What Are Steroid Eye Drops?

Older age woman putting drops in her eye

www.ginomaccanti.com / Getty Images

Ophthalmic steroids can help quell problems associated with eye inflammation caused by allergies, postsurgical issues, and other conditions. These medications include prednisolone eye drops, softer steroids such as loteprednol, injections, and more.

All steroid drops, however, are not the same. The unique structure of each can make a difference in how it functions, what it treats, and what the side effects may be.

Such steroids, as a rule, interrupt gene pathways that otherwise would lead to uncontrolled eye inflammation. Here’s what you need to know to get the right steroid for your eye, including uses, precautions, and side effects of each.

Fluocinolone Ophthalmic

This ophthalmic steroid goes by the brand names Illuvien (fluocinolone acetonide intravitreal implant 0.19 mg), Retisert (fluocinolone acetonide intravitreal implant 0.59 mg), and Yutiq (fluocinolone acetonide intravitreal implant 0.18 mg).

Rather than being drops, these are injected intravitreal implants that provide sustained release of the medication. Each is actually a little different and may have its own appeal.

Uses

In general, fluocinolone is used to tamp down on eye swelling.

Iluvien is prescribed for the treatment of diabetic macular edema. It is used in those who have been previously treated with ophthalmic steroids but who did not have their eye pressure rise significantly. It is an intravitreal implant, injected with a small needle into the eye by the doctor. The implant is expected to last for 36 months.

The Retisert implant is placed in the back of the eye where it locally elutes fluocinolone over time. It is used to treat inflammation associated with chronic noninfectious uveitis. This implant is expected to last for approximately 30 months.

The Yutiq implant is also used for treating noninfectious uveitis at the back of the eye. This implant is designed to last for up to 36 months.

Precautions

An intravitreal injection can help ensure that you get the medication at a steady rate, without interruption. However, there is the potential for serious eye infection, eye inflammation, raised or lowered intraocular pressure, and even choroidal or retinal detachment. There is also a possibility that an implant could move and cause a tear in area tissues.

Be aware that you may temporarily have blurry vision after the implant is first placed. You should not attempt to drive or operate any other kind of machinery until this clears up.

What’s more, with fluocinolone there can be steroid-related effects. Tell your practitioner if you have a history of ocular herpes simplex, since this viral infection can reoccur with steroid use.

Also tell your doctor if you’ve had glaucoma or an eye infection, since steroids can spur reoccurrences and increase intraocular pressure. Be sure to alert the doctor if you have any allergies to any part of the medication.

Side Effects

With fluocinolone ophthalmic implants there can at times be side effects. Contact your doctor immediately if you have any of these more serious side effects:

  • An allergic reaction with signs such as trouble breathing; tightness in the throat or chest; swelling of the face, lips, tongue, or throat; rash; hives; itching; peeling skin; or hoarseness
  • Eyes becoming red
  • Swelling around the eye or eyelid
  • Eyesight changes
  • Eye irritation
  • Light sensitivity
  • Becoming unable to pass urine as frequently or at all

Minor side effects can occur in some cases. With these, you may consider getting medical intervention if there’s no improvement or these seem to worsen. They may include the following:

  • Temporarily blurred eyesight right after the intravitreal implant is placed
  • Dry eyes
  • Floaters
  • Eye scratchiness
  • Signs of developing a cold
  • Flu-like symptoms
  • Joint pain
  • Nausea or vomiting
  • Pain in your back, arms, or legs
  • Headache or dizziness

Loteprednol Ophthalmic

This drop is considered a safer “soft steroid” with an active ingredient that is rapidly deactivated as it is absorbed by the body.

It goes by brand names such as Eysuvis (loteprednol etabonate ophthalmic suspension 0.25%), Inveltys (loteprednol etabonate ophthalmic suspension 1%), Alrex (loteprednol etabonate ophthalmic suspension 0.2%), Lotemax (loteprednol etabonate ophthalmic gel 0.5%), and Lotemax SM.

Uses

This type of ophthalmic steroid is approved to reduce pain and inflammation after eye surgery such as cataract removal.

Commonly, this is also used to treat:

  • Eye irritation
  • Dry eye
  • Eye-related seasonal allergy signs

Precautions

While loteprednol can help in many situations and is considered somewhat safer than some other drops, it is still an ophthalmic steroid. Keep in mind that:

  • If you use this for too long, it could result in an increase in intraocular pressure and can cause glaucoma.
  • It has the potential to cause posterior subcapsular cataract formation.
  • It may delay healing in some cases.
  • If areas of the eye are already thinning, loteprednol has been known to put some at risk for small perforations.
  • Because loteprednol is a steroid, it can reduce immune response. This may result in the rise of secondary bacterial infections or make an existing infection worse. In the case of infections with eye discharge like pink eye, it may also mask these.
  • This may cause cases of some viruses such as herpes simplex to worsen or to last longer.
  • If used long term, fungal infections may arise, particularly in cases of corneal ulcer.

Side Effects

Even though this soft steroid may be better tolerated, in some cases side effects can still occur. Some to be aware of include:

  • Burning sensation
  • Headache
  • Itching
  • Blurred vision
  • Light sensitivity
  • Temporary pain, stinging, or irritation
  • Runny nose
  • Dry eyes
  • Throat soreness

Dexamethasone

This corticosteroid drop is also considered somewhat safer than some of the other ophthalmic steroids. It may be given in cases where there are particular risks at play. It comes as a suspension that needs to be shaken before use to equally distribute the active particles.

Dexamethasone drops commonly go by the brand names AK-Dex (dexamethasone sodium phosphate ophthalmic drops 0.1%), Decadron (dexamethasone phosphate 0.1% ophthalmic solution), and Maxidex (dexamethasone ophthalmic suspension 0.1%).

Uses

Dexamethasone is usually used to tamp down on inflammatory eye conditions with redness, swelling, and itching such as:

Precautions

When using dexamethasone, keep in mind that as with any ophthalmic steroid, extended use may be problematic in some cases. Here’s what to consider:

  • Only use for the prescribed period. With prolonged use comes the possibility of persistent fungal infection.
  • Some patients may go on to develop glaucoma, cataracts, or secondary infections.
  • Especially if you already have thinning of the eye surface, be aware that small perforations of the globe can occur.

Side Effects

While many have no issues after taking dexamethasone, some patients may complain of symptoms such as:

  • Swelling
  • Light sensitivity
  • Blurred vision
  • Tearing
  • Itching
  • Redness
  • Pain
  • Crusting around the eyelid

Difluprednate

This formulation found under the brand name Durezol includes fluorine atoms designed to enhance its potency. This needs to be taken half as frequently as ophthalmic steroids such as prednisolone drops. However, this higher potency also comes with increased risk for raising intraocular pressure.

Since this is an emulsion, it does not need to be shaken and will still remain uniform throughout.

Uses

This medication is used to combat swelling and pain related to inflammation in the eye wall from uveitis or resulting from recent eye surgery.

Precautions

With a steroid such as difluprednate, prolonged use can be problematic. Keep in mind the following:

  • If you must be on this medication for more than 10 days, remember that it can cause an increase in intraocular pressure and may even result in glaucoma.
  • With this medication you may be prone to posterior subcapsular cataract formation.
  • Your immune responses may be reduced if on difluprednate for an extended period, making you vulnerable to bacterial, viral, and fungal infections. If you have herpes simplex virus, use the medication with caution.
  • Following cataract surgery, use of steroids such as difluprednate can delay healing and cause thinning with the potential for perforations. The initial prescription should not be extended beyond 28 days without a thorough eye examination first.

Side Effects

After taking difluprednate, you may notice side effects including:

  • Eye pain
  • Additional eye redness or swelling
  • Vision changes
  • Light sensitivity
  • Foreign body sensation
  • Itchy, tearing eyes

Alert your practitioner right away if you notice an increase in symptoms such as pain, redness, swelling, or changes in vision.

Prednisolone Ophthalmic

Prednisolone was the original ophthalmic steroid tasked with protecting the eye from inflammation. This usually comes as a suspension with prednisolone particles that need to be vigorously shaken to distribute these equally before use.

The drops are often prescribed under common brand names such as Econopred (prednisolone acetate ophthalmic suspension 1/8th%), Econopred Plus (prednisolone acetate ophthalmic suspension 1%), Omnipred (prednisolone acetate ophthalmic suspension 1% prednisolone acetate), Pred Mild (prednisolone 0.12%), Pred-Forte (prednisolone 1%), and Pred-Phosphate.

Branded drops tend to distribute more uniformly when shaken due to their smaller size. Prednisolone does come in a uniform solution in a phosphate form. However, this is not as powerful as the original suspension.

Uses

The aim in prescribing prednisolone solution or suspension is to quell any ocular allergic reactions, as well as treat any itching, redness, or swelling.

Precautions

When on prednisolone, it’s important for patients to be carefully monitored before renewing the prescription. The examination should include a magnified look at the eye, such as at the slit lamp. Also, fluorescein staining of the corneal surface may be helpful in some cases.

In addition, if prednisolone is taken for more than 10 days, intraocular pressure should be checked. This has been known to increase and cause glaucoma in some cases. Vision should be thoroughly tested as well.

If you develop an eye infection while on prednisolone, keep in mind that it may be a fungal infection. People on prednisolone long term tend to be prone to this type of infection.

Side Effects

In some cases you may experience side effects while on prednisolone. Be sure to alert your doctor right away if you experience any signs of infection, eye pain, or blurred or reduced vision.

Some other potentially less serious side effects that may occur include:

  • Stinging
  • Burning
  • Redness
  • Eye watering
  • Temporary blurring

Always alert your doctor if any side effect appears to be worsening or if you simply have questions.

Rimexolone Ophthalmic

This ophthalmic steroid, known by the trade name Vexol 1% (rimexolone ophthalmic suspension), helps to combat eye inflammation.

Uses

Rimexolone is used for reducing postoperative swelling and redness after ocular surgery, as well for treating uveitis at the front of the eye.

Precautions

Before taking this medication, talk to your doctor about whether you have had any eye infections, particularly fungal ones. Also, let them know if you have glaucoma, since these drops can raise pressure and possibly put you at risk.

In addition, mention if you’ve previously had any allergies to rimexolone, any other corticosteroids, or the dyes or preservatives used in it.

If this is to be used for your child, talk first to your pediatrician. Safety and effectiveness have not yet been established in this population. Also, it is not known whether this can be safely used in people who are pregnant or nursing.

After 10 days on this medication, your intraocular pressure should be monitored. If you are on rimexolone for more than 14 days, you should undergo a thorough eye examination before getting a prescription renewal.

Side Effects

Some more serious side effects that you may notice while on rimexolone should be brought to your doctor’s attention right away. These include:

  • Allergic reaction with facial swelling or swelling of the tongue or lips, hives, itching, or skin rash
  • Vision changes
  • Eye pain
  • Signs of infection
  • Headache
  • Upset stomach or vomiting
  • Red or tearing eyes

Other side effects that may be irritating but not of as much concern include:

  • Stinging or itching
  • Taste changes
  • Short-term blurring of vision or tearing
  • Runny nose

Of course, if you have any concerns or don’t feel as if you are responding as you should, reach out to your eye professional for guidance.

Summary

Steroid eye drops or injected implants can treat conditions that cause eye inflammation. Your healthcare professional will choose the specific medication and formulation that best addresses your needs.

All ophthalmic steroids come with some risks for glaucoma or infection. For this reason, they are generally used for as short of a period as possible and with monitoring.

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Article Sources
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