Corticosteroid (ophthalmic route)

Ophthalmic corticosteroids are a fast-acting form of medication often used after eye surgeries. However, they need to be used carefully under a doctor's prescription, so as to avoid unwanted side effects.

Overview

Corticosteroids are a form of cortisone-like medication that are often used to help prevent permanent eye damage from various eye problems. They are also used when relief is required from signs of irritation and inflammation, such as reddened eyes, itching and other discomforts. Therefore, it is common for patients to use ophthalmic corticosteroids post-eye surgery.

Several brands and types of corticosteroids meant for use with the eye currently exist in the market, and are usually only available through a doctor’s prescription. They come in different forms, including gels, solutions, emulsions, suspensions and ointments, and are also available in various drug types.

Ophthalmic corticosteroids should not be used long-term unless under close observation by a doctor, who will be able to check the patient at regularly scheduled times to ensure that no unwanted effects have developed. The usual period of treatment does not extend past a few weeks and sometimes takes even less time, as corticosteroids are very fast-acting and effective.

Use of corticosteroids in children, especially young children below two years of age, should be carried out carefully, as they are sensitive to the medication.

There are comparatively few side effects to proper usage of corticosteroids, but patients should be wary of prolonged usage of them, as they can cause a wide range of unwanted effects. Ophthalmic corticosteroids can also cause an increased chance of cataracts and certain eye problems, so patients should take care to inform themselves of the risks and talk to their doctors or primary healthcare providers about any issues and questions they have.

Condition(s) treated

  • Prevention of permanent eye damage
  • Relief from eye inflammation

Type of medicine

  • Corticosteroid

Side effects

As with any drug, the use of ophthalmic corticosteroids may result in the appearance of side effects. However, it is important to note that corticosteroids are prescribed because it is felt that the benefits of it outweigh the negative side effects.

Not all patients will encounter side effects. However, if they do, they should inform the doctor about them as quickly as possible for further advice on what to do, or get immediate medical help. They should also seek a doctor’s help if they notice a side effect or symptom that has not been covered in this guide. The following is an incomplete list of more common side effects:

  • Nausea
  • Vomiting
  • Pain in the eye
  • Infection of the eye
  • Gradual blurring or loss of vision
  • Decrease in vision

The patient may experience some milder side effects during treatment that do not require medical attention. Their vision may blur a little, especially after application, or they may feel stinging or burning in the eye, which can cause redness or wateriness. These symptoms generally go away by themselves after a while, but, if they persist, the patient should seek a doctor’s advice. They should also contact their doctor if they have any questions about the side effects of using the medicine.

Dosage

Prior to starting treatment, the patient should read all available information on ophthalmic corticosteroids that is available to them from their healthcare giver, and consult with them on any questions and doubts they may have.

Dosage of an ophthalmic corticosteroid is heavily dependent on the patient, their problems and their needs. Each patient may be prescribed a different strength of medication, or may be required to undergo treatment for a different length of time.

The use of corticosteroids should be carefully monitored by a doctor to ensure that there is no increased risk of unwanted side effects. Patients should take care not to use ophthalmic corticosteroids more often or for longer periods than prescribed, as this will not help their condition - rather it may lead to eye damage or an increased chance of side effects.

Ophthalmic corticosteroids come in different forms. The following lists the proper usage for each form of the medication.

For ophthalmic suspensions or solutions:

  • Shake the container well right before use. Wash hands thoroughly before tilting the head back and pulling the lower eyelid away to form a space, by placing a finger gently on the skin just below the lower eyelid.
  • Place a drop of the medicine into the space. Close the eyes and apply pressure to the inner corner of the eye for one to two minutes, so that the medicine can be absorbed properly. Refrain from blinking.
  • If the medicine did not get into the eye properly, i.e. it dripped out or did not enter the eye, try another drop.
  • After usage, wash the hands and ensure that there is no suspension or solution left behind.
  • Keep the container tightly closed and do not touch the tip of the applicator to any surface in order to avoid contamination.

For ointments:

  • Wash the hands thoroughly. Tilt the head back and pull the lower eyelid away to form a space by placing a finger gently on the skin just below the lower eyelid.
  • Squeeze a strip of the ointment into the space, usually no more than 1/3 inch or 1 cm. This dosage may vary according to the doctor’s instructions.
  • Remove your finger and close the eyes for one to two minutes to allow the medication to work. Refrain from blinking.
  • Clean the tip of the tube after application with a clean tissue. Do not use water to wash the tip. Keep the tube tightly closed after use. Do not touch the tip of the tube to any surface in order to avoid contamination.

As there are several forms of ophthalmic corticosteroids, the average dosage for eye disorders is listed for the individual drug. The dosages given here are applicable to both adults and children, but again, the actual dose for each patient may vary according to their needs. Prescription should be given by a doctor and the patient should adhere strictly to that.

For betamethasone:

  • For ophthalmic solutions: One drop of the solution should be applied every one to two hours initially. As the condition improves, the doses should be spaced further apart.

For dexamethasone:

  • For ophthalmic ointments: Initial dosage is one application of the ointment three or four times across a day. As the condition improves, the doses should be spaced further apart.
  • For ophthalmic solutions: One or two drops of the solution four to six times a day.
  • For ophthalmic suspensions: One or two drops of the suspension up to six times in a day.

For fluorometholone:

  • For ophthalmic ointments: Apply ointment one to three times per day.
  • For ophthalmic suspensions: Apply one or two drops two to four times per day.

For hydrocortisone:

  • For ophthalmic ointments: The ointment should be applied three or four times a day at first. Dosage should be spaced further apart as the condition improves.

For medrysone:

  • For ophthalmic suspensions: Apply one drop up to every four hours.

For prednisolone:

  • For opthalmic suspensions: Apply one or two drops up to six times a day.
  • For ophthalmic solutions: Apply one or two drops two to four times a day.

If the patient misses a dose, it is recommended that they apply it as soon as possible. However, if it is close to the time of their next dosage, then they should simply skip the missed dose and resume the schedule.

Interactions

If the patient has any allergies, they should inform their doctor prior to starting any treatment with opthalmic corticosteroids, especially if they have had any allergic reactions to the medicine prescribed or to any medicine in the same group.

Drugs may interact with other drugs or supplements that the patient may be taking, such as herbal products or vitamin supplements. These interactions may affect the effectiveness of the medicine or even lead to an increased risk of side effects. Therefore, the patient should be sure to let their doctor know of any other medication, prescription or otherwise, and supplements that they are currently using.

In certain cases, however, the doctor may prescribe a medicine despite a chance of drug interactions, if they consider it to be necessary. In cases like this, the dosage may be altered or the patient may need to take certain precautions.

Alcohol and tobacco are likely to interact with most medications. Certain foods may also interact with the patient’s medication. It is recommended for them to consult with their doctor on whether they may drink, smoke, or eat these foods while receiving treatment.

Ophthalmic corticosteroids may interact with or lead to an increased risk of certain medical problems. The patient should take special note to let their doctor know of pre-existing conditions, such as:

  • Cataracts
  • Herpes infection of the eye
  • Tuberculosis of the eye
  • Type 2 mellitus diabetes

Patients should also inform their doctor of any history of or existing eye problems and infections, as the use of ophthalmic corticosteroids may either make these infections worse or cause new infections.

Warnings

Patients who wear contact lenses should refrain from doing so during application of the medicine, as the use of ophthalmic corticosteroids may increase the chance of infection. This precaution affects both hard and soft contact lenses. The patient should check with their doctor as to how long they should wait after applying the corticosteroid before they can wear their contact lenses again. In certain cases, the patient may be asked to refrain from wearing contact lenses for the entire duration of treatment.

Children who are aged 24 months and below may be extra sensitive to the use and effects of corticosteroids, and may be more vulnerable to side effects. If they are prescribed it, their parent or caretaker should discuss the use of the medicine carefully with the doctor, and make sure to follow the doctor’s instructions rigorously.

So far, there is little information specifically about the use of corticosteroids in the elderly, but it is assumed that the medicine affects them the same way that it does for younger adults.

No studies have been conducted yet on whether the use of ophthalmic corticosteroids with pregnant patients will result in birth defects. There have also been no reported cases of side effects in nursing babies. However, animal studies do show that ophthalmic corticosteroids lead to birth defects and other unwanted effects in their young.

If the patient will be using corticosteroids for more than a few weeks, they should make sure to check in often with their doctor or ophthalmologist to ensure that no unwanted effects are developing. If their condition does not improve or even worsens within the first week of treatment, they should also check with their doctor.

Any leftover medication should be disposed of properly and it should not be used for future eye problems, or if certain kinds of infection are present, without consulting a doctor. Otherwise, the infection may worsen and this could lead eye damage.

Storage

The medication should be stored in a closed container, in a cool and dry place that is away from direct sunlight. It is preferable to keep it around room temperature and it should not be exposed to freezing temperatures. Do not keep it in the bathroom, as it may be too humid there. The medicine should also be stored where children and animals cannot reach it.

Medication that is expired or no longer required should be disposed of properly. If the patient is unsure on how to handle the medical waste, they can consult their doctor or local waste management.

Summary

Corticosteroids are cortisone-like medication of which ophthalmic forms are often used to treat inflammation or irritation of the eyes, particularly post-surgery. They also help prevent permanent eye damage from eye disorders. However, use of them should be carefully monitored, as they are fairly strong medications and there is a high chance of side effects. Therefore, they are usually only available through a doctor’s prescription.

There are various forms of corticosteroids available on the market. These include betamethasone, dexamethasone, fluorometholone, hydrocortisone, medrysone and prednisolone, and can be bought under a variety of brand names. They come primarily in gels, ointments, suspensions, solutions and emulsions.

Patients should be vigilant about hygiene when using ophthalmic corticosteroids as they may be easily contaminated, and, therefore, may lose their effectiveness or even lead to other eye infections, if not properly cleaned and stored. Ensuring that hands are washed before and after use and that the medicine containers are properly cleaned is essential.

While there is little information on human use of corticosteroids when it comes to pregnancy and breastfeeding, patients should be aware that ophthalmic corticosteroids have led to birth defects and other unwanted effects in animal studies. Parents and caretakers should also be aware that children under the age of two can be highly sensitive to corticosteroids, and that the use of these medications with young children should be monitored by a doctor.

When used correctly, however, ophthalmic corticosteroids are a fast and effective solution for preventing permanent eye damage, as well as soothing irritation and inflammation in the eyes, whether this is an effect of surgery or an existing eye disorder.