Corticosteroids and Anti-Inflammatory Preparations

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

Eye drops containing corticosteroids should not be used for longer than a week except under an eye specialist's careful surveillance combined with regular measurement of intraocular pressure.

Corticosteroids – MILD Potency

Specialist initiation (S1)

FLUOROMETHOLONE 0.1% eye drops (FML® Liquifilm®)

  • Excipient: Benzalkonium chloride can be irritant to the eye and could cause discoloration of soft contact lenses.

Corticosteroids – MODERATE Potency

Specialist initiation (S1)

BETAMETHASONE sodium phosphate 0.1% eye drops (Vistamethasone®)

PREDNISOLONE sodium phosphate 0.5% eye drops

  • Discontinue if no improvement after 7 days.

With Antimicrobial:

Specialist initiation (S1)

BETAMETHASONE WITH NEOMYCIN eye drops (Betnesol-N®) 

  • Betamethasone sodium phosphate 0.1% with neomycin 0.5%

Corticosteroids – POTENT Potency

Specialist initiation (S1)

DEXAMETHASONE 0.1% eye drops (Maxidex®) 

PREDNISOLONE acetate 1% eye drops (Pred Forte® 5ml bottle)

Intravitreal Corticosteroids

Specialist use only (S2)

DEXAMETHASONE 700mcg intravitreal implant

Indications:

  • Visual impairment due to diabetic macular oedema who are pseudophakic or who are considered insufficiently responsive to, or unsuitable for non-corticosteroid therapy.
  • Patients with macular oedema following either branch retinal vein occlusion or central retinal vein occlusion.                                                               
  • SMC restriction: for use in adult patients with macular oedema

(i) following central retinal vein occlusion (CRVO) and

(ii) in patients with branch retinal vein occlusion (BRVO) who are not clinically suitable for laser treatment including patients with dense macular haemorrhage or patients who have received and failed on previous laser treatment.

FLUOCINOLONE ACETONIDE 190 microgram intravitreal implant

Indications:

  • Visual impairment associated with chronic diabetic macular oedema, considered insufficiently responsive to available therapies.
    SMC restriction:

• only in patients in whom the affected eye is pseudophakic (has an artificial lens after cataract surgery) and;

• retreatment would take place only if the patient had previously responded to treatment with fluocinolone acetonide and subsequently best corrected visual acuity had deteriorated to less than 20/32.

  • Prevention of relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye. 

Other Anti-Inflammatory Preparations

Preferred list (P)

OLOPATADINE 1mg/ml eye drops

  • For acute allergic conjunctivitis.

SODIUM CROMOGLICATE 2% eye drops

  • For recurrent/long term allergic conjunctivitis.

Specialist initiation (S1)

ANTAZOLINE WITH XYLOMETAZOLINE 0.5%/0.05% eye drops

  • Acute use

LODOXAMIDE trometamol 0.1% eye drops

  • Prophylactic use

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.