The Dry Eye Zone

Rebecca's Blog


Abstract: Lotemax and Zylet users take note

This is an interesting little study. They looked at people whose intraocular pressure rose while on a "mild" steroid and reviewed how long they were on it before their pressure rose and what happened in the end. 28% had a history of glaucoma or something related but that still leaves a large majority of patients with no adverse history. The median length of treatment before elevated IOP was noted was 55 days.

For those of you on mild steroids, the moral of this story is you should check in with your doctor about being monitored for IOP elevation on a regular basis - not just once in the beginning. Honestly, I am horrified at some of the stories I hear from time to time of people being put on steroids and having prescriptions refilled regularly without ever having their IOP checked. I'm sure many doctors are doing a great job but obvious some are doing a really poor job at this.

Just because it's not Pred Forte doesn't mean you get off scot free when it comes to IOP risk from steroids.

Intraocular pressure elevations with loteprednol etabonate: a retrospective chart review.

Abstract Purpose:
Ocular corticosteroids can cause elevations in intraocular pressure (IOP). The purpose of this study was to characterize the timing and severity of IOP elevations in patients receiving loteprednol etabonate 0.5% or loteprednol etabonate 0.5%/tobramycin 0.3%.

A retrospective chart review was conducted at 5 academic and private practices. Any patient who experienced an elevation in IOP ≥5 mm Hg while using loteprednol etabonate or loteprednol etabonate/tobramycin was eligible for inclusion in the study. Data collected included patient demographics, medical and ophthalmic history, concomitant medications, reason for treatment, IOP, and medical and surgical interventions.

Fifty patients experienced IOP elevations after use of topical loteprednol etabonate and were included in the study. The mean (standard deviation [SD]) patient age was 58.8 (20.3) years and 66% were women. The most common reasons for prescribing loteprednol etabonate were dry eye (30%), postoperative therapy (22%), and allergic conjunctivitis (16%). Before treatment, 28% of patients had a history of open-angle glaucoma or ocular hypertension. Mean (SD) IOP before treatment was 15.5 (3.2) mm Hg and increased to a mean (SD) of 24.7 (6.5) mm Hg, a statistically significant increase of 9.2 (SD: 5.8; range: 5-29) mm Hg (P < 0.0001). The median duration of treatment with loteprednol etabonate at the time of observed IOP elevation was 55 days (range: 3 days to 3 years). Twenty-four percent of patients required IOP-lowering medications and 8% required surgery to control the elevated IOP.

Alternatives to corticosteroids should be considered when long-term treatment is required for an ocular surface condition.

J Ocul Pharmacol Ther. 2011 Jun;27(3):305-8. Epub 2011 May 16.
Rajpal RK, Digby D, D'Aversa G, Mah F, Hollander DA, Conway T.
1 SeeClearly Vision , McLean, Virginia.