Pulse-Dosing for Dry Eye
It is well-established that inflammation is a key component to the clinical presentation of most cases of Dry Eye Disease. It is further recognized that "pulse dosing" of a corticosteroid is an excellent way to obtain the beneficial effects of corticosteroid suppression while minimizing the potential for any side-effects.
The following form is the patient handout we give to our patients whom we treat with Lotemax Gel. We commonly prescribe the Gel-Drop every 4 hours (qid) for 1 week, then stop. For the ointment, we prescribe it at bedtime for 1 week, then stop. Notice that the patient handout has blank spaces so that each patient's care can be individualized. We always recommend the use of a lipid-based tear such as Soothe XP or Systane BALANCE, and a good quality fish oil at 2,000mg per day. We hope that a handout such as this will enhance the care of your dry eye patients.
Initial Therapy
You have been prescribed a medicine known as Lotemax (loteprednol) – which comes as a Gel-drop, or as an ointment. The Lotemax Gel-drop is a thick drop, so wait a few seconds after instillation before blinking. Then after several blinks the brief blur will clear. No shaking is required.
Loteprednol is used to treat the inflammatory component of "dry eye disease". Suppressing the ocular surface inflammation is a key step in setting the stage for the artificial tears and fish oil to provide the most help. We ask that you use the medicine in the following way:
For the Gel-drop formulation, use ____ times a day for ____ weeks, then just morning and evening for ____ more weeks, then stop. It is best to have your face looking straight up when instilling eye drops.
For the ointment formulation, instill a ¼ to ½ inch strip into the inside of your lower eyelids at bedtime for ____ weeks, then just every other night for two weeks, then stop.
It takes a few weeks to get the inflammatory component of your dry eye disease controlled.
At this point, you may go for many weeks or many months where your eyes feel better. It is very important to consistently use your artificial tears and fish oil as directed every day.
Pulse Therapy
Now, after weeks or months, your eyes may become uncomfortable again. This is called "symptomatic breakthrough". If or when this occurs, use the Lotemax eye drops four times a day for one week, then stop. Or, if using the Lotemax ointment, instill at bedtime for a week, then stop. This therapeutic maneuver is called "pulse-dosing", and has been shown to be very beneficial in regaining control of dry eye symptoms. Most patients need to do this only once, or twice, a year.
Loteprednol is a relatively safe corticosteroid, especially when used as described above. There is a slight risk that loteprednol can increase the pressure inside your eyes. For this reason, your eye pressure will be checked from time to time, just to be completely safe.
Always call us if you have any questions.