Inflammatory eye conditions

For general guidance on administration of drugs to the eye and control of microbial contamination of eye drops, please see the ‘General information on eye drops’ section.

Very weak potency.

Use depends on condition. Can be anything from once on alternate days up to 4 times daily depending on condition.

Weak potency.

Use depends on condition. Can be anything from once on alternate days up to 4 times daily depending on condition.

Note - the different prednisolone salts have different potencies.
Prednisolone sodium phosphate 0.5% preparations - Moderate potency.
Prednisolone acetate 1% preparation - Very potent.

Moderate potency. Use depends on condition. Can be anything from once on alternate days up to 4-6 times daily depending on condition.

Very potent. Use depends on condition. Can be anything from once on alternate days up to 4-6 times daily depending on condition.

Potent.

Use depends on condition. Can be anything from once on alternate days up to 4 times daily depending on condition.

Very potent. Prednisolone acetate 1% is also a very potent preparation.

Often used 4-6 times daily postoperatively, but may be used from as little as once every second day to as often as every hour depending on condition. Frequency reduced gradually as condition is controlled.

Maxitrol (dexamethasone, polymyxin b sulfate and neomycin sulfate). Very potent.

Instil two to three times daily or at night.

Prescribing Notes:

Corticosteroid eye preparations should normally only be used under the supervision of an ophthalmologist because:
- their use may mask and worsen infection (especially herpes simplex keratitis);
- they may cause glaucoma in some patients;
- long-term use can cause cataracts.
Dexamethasone 0.1% with neomycin (Maxitrol) eye ointment is used because a plain steroid eye ointment is not available.
Fluorometholone 0.1% eye drops are not so well absorbed, have a weaker action, and are less likely to raise intra-ocular pressure as much as stronger steroids. They are used for patients where a rise in pressure is a known hazard. May be useful in patients who are known ‘steroid responders’ and are good for superficial inflammation. Fluorometholone suspension is restricted to use where a weaker steroid is needed for more superficial conditions.
Hydrocortisone 0.335% (Softacort) is used for the treatment of low-grade non-infectious corneal inflammation.
Maxitrol is approved for hospital use only in the post-operative management of trabeculectomy.
Adalimumab (Amgevita) is recommended for third or fourth line treatment of uveitis after failure of steroids or immunomodulatory drugs such as mycophenolate, mycophenolic acid or tacrolimus.
Dexamethasone intravitreal implant (Ozurdex) is recommended for third or fourth line treatment of uveitis after failure of steroids or immunomodulatory drugs such as mycophenolate or tacrolimus.
Hydrocortisone sodium phosphate UDV preservative-free rarely has an effect on intraocular pressure and can be considered as an option for low grade inflammation in patients with glaucoma and other ophthalmic diseases.
Fluocinolone acetonide (Iluvien) is approved for second line treatment in patients with a noninfectious uveitis with sight-threatening features who are not suitable for systemic immunosuppressive therapy and for whom shorter – acting alternatives such as Ozurdex and peri-ocular triamcinolone have been effective but not lasting.
Maxitrol and ketorolac should not be used together.

History Notes

15/06/2022

East Region Formulary content agreed.

Usually used 3-4 times daily.

Prescribing Notes:

Ketorolac eye drops may have a role in stabilising inflammation when steroid dosing is being tapered down.
Ketorolac may have a role in the treatment of patients with recurrent episcleritis for symptomatic relief of pain.
Maxitrol and ketorolac should not be used together because of the increased risk of corneal melt.

History Notes

15/06/2022

East Region Formulary content agreed.

Specialist advice.

Prescribing Notes:

Nepafenac 1mg/ml eye drops are approved for use following cataract surgery in diabetic patients to reduce the risk of postoperative macular oedema. Treatment is recommended for up to 60 days following surgery. These may be an option for occasional use. They are more expensive than ketorolac.

History Notes

15/06/2022

East Region Formulary content agreed.

Specialist advice.

Prescribing Notes:

Ketorolac eye drops may have a role in stabilising inflammation when steroid dosing is being tapered down.
Ketorolac may have a role in the treatment of patients with recurrent episcleritis for symptomatic relief of pain.
Maxitrol and ketorolac should not be used together because of the increased risk of corneal melt.

History Notes

15/06/2022

East Region Formulary content agreed.

Apply one drop every 1-2 hours until controlled then reduce frequency

Prescribing Notes:

Corticosteroid eye preparations should normally only be used under the supervision of an ophthalmologist because:
- their use may mask and worsen infection (especially herpes simplex keratitis),
- they may cause glaucoma in some patients, and
- long-term use can cause cataract.
Fluorometholone 0.1% eye drops are weaker and less likely to raise intra-ocular pressure; they are used for patients where a rise in pressure is a known hazard. Long-term treatment may be prescribed for severe allergic eye disease under hospital supervision. Alternatively, ciclosporin eye drops 2%, one drop four times daily, (available on a named patient basis from Moorfields Eye Hospital) may be prescribed by specialists for severe allergic eye disease. They are available from secondary care.
Preservative-free preparations are available for patients suspected to be intolerant of preservatives, e.g. dexamethasone 0.1% (Moorfields Eye Hospital) and prednisolone sodium phosphate 0.5% Minims.

History Notes

29/07/2020

Content migrated from LJF website.