Eyes on Steroid Drops: How to Select the Right One (2024)

Steroid eye drops can help quell problems associated with eye inflammation caused by allergies, postsurgical issues, and other conditions. These medications include prednisolone eye drops, steroids such as loteprednol, injections, and more. Such steroids, as a rule, interrupt gene pathways that otherwise would lead to uncontrolled eye inflammation.

All steroid eye 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.

This article discusses five types of steroid eye drops, as well as the uses, precautions, and side effects of each.

Fluocinolone Ophthalmic

This ophthalmic steroid goes by the brand names Illuvien, Retisert, and Yutiq.

Rather than being drops, these are injected intravitreal implants that place the medication in the vitreous—a gel-like substance in the back chamber of the eye.The implant provides sustained release of the medication. Each brand is a little different and may have its own appeal.

Uses

In general, fluocinolone is used to reduce retinal 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. This intravitreal implant is injected with a small needle into the eye and is expected to last for 36 months.

The Retisert implant is placed in the back of the eye where it locally releases fluocinolone over time. It is used to treat inflammation associated with chronic noninfectious uveitis—inflammation in the middle tissue layer of the eye wall. 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.

Dosage

The milligram (mg) dosage of fluocinolone acetonide for each implant is:

• Iluvien: 0.19 mg
• Retisert: 0.59 mg
• Yutiq: 0.18 mg

Precautions

An intravitreal injection can help ensure 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 eye tissues.

It is possible to temporarily have blurry vision after the implant is first placed. You should not attempt to drive or operate any kind of machinery until your vision clears.

Fluocinolone can also have steroid-related effects. Tell your healthcare provider if you have a history of ocular herpes simplex, since this viral infection can reoccur with steroid use.

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

Side Effects

Occasionally there can be side effects from fluocinolone ophthalmic implants. Contact your healthcare provider 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
• Eye redness
• Swelling around the eye or eyelid
• Eyesight changes
• Eye irritation
• Light sensitivity
• Unable to pass urine regularly or at all

Minor side effects may include:

• 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

Talk with your healthcare provider if any of these symptoms don't improve or get worse.

Loteprednol Ophthalmic

This steroid eye 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, Inveltys, Alrex, Lotemax, and Lotemax SM. Depending on the brand, the medication will be an eye drop suspension or gel.

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

Dosage

The dosage varies slightly with each brand.

• Eysuvis: 0.25% loteprednol etabonate ophthalmic suspension
• Inveltys: 1.0% loteprednol etabonate ophthalmic suspension
• Alrex: 0.2% loteprednol etabonate ophthalmic suspension
• Lotemax: 0.5% loteprednol etabonate ophthalmic gel
• Lotemax SM: 0.38% loteprednol etabonate ophthalmic gel

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.
• 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 mask these.
• It may cause some viruses such as herpes simplex to worsen or to last longer.
• If used long-term, fungal infections may arise, particularly with corneal ulcer.

Side Effects

Even though this soft steroid may be better tolerated, in some cases side effects can still occur, such as:

• 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-Dexand, Decadron, and Maxidex.

Uses

Dexamethasone is usually used to treat inflammatory eye conditions causing redness, swelling, and itching such as:

• Allergic conjunctivitis
• Inflammation of the cornea (the clear outer layer on the front of the eye)
• Inflammation of the iris (the colored tissue that contains the pupil)
• Ocular rosacea

Dosage

The dexamethasone compound will vary depending on the brand.

• AK-Dex: 0.1% dexamethasone sodium phosphate ophthalmic drops
• Decadron: 0.1% dexamethasone phosphate ophthalmic solution
• Maxidex: 0.1% dexamethasone ophthalmic suspension

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.
• Some people may develop glaucoma, cataracts, or secondary infections.
• If you already have thinning of the eye surface, in particular, be aware that small perforations of the cornea can occur.

Side Effects

While many people have no issues when taking dexamethasone, some people may experience 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 contains fluorine atoms designed to enhance its potency. Therefore, it is used half as frequently as ophthalmic steroids like prednisolone drops. However, this higher potency also comes with an increased risk of raising intraocular pressure.

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

Uses

Difluprednate is a corticosteroid used to treat eye swelling and pain after eye surgery.

Dosage

Durezol contains 0.05% difluprednate. It is usually applied to the affected eye(s) four times a day beginning 24 hours after surgery and continuing for two weeks, and then two times a day for one week. Your healthcare provider will decrease the dose gradually depending on your condition and how you respond to treatment.

Precautions

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

• Use of this medication for more than 10 days may cause increased intraocular pressure and may result in glaucoma.
• You may be prone to posterior subcapsular cataract formation.
• Your immune responses may be reduced if taking difluprednate for an extended period, making you more susceptible to bacterial, viral, and fungal infections. If you have herpes simplex virus, use the medication with caution.
• Following cataract surgery, using 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:

• Blurred vision
• Decreased vision or vision changes
• Seeing a glare from lights or sun or light sensitivity
• Eye pain
• Additional eye redness or swelling
• 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 used to protect the eye from inflammation. It usually comes as a suspension with prednisolone particles that need to be vigorously shaken to distribute these equally before use.

Some of the common brand names include Econopred, Econopred Plus, and Omnipred. It also goes by Pred Mild and Pred-Forte.

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

Prednisolone solution or suspension is prescribed to reduce the irritation, redness, burning, and swelling of eye inflammation caused by chemicals, heat, radiation, infection, allergy, or foreign bodies in the eye. Sometimes it is used after eye surgery.

Dosage

Dosage will vary depending on the product.

• Econopred: 1/8th% prednisolone acetate ophthalmic suspension
• Econopred Plus: 1% prednisolone acetate ophthalmic suspension
• Omnipred: 1% prednisolone acetate ophthalmic suspension
• Pred Mild: 0.12% prednisolone acetate ophthalmic suspension
• Pred-Forte: 1% prednisolone acetate ophthalmic suspension

Precautions

When taking prednisolone, it’s important to be carefully monitored before renewing the prescription. The eye examination may include the use of a slit lamp to get a magnified look at the eye and fluorescein staining of the corneal surface.

If prednisolone is taken for more than 10 days, vision should be thoroughly tested and intraocular pressure checked. The use of prednisolone for more than 10 days has been known to increase intraocular pressure and, in some cases, cause glaucoma.

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. Alert your healthcare provider right away if you experience any signs of infection, eye pain, or blurred or reduced vision.

Some other potentially less serious side effects may include:

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

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

Summary

Steroid eye drops or injected implants can treat conditions that cause eye inflammation. Your healthcare provider 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.