Corticosteroids and other anti‑inflammatory preparations

Corticosteroids

Topical corticosteroids should normally only be used under expert supervision; three main dangers are associated with their use: a ‘red eye’, where the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal and amoebic infections pose a similar hazard. ‘steroid glaucoma’ may follow the use of corticosteroid eye preparations in susceptible individuals. a ‘steroid cataract’ may follow prolonged use. Combination products containing a corticosteroid with an anti-infective drug are sometimes used after ocular surgery to reduce inflammation and prevent infection; use of combination products is otherwise rarely justified.

FLUOROMETHOLONE:

Indications: For steroid-responsive inflammation of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe.

Contraindications: Acute superficial herpes simplex (dendritic) keratitis, vaccinia, varicella and most other viral diseases of the conjunctiva and cornea. Ocular tuberculosis. Fungal diseases of the eye. Hypersensitivity to any of the constituents of the medication.

Dose and Administration: Adults: One to two drops instilled into the conjunctival sac two to four times daily. During the initial 24 to 48 hours the dosage may be safely increased to 2 drops every hour. Care should be taken not to discontinue therapy prematurely.

PREDNISOLONE ACETATE:

Indications: For short-term treatment of steroid-responsive inflammatory conditions of the eye, after excluding the presence of viral, fungal and bacterial pathogens.

Contraindications: Acute untreated purulent ocular infections. Acute superficial herpes simplex (dendritic keratitis); vaccinia, varicella and most other viral diseases of the cornea and conjunctiva. Fungal diseases of the eye. Ocular tuberculosis. Sensitivity to any component of the formulation.

Dose and Administration: Adults: One to two drops instilled into the conjunctival sac two to four times daily. During the initial 24 to 48 hours the dosing frequency may be safely increased to 2 drops every hour. Care should be taken not to discontinue therapy prematurely. Children and elderly patients: Pred Forte has not specifically been studied in these patient groups. No adjustment in the adult dosage regimen is recommended.

RIMEXOLONE:

Indications: indicated for the treatment of postoperative inflammation following ocular surgery, for the treatment of anterior uveitis, and for the treatment of corticosteroid responsive inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. The inflammation should be of a non­infectious nature.In more serious cases, and if the posterior part of the globe is affected, subconjunctival injection or systemic treatment is recommended. Contraindications: contraindicated in epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, and most other viral diseases of cornea and conjunctiva; mycobacterial infection of the eye; fungal diseases of the eye; acute purulent untreated infections which, like other diseases caused by microorganisms may be masked or enhanced by the presence of the steroid; red eye, where the diagnosis is unconfirmed; and amoebic infections; and in those persons with hypersensitivity to any component of this preparation.

Dose and Administration: Apply one drop of into the conjunctival sac of the affected eye four times or more daily. The duration of treatment should be determined by the prescribing physician according to the severity of the disease, but should not exceed four weeks.

Corticosteroids with Anti-Infective

HYDROCORTISONE-CHLORAMPHENICOL:

Indications: acute and chronic keratitis and blepharitis of an infectious, but non-viral nature. Inflammation of the anterior uvea. Scleritis and episcleritis. Contraindications: Undiagnosed red eye. Raised intra-ocular pressure. To treat fungal or viral diseases of the cornea or conjunctiva or in cases of ocular

tuberculosis or purulent infections. Hypersensitivity to any component of the preparation.

Dose and Administration: apply a strip of 3-5mm into the lower conjunctival sac 2-4 times daily.

DEXAMETHASONE-NEOMYCIN SULPHATE-POLYMEXIN:

Indications: short-term treatment of steroid responsive conditions of the eye when prophylactic antibiotic treatment is also required, after excluding the presence of fungal and viral disease.

Contraindications: Hypersensitivity to neomycin or to any component of the preparation. (Cross-sensitivity with other aminoglycoside antibiotics may occur). Herpes simplex and other viral diseases of the cornea and conjuctiva, fungal disease, ocular tuberculosis, amoeba infections and untreated purulent infections. This product contains benzalkonium chloride and should not be used when soft contact lenses are worn. Topical corticosteroids should never be given for an undiagnosed red eye as inappropriate use is potentially blinding.

Dose and Administration: Apply one or two drops to each affected eye up to six times daily or, more frequently if required. Or apply a strip of 3-5mm into the lower conjunctival sac 2-4 times daily.

DEXAMETHASONE-CHLORAMPHENICOL:

Indications: Acute purulent conjunctivitis, fresh inflammation of the superficial and deeper corneal layers and corneal ulceration. Keratitis disciformis and the more deep-seated forms of post-herpetic keratitis. Allergic conjunctivitis, allergic blepharitis. Acute and chronic iritis and iridocyclitis.

Contraindications: Fresh herpes simplex cornealis, tubercular processes involving the conjunctiva, the cornea and the anterior uvea.

Dose and Administration: One drop, 1 to 4 times daily, into the lower eyelid.

DEXAMETHASONE-TOBRAMYCIN:

Indications: indicated for reduction of inflammation and prophylaxis of infection following cataract surgery.

Contraindications: Epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella and other viral disease of the cornea and conjunctiva. Mycobacterial infections of the eye caused by, but not limited to, acid-fast bacilli such as Mycobacterium tuberculosis, Mycobacterium leprae, or Mycobacterium avium. Fungal diseases of ocular structures. Untreated purulent infection of the eye. Hypersensitivity to any component of the medication.

Dose and Administration: One drop instilled into the conjunctival sac(s) every 4 to 6 hours while the patient is awake. During the initial 24 to 48 hours, the dosage may be increased to one drop every two hours while the patient is awake, for a maximum of 24 days. Or apply a strip of 3-5mm into the lower conjunctival sac 2-4 times daily.

FLUOROMETHOLONE-NEOMYCIN:

Indications: treatment of infectious conjunctivitis due to organisms sensitive to neomycin. Treatment of anterior segment inflammatory disorders complicated by bacteria sensitive to neomycin. Effective following removal of foreign bodies as well as before and after surgery.

Contraindications: Acute untreated purulent ocular infections caused by microorganisms not sensitive to neomycin. Superficial herpes simplex (dendritic keratitis), vaccinia, varicella, and most other viral diseases of the conjunctiva and cornea. Ocular tuberculosis. Fungal diseases of the eye. Hypersensitivity to any of the components of the drug.

Dose and Administration: 1 to 2 drops in the conjunctival sac two to four times daily. During the initial 24-48 hours, the dosage may be safely increased to 1 drop every hour. Care should be taken not to discontinue treatment prematurely.

PREDNISOLONE-OFLOXACIN-TETRAHYDROZOLINE HCL: 

Indications: for corticosteroid responsive inflammatory conditions of the conjunctiva, cornea and anterior segment of the eye where bacterial infection exists.

Contraindications: epithelial herps simplex keratitis and many viral diseases of the cornea and conjunctiva. Tuberculosis of the eye, fungal diseases of the ocular structure. Hypersensitivity to any of the ingredient of the medication.

Dose and Administration: apply 1-2 drops, 3-4 times daily.

FLUOROMETHOLONE-TETRYZOLINE:

Indications: Acute allergic, noninfectious conjunctivitis & keratitis w/ severe swelling & hyperaemia. Noninfectious inflammation of the anterior segment of the eye (including anterior uveitis, episcleritis & scleritis). Post-op conditions following squint, cataract or glaucoma operation along w/ supplementary antimicrobial therapy.

Contraindications: Infectious conjunctivitis or keratitis. Injuries & ulcerous processes of the cornea. Glaucoma. In diseases associated w/ stromal damage of the cornea or sclera. Dry eyes, esp keratoconjunctivitis sicca. Childn <2 yr.

Dose and Administration: Instill 1 drop in the conjunctival sac bd-tds increasing to 1-drop hrly for adults if required in the 1st 24-48 hr.

FLUOROMETHOLONE-SODIUM CROMOGLICATE:

Indications: treatment of allergic conjunctivitis & vernal kerato conjunctivitis.

Contraindications: acute superficial herpes simplex keratitis. Fungal diseases of ocular structures.

Dose and Administration: 1-2 drops to be instilled in affected eye (s) 4 times a day.

Other anti-inflammatory preparations

Other preparations used for the topical treatment of inflammation and allergic conjunctivitis include antihistamines, lodoxamide, and sodium cromoglicate.

ANTAZOLINE-TETRYZOLINE:

Indications: Temporary relief of the signs & symptoms of allergic conjunctivitis including conjunctival hyperaemia, chemosis, itching.

Contraindications: Narrow irodocorneal glaucoma, dry eye syndrome.

Dose and Administration: Adult & adolescents 1 drop bd-tds. 1 drop 3 hrly. Childn Max: 1-2 drops/day.

KETOTIFEN:

Indications: Symptomatic short-term treatment of seasonal allergic conjunctivitis in adult & childn ≥3 yr.

Contraindications: Hypersensitivity to ketotifen or to any of the excipients.

Dose and Administration: Adults, elderly and children (age 3 and older): one drop of into the conjunctival sac twice a day.

OLOPATADINE:

Indications: indicated for the temporary prevention of itching of the eye due to allergic conjunctivitis.

Contraindications: Hypersensitivity to or any of the excipients.

Dose and Administration: Instil one drop of in the conjunctival sac of the affected eye(s) twice daily.

SODIUM CROMOGLICATE-TETRAHYDROZOLINE:

Indications: treatment of allergic conjunctivitis.

Contraindications: Hypersensitivity to or any of the components. Also not to

be used in patients affected from glaucoma or other serious ophthalmic diseases,

nor in cardiopatic, hypertensive, hyperthyroid and diabetic patients.

Dose and Administration: 1-2 drops to be instilled in affected eye (s) 4 times a day.

NAPHAZOLINE NITRATE-ZINC SULPHATE:

Indications: Acute and chronic non-infectious conjunctivitis. Unspecific conjunctival irritations, including allergies. After successful treatment of bacterial and viral infections. Irrigation of the tear duct.

Contraindications: Hypersensitivity to any of the ingredients. In patients suffering from narrow-angle glaucoma, dry eye and keratoconjunctivitis sicca. Not to be used in infants. Not to be administered during Monoamine oxidase inhibitors or within 14 days of termination of such treatment. In pregnancy and lactation as safety has not been established.

Dose and Administration: One drop into the lower eyelid four times per day.

NAPHAZOLINE HYDROCHLORIDE-PHENIRAMINE MALEATE:  Indications: used to relieve itchy, red eyes caused by ragweed, pollen, and animal hair.

Contraindications: should not be used if you have ever had an allergic reaction to it or are sensitive to any of its ingredients. Or if you have heart disease, high blood pressure or trouble urinating because of enlargement of the prostate gland.

Dose and Administration: Place 1 or 2 drops in the affected eyes, up to 4 times a day.

LEVOCABASTINE:

Indications: Symptoms of seasonal allergic conjunctivitis.

Contraindications: Hypersensitivity to any of the ingredients.

Dose and Administration: ADULTS AND CHILDREN OVER 5 YEARS: The usual dose is 1 drop of Levocabastine E.D. eye drops per eye, twice daily. The dose may be increased to 1 drop per eye, 3 to 4 times daily. Treatment should be continued up to maximum of 8 weeks.