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11.4 Corticosteroids and other anti-inflammatory preparations

Corticosteroid treatment of the eye should normally be initiated by or on the recommendation of, an Ophthalmologist.

11.4.1 Corticosteroids

Betamethasone drops, ointment
Betamethasone + Neomycin drops, ointment
Dexamethasone + hypromellose (Maxidex) drops
Dexamethasone minims
Dexamethasone + hypromellose + neomycin + polymyxin (Maxitrol) drops
Dexamethasone + neomycin + polymyxin (Maxitrol) ointment
Dexamethasone + framycetin + gramicidin (Sofradex) drops
Dexamethasone (Ozurdex) intravitreal implant - refer to NICE TA 229 (macular oedema due to retinal vein occlusion); Also NICE TA 349 (diabetic macular oedema)
Fluorometholone ophthalmic suspension
Hydrocortisone acetate ointment
Hydrocortisone + neomycin (Neocortef) drops, ointment
Prednisolone drops 0.03% (hosp only), 0.1% (hosp only), 0.5% drops and minims, 1% eye drops.
Rimexolone Drops

Notes:

1. Topical steroids should not be prescribed for 'red-eye' unless the possibility of Herpes simplex infection of the cornea has been eliminated by corneal staining. Use with caution in patients with glaucoma or a family history of glaucoma.

2. Treatment with steroid eye drops can increase intraocular pressure and precipitate glaucoma in those with a predisposition to the condition. Referral to an ophthalmologist should occur if these preparations are required.

3. Rimexolone is included for use in "steroid responders".

4. Intravitreal dexamethasone is for the treatment of macular oedema secondary to retinal vein occlusion (Nice TA 229) and also for non-infectious posterior uveitis.

 

11.4.2 Other Anti-inflammatory preparations

Antazoline + xylometazoline drops (Otrivine-Antistin)
Olopatadine eye drops - third line agent for ocular symptoms associated with seasonal allergy.
Sodium cromoglicate drops
Ciclosporin eye drops – severe keratitis with chronic dry eye disease  despite treatment with tear substitutes (specialist use only) – see NICE TA 369

Notes:

1. Otrivine-Antistin is used to relieve acute ocular symptoms of allergy. Where the condition is systemic (e.g.hayfever), oral antihistamines are often preferred.

2. Sodium cromoglicate is used prophylactically before the onset of predictable seasonal allergies such as hayfever and vernal kerato-conjunctivitis. 

For link to BNF section: 11.4 Corticosteroids and other anti-inflammatory preparations