lotemax long-term?

[ringo]

Thanks Stella and Kitty for your remarks,

I just feel like a patient should try all options regarding the cyclosporine preparatons before they totally give up on it, as it is the only thing thatFDA has acknowledged to treat certain aspcts of dry eye and it did help so much in my case (others have benefited here on the forum and in the clinical trials).

[ringo]

Just a quick note to Stella regarding Tobradex-- I was prescribed this ointent for a month when I had ulcers/corneal erosions. It did help me a lot, I was putting it at night.

One word of caution: it has a much greater potential to raise IOP than Lotemax or FML. Dexamethasone is a strong steroid. I do not think it can be used for longer periods, like Lotemax for example, even in non steroid responders.

[stella]

Thank you for that info Ringo

[sighthound]

Hi ringo,
I will give it a try putting the lotemax in after the restasis. I can't use other eyedrops because my eyes hate everything. I think I will look into the compounded cyclo.
Stella: I first used tobradex 4 years ago. It was a mircacle drug. My eyes were gushing 2 days after I started! Even a co-worker commented on my eyes looking 'bigger'. I wasn't wincing them as usual. I used it for a month. The first day I didn't use it, I felt a little drier, then slowly went back to being really dry again. What a downer. I used it 3 months later and only got 50% the same result. Go figure. You don't need to use very much. About a 1/4 " bead. Just don't stay on it very long.

[Bored]

Hi guys. I skimmed through the thread, but I have one question which hasn't seem to be answered anywhere.

What constitutes as "long-term" use? I keep reading that long-term use of the steroids can cause problems; but what is long term? To try to understand my issue; my original thread on this site might help: http://www.dryeyezone.com/talk/showt...2695#post52695

Below is what I wrote on that thread:

So now he has me on some drops called Bion and has also told me to use Alrex for 2 weeks.

3 times a day for 1 week, and 2 times a day for 1 week. I have only used Alrex (0.2%) 5 times so far [almost 2 days now], but I have a very bad feeling about it. He told me to come back in 2 weeks, but after reading up a bit on it online, it seems that it can increase eye pressure and make things even more worse. I am going to call the hospital on Monday and see if I can get a follow-up appointment ASAP to get my eye pressure monitored. The last thing I want is to get Glaucoma or something!

With my 5th time putting in the drops, I think I have feeling some of the side effects of it [a very slight headache] and eyes feel a bit weird and I definitely get that weird taste in the back of my throat. My eyes right now are white in general, but as I said I have some very permanent veins caused by rebound hyperemia which are still there.

I am wondering if anyone has any experience with Alrex? Is 14 days too much of a time to use it without getting your eyes checked in the middle? Most online sites say that if you are using it for more than 10 days make sure to get them checked. Some even say 3 days. I am kind of worried - should I continue to use it or just stop? If I stop, there won't be too much point of the next follow up, because the doc will say I have nothing to assess.

[littlemermaid]

http://www.osnsupersite.com/view.aspx?rid=63670 OCULAR SURGERY NEWS U.S. EDITION May 10, 2010 Steroids enable aggressive treatment of ocular inflammatory disease - here's some of what they're currently thinking on short-term/long-term risks/benefits, ie inflammation damage is worse but make sure the prescription is tailored to your needs.

Read somewhere it's the length of time you use steroid eyedrops that affects the possibility of cataracts rather than number of drops per day, therefore US ophths prescribe initially in high dose pulse therapy to reduce inflammation fast (UK ophths 'pulse therapy' for eg prednisolone reflects standard NHS follow up time more than clinical need IMHO but they think FML is OK for long term, ie months, years because it is not readily absorbed by eye surface... hmm). Dr Latkany thread also has some noble thoughts on how he ideally uses steroid (minimally) to control inflammation fast, then off it to concentrate on causes.

No one knows how often to get intraocular pressure checked (some drug info says within first 3 or 7 days in case of immediate response, then periodically as you assess risk; UK ophth risk it between 4 wk appointments and look relieved when you're OK - 6 point variation through the day is normal says our optom). I read they think is related to your eyes' individual response to absorption so raised IOP could be within days of starting or years.

Also patient leaflets say to prevent absorption in system, press tear drain (hole at nose side of lower lid) for a minute or two (should not get taste at back of throat). Place drop carefully under lower lid rather than habitually dropping onto eye surface from a height, clean eye surround in case of splashes (skin thinning).

You mustn't just stop a steroid - you have to taper the dose according to doc's monitoring, even within a week. We have had steroid rebound inflammation. Also inflammation untreated by steroid dose too low, severe neovascularisation, epithelial damage. (Now we are successfully tapered, inflammation under control, 1 x FML weekly, surface looking good.) Love/hate steroids. I think, satisfy yourself whether prescription is tailored to your needs, ask for IOP checks according to your fears (check out different tonometry techniques, don't want eye surface desensitised too often).