advantage of this drug is that it has more of a site-specific action than other corticosteroids. In other words, the majority of its action occurs at the site where it is applied and less so elsewhere. www. company. com

Thus, while having efficacy similar to prednisolone acetate 1%, it has less tendency to increase the IOP. Due to its limited systemic absorption, it is also less likely to cause adverse adrenocortical effects. For these reasons, rimexolone is a valuable addition to the armamentarium against ocular inflammation. www. company. com

Difluprednate 0. 05%, This drug is a solution and does not need to be shaken before instillation. We use it as our “big gun” to treat advanced cases of iritis and episcleritis. Its longer duration of action permits less frequent dosing than with prednisolone formulations, and provides efficacy. So, typically we dose it every two hours initially, rather than hourly. But along with its increased efficacy comes an increased risk of significant IOP elevation, especially in children. So, be sure to monitor IOP at follow-up visits. www. company. com

Loteprednol etabonate ophthalmic suspension 0. 2% and 0. 5% is a less potent steroid indicated for temporary relief of the signs and symptoms of seasonal allergic conjunctivitis. Because it is a suspension, it needs to be shaken vigorously before use. It is less effective in cases requiring more potent steroid activity, such as deep-seated inflammatory diseases. www. company. com