11.4.1 Corticosteroids

Drugs used, not listed here:

Topical corticosteroids should normally only be used under expert supervision.

Topical ophthalmic steroids placed in descending order of potency:

  • prednisolone acetate 1% (most potent)
  • dexamethasone 0.1%
  • betamethasone 0.1%
  • prednisolone sodium phosphate 0.5%
  • fluorometholone 0.1% (least potent)

The severity of the inflammation determines the choice of steroid. Topical steroids should not be used for undiagnosed red eye. If red eye is due to herpes simplex, corticosteroids will aggravate this condition possibly leading to loss of vision or even loss of the eye. A steroid cataract may follow prolonged use of topical steroids.

Steroid eye drops can raise intra-ocular pressure (IOP) and therefore precipitate glaucoma in patients pre-disposed to chronic simple glaucoma. Evidence suggests that fluorometholone is less likely to raise IOP though this may be due to reduced penetration of the cornea.

Use of a combination product containing a steroid plus antibiotic is rarely justified and should not be routinely used, except post intraocular surgery e.g. cataract.

Betamethasone
  • Eye drops 0.1% (£2.32 = 10ml)
  • Eye ointment 0.1% (£1.41 = 3g)

Indications

  • local treatment of inflammation (short-term)

Dose

  • drops: every 1–2 hours until controlled then reduce frequency
  • ointment: apply 2–4 times daily or at night when used with eye drops
Dexamethasone
  • Eye drops 0.1%, hypromellose 0.5% (£1.42 = 5ml)
  • Single use eye drop 0.1% (£11.46 = 20 units)
  • Intravitreal implant 700microgram

Indications

  • local treatment of inflammation (short-term)

Notes

  1. NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis (July 2017)
Maxitrol®

(Dexamethasone with (hypromellose), neomycin and polymyxin B sulfate)

  • Eye drops (£1.68 = 5ml)
  • Eye ointment (£1.44 = 3.5g)

Indications

  • Post-operative inflammaton when bacterial infection is likely

Dose

  • drops: every 30–60 minutes until controlled then reduce frequency to 4–6 times daily
  • ointment: (with neomycin) apply 3–4 times daily or at night when used with eye drops

Notes

  1. Eye drops: Each 1 ml contains dexamethasone 1mg, hypromellose 5mg, neomycin 3,500 units and polymyxin B sulfate 6,000 units
  2. Eye ointment: Each gram contains dexamethasone 1mg, neomycin 3,500 units and polymyxin B sulfate 6,000 units
Fluorometholone
  • Ophthalmic suspension 0.1% (£1.71 = 5ml)

Indications

  • Local treatment of inflammation (short-term)

Dose

  • Every hour for 24-48 hours then reduce frequency to 2-4 times daily
Prednisolone
  • Sodium phosphate 0.5% (£2.00 = 10ml)
  • Acetate eye drops 1% (£3.66 = 5ml)
  • Sodium phosphate single use eye drops 0.5% (£11.78 = 20 units)
  • Eye drops 0.1% (unlicensed preparation)
  • Eye drops 0.05% (unlicensed preparation)

Indications

  • Local treatment of inflammation (short-term)

Dose

  • Every 1-2 hours until controlled then reduce frequency
Loteprednol
  • Ophthalmic suspension 0.5%

Indications

  • Post-operative inflammation following ocular surgery
  • Local treatment of inflammation when patients have a clinically significant rise in intraocular pressure with other formulary treatment options (unlicensed indication)

Notes

  1. If used for 10 days or more, intraocular pressure should be monitored
  2. The routine commissioning of loteprednol is accepted in Devon for the treatment of patients with steroid responsive inflammatory eye conditions who have a known clinically significant rise in intraocular pressure with other steroid eye drops (see Commissioning Policy for more details)

Intravitreal corticosteroids

Betamethasone
  • Sub-conjunctival 2mg in 0.5ml (using 4mg/ml injection) (unlicensed preparation)
Dexamethasone
  • Intravitreal implant 700 micrograms

Notes

  1. NICE TA229 - Dexamethasone intravitreal implant is recommended for the treatment of macular oedema caused by retinal vein occlusion (July 2011)
  2. NICE TA349 - Dexamethasone intravitreal implant is recommended for treating diabetic macular oedema (July 2015)
  3. NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis (July 2017)
Fluocinolone acetonide
  • Intravitreal implant in applicator 190 micrograms

Notes

  1. NICE TA301: Fluocinolone acetonide intravitreal implant (Iluvien) is recommended as an option for treating chronic diabetic macular oedema that is insufficiently responsive to available therapies, only when the criteria of the NICE TA are met (November 2013)
  2. NICE TA590: Fluocinolone acetonide intravitreal implant (Iluvien) is recommended as an option for preventing relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye (July 2019)
  3. NICE TA613: Fluocinolone acetonide intravitreal implant (Iluvien) is not recommended as an option for treating chronic diabetic macular oedema that is insufficiently responsive to available therapies in an eye with a natural lens (phakic eye) (November 2019)
Methylprednisolone
  • Intralesional injection 24mg in 0.6ml (unlicensed preparation)
Triamcinolone
  • Intraorbital/intravitreal injection 40mg in 1ml

Notes

  1. Aseptically produced by SDHCFT pharmacy

 

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