Eyes: allergic and inflammatory eye conditions

Question 1

What is the use of corticosteroids in the eye?

Answer 1

• Use of inflammation and pain
• Inflammation after surgery e.g. cataract
• Macular oedema

Question 2

Which corticosteroids are used?

Answer 2

1. Betamethasone
   - Available as ear/eyes/nose drops
   - Brand: Betnesol and
   Vistamethasone
   - Available as an eye ointment
   - With neomycin = Betnesol-N
2. Dexamethasone
   - E.g. Maxidex
   - Available as eye drops only
3. Fluorometholone
   - e.g. FML liquifilm
4. Prednisolone

Question 3

How often are corticosteroids applied?

Answer 3

• Short term use ONLY
• Frequently for the first 24-48 hours
• Once inflammation is controlled, frequency is reduced

Question 4

What are the THREE main dangers associated with corticosteroids

Answer 4

1. A red eye - when diagnosis is unconfirmed, it may be due to herpes simplex virus, which corticosteroids aggregate
2. Steroid glaucoma
3. Steroid cataract - can follow especially after prolonged use

Question 5

Which formulation of corticosteroids is normally used for macular oedema?

Answer 5

Intravitreal implants

Question 6

What is the use of NSAID eye drops?

Answer 6

• NSAIDs can be used for prophylaxis and treatment of inflammation of the eye
  following surgery
• Diclofenac is also licensed for seasonal allergic conjunctivitis

Question 7

Which NSAIDs are available as eye drops

Answer 7

• Diclofenac
• Flurbiprofen
• Ketorolac
• Nepafenac

Question 8

Which drugs are used for seasonal allergic conjuctivitis?

Answer 8

1. Antihistamines
   - Antazaoline (with sympathomimetic - Xylometazoline)
   - Azelastine
   - Epinastine
   - Ketotifen
   - Olopatadine
2. Mast-cell stabilisers
   - Lodoxamide
   - Sodium cromoglicate

Question 9

What is the use of ciclosporin as an eye drop?

Answer 9

• Severe keratitis in dry eye disease that has nit responded to tear substitute treatment

Question 10

How do you treat uveitis

Answer 10

1. Antimuscarinic eye drops!
   - Atropine sulfate
   - Cyclopentolate

Question 11

What are the side effects of antimuscarinic eye drops?

Answer 11

• Side-effects of usual anti-muscarinic effects can occur due to systemic absorption
• Conjunctivitis can also occur due to prolonged use

Question 12

Which patients are cautioned on the use of antimuscarinic eye drops?

Answer 12

• < 3 months
• Dark iris (More resistant to pupillary dilation)
• Mydriasis (dilation of the pupil) can precipitate acute-angle colure glaucoma (especially in those over 60 years old)