Safe Use of Topical Corticosteroids Near the Eye

First-Line Agents and Safer Alternatives

The American College of Rheumatology recommends prednisolone acetate 1% as the gold standard topical corticosteroid for periocular inflammation due to its superior corneal penetration, with dexamethasone being equally recommended for both acute and chronic anterior uveitis 1, 2, 4
For prolonged therapy, fluorometholone and loteprednol etabonate are recommended as safer alternatives due to their reduced risk of intraocular pressure elevation and cataract formation 5, 6

Short-term use (≤3 months) of topical corticosteroids is strongly emphasized to minimize complications, with the risk profile changing dramatically with dosing 1, 7
The American Academy of Ophthalmology recommends baseline intraocular pressure measurement before initiating therapy, periodic IOP monitoring during treatment, and pupillary dilation to evaluate for cataract formation 5, 6, 8

The goal is always to discontinue topical corticosteroids as soon as clinically feasible due to the dose-dependent and duration-dependent risks of glaucoma and cataract formation, with systemic immunosuppressive therapy considered when inflammation cannot be controlled with ≤2 drops daily of prednisolone acetate 1% within 2-3 months 1, 4, 7
Topical corticosteroids should be tapered to the minimum effective dose once inflammation is controlled, rather than abrupt discontinuation, to minimize the risk of rebound inflammation 5, 6