Links to other pages within Patient UK which are related to this topic:
Experience | Medicines | News | Products | Other
Print options:   Other options:   Bookmark and Share

This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Anti-inflammatory Eye Preparations

Post your experience

This record 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 separate article Prescribing for and Administration of Drugs to the Eye.

Overview

There are four broad categories of ophthalmic anti-inflammatory preparations:

In the primary care setting, topical agents are most commonly used, with the marked exception of suspected giant cell arteritis (GCA) 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

Overview1

  • Examples - betamethasone, dexamethasone, fluoromethalone, hydrocortisone acetate, prednisolone, rimexolone, loteprednol etabonate (not in Scotland).
  • Use - short-term treatment of local inflammation, usually in the anterior segment of the eye. This includes inflammation post surgery.
  • Action2 - 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, depends on 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 - 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.
  • Use - atopic conditions involving the periocular skin; can be used as a substitute for night time steroid drop application in some cases and where there is difficulty in applying drops, e.g. due to arthritic hands.

Corticosteroid/antibiotic combinations3

  • 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, e.g. post 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, olopatidine, epinastine hydrochloride, ketotifen.
  • Use4 - allergic conjunctivitis, seasonal and perennial conjunctivitis.
  • Action - they inhibit histamine-mediated inflammatory responses.
  • Caution - some agents are not licensed for young children, there can be rebound vasodilation after prolonged use,5 severe renal impairment, pregnancy and breast-feeding.
  • Administration - most preparations twice-daily until cessation of symptoms.
  • Ocular side-effects - local irritation and stinging possible, visual disturbances, keratitis, oedema, photophobia.
  • Systemic side-effects - (rare): headache, pruritus and skin reactions, drowsiness and dry mouth reported.
  • Additional information4 - these drugs act quickly but consider oral antihistamines if symptoms severe or not limited to the eye. May be used concurrently with mast cell stabiliser (ketotifen has mast cell stabilising properties too). Antazoline preparations are available over-the-counter (OTC).6
Mast cell stabilisers
  • Examples - lodoxamide, nedocromil sodium, emedastine, sodium cromoglicate.
  • Use4 - allergic, seasonal and vernal conjunctivitis.
  • Action2 - 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.7
  • 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.6
Non-steroidal anti-inflammatory drugs
  • Examples - diclofenac, ketorolac, flurbiprofen sodium.
  • Use - postoperative inflammation in cataract surgery (e.g. macular oedema), pain after accidental or surgical corneal trauma. Diclofenac also has a role in seasonal allergic conjunctivitis.
  • Action2 - 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,5 pregnancy and breast-feeding.
  • Administration - this varies depending on condition. May be a single stat dose.
  • Ocular side-effects - local irritation and stinging possible.
  • Systemic side-effects - none reported for topical drugs.
Prescribing anti-inflammatories in primary care4
  • Rule out worrying causes of a red eye.
  • Prescribe mast cell stabiliser for prophylaxis.
  • Prescribe antihistamine drops for acute relief of symptoms (possibly systemic antihistamines if nose and sinuses 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.


Document references
  1. Titcomb LC; Mydriatic-cycloplegic drugs and corticosteroids. Pharmaceutical Journal. Vol 263 No 7074 p900-905, December 4, 1999.
  2. Forrester JV, Dick AD, McMenamin PG, Lee WR. The Eye: Basic Sciences in Practice (2nd ed.) 2002, WB Saunders.
  3. Denniston AKO, Murray PI. Oxford Handbook of Ophthalmology, OUP (2008).
  4. Conjunctivitis - allergic, Clinical Knowledge Summaries (November 2007)
  5. Kunimoto DY, Kanitkar KD, Makar MS. The Wills Eye Manual, 4th Ed, 2004 Lippincott Williams &Wilkins
  6. Titcomb LC; Over-the-counter ophthalmic preparations. The Pharmaceutical Journal 264 (7082), p212-218 February 5, 2000.
  7. The American Academy of Optometry; NSAIDs and Anti-inflammatories: side effects. Last updated 2003.
Acknowledgements EMIS is grateful to Dr Olivia Scott for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2009.
Document ID: 260
Document Version: 3
Document Reference: bgp25064
Last Updated: 4 Nov 2009
Planned Review: 4 Nov 2011

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

Patient UK Hearing Impairment Survey

Patient UK are grateful to the 550 people who took part in this survey.
To see the results click here.
If you'd like to leave your feedback, please go to our interactive forum.

Links to other pages within Patient UK which are related to this topic:
Experience | Medicines | News | Products | Other
Print options:   Other options:   Bookmark and Share
Want to search some more? Use the Google Search box below to search our site.

Related pages in Patient UK

Your Experience (^ top of page)

 Please add your experience about this condition / medicine
 Azelastine eye drops

Latest Health News

 View current health news

Medical equipment

 Pill/Tablet Equipment

Visit the Patient UK Medical Equipment shop

Books


Visit the Patient UK shop

Other - Useful resources (^ top of page)

Pictures, diagrams, photos, images, etc.
Evidence based medicine
Online textbooks and journals
UK Guidelines
Online Videos
Medline
Other good health sites

Want to search some more? Use the Google Search box below to search our site.

Advertisements











Disclaimer: Patient UK has no control over the content of any external links above. Inclusion does not imply endorsement by Patient UK.

Want to advertise on this site? Find out how >>

Clicking here will take you to the foot of this page where you'll find a list of Information Leaflets which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Support Groups which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Medicines & Drugs which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of diagrams which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of PatientPlus (detailed reference) articles which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of UK Guidelines which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of other selected websites which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Poems and Stories which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Operations and Procedures which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Online Videos which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find links through to our interactive forum.
Here you can follow a link to view existing patient experiences on this subject, or to add your own
Clicking here will take you to the foot of this page where you'll find links to news stories on this subject in our Online Newspaper
Clicking here will take you to the foot of this page where you'll find links to related products
Clicking here will take you to the foot of this page where you'll find links to other useful sources of information
Click here to open a printer-friendly version of this document, in a new window, together with the print dialogue box
Click here to open this document in PDF format
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Click here to listen to the MP3 audio recording of this document
Click here to download the audio recording of this document as a podcast, for listening to at your leisure
Click here to open our Dictionaries and Glossaries page
Click here to see related products in our Online Pharmacy
Note: this will open in a new window
Click here to add this page to a social bookmarking site of your choice
Click here if you want to find out more about social bookmarking. This link will take you to the Wikipedia explanation
Note: this will open in a new window
Clicking here will take you to the foot of this page where you'll find a list of Information Leaflets which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Support Groups which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Medicines & Drugs which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of diagrams which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of PatientPlus (detailed reference) articles which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of UK Guidelines which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of other selected websites which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Poems and Stories which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Operations and Procedures which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Online Videos which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find links through to our interactive forum.
Here you can follow a link to view existing patient experiences on this subject, or to add your own
Clicking here will take you to the foot of this page where you'll find links to news stories on this subject in our Online Newspaper
Clicking here will take you to the foot of this page where you'll find links to related products
Clicking here will take you to the foot of this page where you'll find links to other useful sources of information
Click here to open a printer-friendly version of this document, in a new window, together with the print dialogue box
Click here to open this document in PDF format
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Click here to listen to the MP3 audio recording of this document
Click here to download the audio recording of this document as a podcast, for listening to at your leisure
Click here to open our Dictionaries and Glossaries page
Click here to see related products in our Online Pharmacy
Note: this will open in a new window
Click here to add this page to a social bookmarking site of your choice
Click here if you want to find out more about social bookmarking. This link will take you to the Wikipedia explanation
Note: this will open in a new window
Click here to return to the home page
Click here to read our 'About Us' page
Go to the Emis Access website, where you can book an appointment with your GP, order a repeat prescription or view you medical record online.
Note: this will open in a new window
View and/or join in discussion about health, lifestyle and disease in our interactive forum.
Note: this will open in a new window
Visit our pharmacy product price comparison website
Go to our online newspaper for current medical news and commentary.
Note: this will open in a new window
Adverts on this site do not influence the medical content. Click to read more.
Adverts on this site do not influence the medical content. Click to read more.