Moderate Strength Steroids
The fluorometholone-based steroids are somewhat less effective
than the maximum-potency agents, but have a decreased propensity
to cause intraocular pressure elevations. These moderate-strength
drugs are useful for treating mild to moderate inflammation.
Fluorometholone comes in two forms, alcohol and acetate, and
is also available as an ointment.
Fluorometholone alcohol
Fluorometholone alcohol (FML, Allergan; Fluor-Op, Novartis)
is a well-known, moderate-strength ophthalmic suspension. It
is used commonly to treat a host of mild to moderate ocular
surface inflammatory conditions. It is also a useful drug in
treating chronic inflammations requiring long-term (beyond
three to four weeks) therapy.
Fluorometholone alcohol is available in both 0.1% and 0.25%
suspensions and 0.1% ointment. The 0.25% suspension offers
little, if any, clinical advantage over the 0.1%, and is rarely
used.
Fluorometholone alcohol’s value in chronic care lies in its
reduced tendency to cause secondary IOP increase. Although
chronic use of any steroid can result in increased IOP, the
fluorometholone class of steroids is less likely to do so.
It is likely that the site-specific loteprednol is even safer
with regard to its IOP-sparing effect.
Fluorometholone acetate
Fluorometholone acetate (Flarex, Alcon; Eflone, Novartis) is
a more potent form of fluorometholone, and is used for moderate
to moderately severe conditions. It features greater intraocular
penetration and therefore offers increased clinical efficacy
while still enjoying the relative IOP-sparing effect of a fluorometholone.
This drug does not have quite the clinical efficacy of 1% prednisolone
acetate, yet can be useful in a wide array of ocular inflammatory
conditions.
Dexamethasone 0.1%
The dexamethasone steroids are less effective than prednisolone,
and have the highest propensity for increasing intraocular
pressure, particularly in the long term. Thus, there is little
reason to use dexamethasone monotherapy.
However, for short-term use in combination products, it works
very nicely in treating moderate inflammation.
Hydrocortisone
Hydrocortisone is not available in pure ophthalmic form but
is used quite frequently in dermatology to treat skin conditions.
We are frequently asked if hydrocortisone 1% OTC can be used
to treat common contact blepharodermatitis conditions. The
labels on these medications say they are for external use only
and not for ophthalmic use. Ophthalmic steroids are a wiser
choice because they are designed for ophthalmic, periorbital
and eyelid tissues. However, as long as the OTC drug is applied
only to the skin, there should be no problem.
Medrysone
Medrysone was historically marketed to treat ocular allergies,
but newer, better choices have made it obsolete. It has no
application in contemporary practice.
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