Page 1 of 3
`
`View this article online at: patient.info/doctor/anti-inflammatory-eye-preparations
`
`Anti-inflammatory Eye Preparations
`
`This article provides an overview of anti-inflammatory agents used for eye conditions. Check individual drug
`monographs for a more comprehensive account of drug characteristics. At the end, you will find guidance
`regarding prescription of these agents in the primary care setting. See also the separate article on Eye Drugs -
`Prescribing and Administering.
`
`Overview
`There are four broad categories of ophthalmic anti-inflammatory preparations:
`
`Corticosteroids
`Antihistamines
`Mast cell stabilisers
`Non-steroidal anti-inflammatory drugs (NSAIDs)
`
`In the primary care setting, topical agents are most commonly used, with the marked exception of suspected
`giant cell arteritis (temporal arteritis) where systemic steroids may need to be initiated promptly prior to urgent
`specialist review. In a specialist unit, anti-inflammatory agents (typically steroids) can be injected in the sub-
`Tenon's space and within the globe.
`
`Common conditions warranting anti-inflammatory treatment include allergic conjunctivitis and hypersensitivity
`reactions. These drugs are also very commonly used in specialist units to treat a very wide range of conditions.
`These include uveitis, cystoid macular oedema, scleritis and episcleritis, and certain cases of herpes simplex
`keratitis, during and after surgical procedures.
`
`Topical corticosteroids
`Overview
`Examples - betamethasone, dexamethasone, fluoromethalone, hydrocortisone acetate, prednisolone,
`rimexolone, loteprednol etabonate.
`Use - short-term treatment of local inflammation, usually in the anterior segment of the eye. This
`includes inflammation post-surgery.
`Action[1] - decrease number and function of inflammatory cells, increase vascular permeability and
`inhibit chemical mediators of inflammation.
`Contra-indications - undiagnosed red eye; they can aggravate herpes virus and other infections.
`Caution - prescription and monitoring need to be done in a specialist unit.
`Administration - largely depends on the condition: may be as frequent as every 30 minutes in severe
`inflammatory states. There is then a gradual reduction over time (again, this depends on the condition)
`according to symptoms and clinical findings. Period of reduction may be weeks or even months, with
`a small minority of patients being kept on very low doses of weak steroids for extended periods of time
`(years) to prevent recurrence.
`Ocular side-effects - a rise in intraocular pressure (may be insidious or rapid: 'steroid responders'),
`cataract formation in long-term use, corneal thinning, delay in corneal healing, increased susceptibility
`to microbial infections and a paradoxical uveitis.
`Systemic side-effects - theoretical but be aware of susceptible individuals (pregnancy, peptic ulcer
`disease, tuberculosis, active infection, psychosis).
`Additional information - in severe inflammatory states, a local injection of steroids around the globe
`can be performed by ophthalmologists.
`
`Corticosteroids available in ointment form
`Examples - Betnesol® and hydrocortisone acetate.
`
`

`
`Page 2 of 3
`Use - atopic conditions involving the periocular skin; can be used as a substitute for nighttime steroid
`drop application in some cases and where there is difficulty in applying drops - eg, due to arthritic
`hands.
`
`Corticosteroid/antibiotic combinations[2]
`Examples - betamethasone + neomycin, dexamethasone 0.1% + neomycin/polymyxin B/tobramycin,
`dexamethasone 0.05% + framycetin/gramicidin, prednisolone 0.5% + neomycin.
`Use - where there is inflammation associated with a risk or actual infection - eg, following routine
`cataract surgery. Initiation of these drugs is not recommended in the primary care setting.
`
`Corticosteroids available in Minims®
`Examples - dexamethasone and 0.5% prednisolone.
`Use - these are single-use application packs used where there is preservative toxicity.
`
`Antihistamines
`Examples - antazoline sulfate, azelastine hydrochloride, olopatadine, epinastine hydrochloride,
`ketotifen.
`Use - allergic conjunctivitis, seasonal and perennial conjunctivitis. [3]
`Action - they inhibit histamine-mediated inflammatory responses.
`Caution - some agents are not licensed for young children, there can be rebound vasodilation after
`prolonged use, [4] severe renal impairment, pregnancy and breast-feeding.
`Administration - most preparations twice-daily until cessation of symptoms.
`Ocular side-effects - local irritation and stinging are possible, visual disturbances, keratitis, oedema,
`photophobia.
`Systemic side-effects - (rare): headache, pruritus and skin reactions, drowsiness and dry mouth
`reported.
`Additional information - these drugs act quickly but consider oral antihistamines if symptoms are
`severe or not limited to the eye. They may be used concurrently with a mast cell stabiliser (ketotifen
`has mast cell stabilising properties too). Antazoline preparations are available over-the-counter
`(OTC). [3]
`
`Mast cell stabilisers
`Examples - lodoxamide, nedocromil sodium, emedastine, sodium cromoglicate.
`Use - allergic, seasonal and vernal conjunctivitis. [3]
`Action[1] - stabilise mast cell membranes; therefore, these drugs have a more prophylactic role, as
`they are administered before mast cell priming with IgE and allergens.
`Caution - some agents not licensed for young children (check individual drug), pregnancy and breast-
`feeding.
`Contra-indication - soft contact lens wear.
`Administration - most preparations are applied four times daily for a maximum of 12-16 weeks.
`Ocular side-effects - transient local irritation and stinging possible, dry eye, keratitis, lacrimation,
`corneal infiltrates, staining and localised oedema.
`Systemic side-effects - headache, dizziness and taste disturbance.
`Additional information - may be used concurrently with antihistamines. Sodium cromoglicate
`preparations are available OTC.
`
`Non-steroidal anti-inflammatory drugs
`Examples - diclofenac, ketorolac, flurbiprofen sodium, nepafenac.
`Use - postoperative inflammation in cataract surgery (eg, macular oedema), pain after accidental or
`surgical corneal trauma. Diclofenac also has a role in seasonal allergic conjunctivitis.
`Action[1] - inhibit the synthesis of eicosanoids (prostaglandins, thromboxanes and leukotrienes).
`Caution - some agents not licensed for young children (check individual medication), rebound
`vasodilation after prolonged use, [4] pregnancy and breast-feeding.
`Administration - this varies depending on the condition. May be a single stat dose.
`Ocular side-effects - local irritation and stinging possible.
`
`Page 2
`
`

`
`Systemic side-effects - none reported for topical drugs.
`
`Page 3 of 3
`
`Prescribing anti-inflammatories in primary care[3]
`Rule out worrying causes of a red eye.
`Prescribe a mast cell stabiliser for prophylaxis.
`Prescribe antihistamine drops for acute relief of symptoms (possibly systemic antihistamines if nose
`and sinuses are affected too).
`Cool compresses over the eyes can also help with symptom relief.
`Advise to return to the surgery should symptoms not respond or if they worsen.
`
`Do not prescribe topical steroids unless following a management plan agreed with the local ophthalmology team.
`
`Further reading & references
`British National Formulary
`
`1. Forrester JV, Dick AD, McMenamin PG, Lee WR; The Eye: Basic Sciences in Practice (3rd ed.) 2007, WB Saunders
`2. Denniston AKO, Murray PI; Oxford Handbook of Ophthalmology (OUP), 2009
`3. Conjunctivitis - allergic; NICE CKS, August 2012
`4. The Wills Eye Manual (6th ed), 2012
`
`Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
`conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its
`accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
`For details see our conditions.
`
`Original Author:
`Dr Olivia Scott
`
`Document ID:
`260 (v4)
`
`Current Version:
`Dr Colin Tidy
`
`Last Checked:
`28/05/2013
`
`Peer Reviewer:
`Dr Olivia Scott
`
`Next Review:
`27/05/2018
`
`View this article online at: patient.info/doctor/anti-inflammatory-eye-preparations
`Discuss Anti-inflammatory Eye Preparations and find more trusted resources at Patient.
`
`© EMIS Group plc - all rights reserved.
`
`Page 3