Safety and Effectiveness of Steroid Eye drops

[AboveOnlySky]

Hello, I need to find out more about steroid eye drops because I have been prescribed them and told to use them. Sorry if this topic has been covered earlier. I tried to search for it but my eyes are so bad I really can't search for long.

I'm reluctant to use steroid eye drops because I know that cortisone can have very harmful effects and I'm also doubtful that the anti-inflammatory effect will have any long term benefit.

I would appreciate your thoughts and your experiences with using steroid eye drops.

[savino]

............

[AboveOnlySky]

Yes, I was talking about things like Lotemax. I thought it would just be temporary relief. Thanks a lot for your response.

[AboveOnlySky]

So I'm trying to get punctal plugs put in my tear ducts because I'm not producing enough tears. One optometrist says that the anti-inflammatory drops are necessary for a week before I get them in. Not quite sure why. Another says it isn't necessary.

I'd really rather not use the steroid drops. Any advice?

[DryInDenver]

According to a couple of my doctors, some steroids are okay for longer term use and some aren't. One has had patients on fluorometholone (FML) long term and said it's okay. The other told me that FML isn't necessarily a weak steroid, but it did not penetrate well which makes it much safer for long term use. It does, however, have the preservative BAK in it which has, in some cases I've read about can make eyes get worse. I brought this up and he prescribed me Alrex as an alternative. Alrex is much more expensive (at least for me on my high deductible plan) but it doesn't have the BAK in it.

For what it's worth, the doc who gave me the Alrex also brought up lotemax as a potential option. But neither doctor has actually recommended lotemax to the point of writing a prescription for it. I've used it, but I think it was on a short-term basis just after my lasik surgery.

Despite the advice of my doctors, I share some of the concerns of users above about long-term use of steroids. I think one of the main risks is cataracts. The drops do help me though. My compromise has been to use the drops only when I my eyes are giving me more problems than normal. So I end up doing a few days on the drops, a week off, a few days on, a month off. I use them more in the winter, more when I'm working a lot, and more when I'm not getting enough sleep. The drops help to break the inflammation cycle. My guess is that I end up using them 10%-30% of the time, which I hope reduces my risk.

Not sure if that helps or not, but it's what I've been doing for about a year and a half. I wish I could tell you I've been doing it for 30 years and am okay, but you'll have to wait a while for a report like that.
'

[AboveOnlySky]

Thanks DryinDenver. I looked up BAK and this has helped me make a decision:

"Prescription steroids used to combat inflammation in vulnerable dry eye patients such as Flarex, FML, and Patanol are preserved with benzalkoniumchloride (BAK), a chemical used in detergents. BAK can puncture the corneal epithelium, denature corneal protein, and cause irreversible damage to the eye. Steroid drops are usually prescribed with little concern for their toxicity to the ocular surface, and can cause significant worsening of symptoms in some cases, even in the short term.2"


I've been prescribed FML, which I should have mentioned earlier. So regardless of whether using anti-inflammatory drops is the right thing to do, I shouldn't use these ones. I've been to an optometrist that insists on using the drops before having the plugs and another that says it isn't necessary. I guess I'm going with the latter. These decisions are so hard. I don't know what to do! But it's obviously important to do your own research. I may have just dodged a bullet by not using these drops.

[Betsy]

"Prescription steroids used to combat inflammation in vulnerable dry eye patients such as Flarex, FML, and Patanol are preserved with benzalkoniumchloride (BAK), a chemical used in detergents. BAK can puncture the corneal epithelium, denature corneal protein, and cause irreversible damage to the eye. Steroid drops are usually prescribed with little concern for their toxicity to the ocular surface, and can cause significant worsening of symptoms in some cases, even in the short term.2"

Oh no, how long is short term I wonder? And why do they still make them with BAK? there are tons of other less harmful preservatives, this one is the cheapest and worst. Doctors need to say they wont rx them anymore and patients need to be informed to not get them if a doctor prescribes them because if their not being bought, money is not made, so their forced to make them safer. When I told opthamologists I feared taking this steroid or this antibiotic eye drop or something with BAK in it, they either had no opinion or kind of smirked at me, like what do I know. It's sad. I hope I haven't caused more damage when I did use them in desperation.

[AboveOnlySky]

If you haven't used them for long and you didn't notice any worsening of symptoms, it's better to just be optimistic about it and assume that it didn't do you any harm. At least, I think so...

Here is the link to the study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958436/

[Betsy]

I do agree with you above only sky. I am worse but not sure if it was the 2 week course or not as I wonder if some of the things that are suppose to help me are making me worse. It drives me nuts trying to sort it out. I don't see why it would be so difficult to put steroid, antibiotic and any other rx drops in individual preservative free vials. I guess it all boils down to money, always does.

[AboveOnlySky]

For those of us living in Australia, I thought I would mention this: I spoke to my optometrist about my concerns and she contacted a company based in Sydney called Customer Care Compounding Pharmacy. They are going to make the FML drops without a preservative and send them to me. It's a little bit expensive, though. $60 including shipping for 2 weeks supply. I decided I'm more comfortable with this optometrist so I think I will take her advice, despite being uncomfortable using steroid eye drops even without a preservative.

[DryInDenver]

Betsy, I think I saw somewhere in another post you were concerned with previous usage of steroid drops with BAK (benzalkonium chloride) and wondered how long constituted "long-term" use. That is a tough question to answer, but for reference, Rebecca posted a story called In the Blink of An Eye on the home page that describes a patient who developed problems after using drops for 6-years. . My guess is that your use has been much less than that and you don't have anything to worry about if you don't already notice the problems. I feel the less we have to worry about the better for our mental state so I hope that helps.

This conversation has made me rethink my periodic use of Alrex and or FML and I think I'll try to reduce my usage even more. I may still pull them out if my eyes hit an unbearable funk, but instead of using them 10%-30% of the time I'll save them for only 0%-5% of the time. They do help me some but there is a known risk there and it's probably not worth exposing myself to it.

Here's a link to the article I mentioned. It's a good read.

http://mosaicscience.com/story/severe-eye-pain

[AboveOnlySky]

Well, I prompted your decision, so I hope it's the right one for you!

[DryInDenver]

I did a bit of research on Alrex. Some of what I wrote above probably didn't make sence to somebody who knows a bit about steroid drops.
Akrex vs lotemax is a pointless discussion because

Alrex=Loteprednol = lotemax

Also, more importantly, using Alrex instead of FML based in the fact FML has BAK in it is just not helpful because

Alrex has BAK in it too!

So much for that as a better option.

I'm going to try something else that I hope helps. Budweiser has alcohol in it so I'm going to drink Coors instead. That should fix the issue for sure.

[AboveOnlySky]

Knowing that is really helpful when it comes to long term use. The drops that the pharmacist made for me only last a week once opened, so they aren't suitable for occasional use, unfortunately.

Haha nice joke. :P

[AboveOnlySky]

Whether as a result of using these drops or not, my eyes are getting worse. I changed my mind and I'm going with the other optometrist. This sucks.