Low Dose Dexamethasone Eye drops

Inflammatory lesion of the eye are common and are observed in many infection as well. These include allergic keretoconjunctvitis, episcleritis , sclerities , blepharitis, iritis, iridocyclitis , dacrocystitis, uveitis, , operative and post traumatic inflammation to name a few. These inflammatory conditions are characterised by the presence of hyperaemia , atiching and tears .Cortic costeroids administered trpically have an important place intreating maney of these conditions. The actions of corticosteroids are diverse and ancompass all most all aspects of this Inflammatory procress and immune response.
There use may how ever , lead to setious local and systematic side effects and complications. They interfere with the local defence mechanism, so that there is increased susceptibility to ocular infections, especially herpes simplex, mysoses and toxoplasmosis. Furthermore , prolonged use of corticosteroids is associated with increased risk of development of glaucoma and cataract. A verity of corticosteroids preparation are available for typical use either alone or in combination with antibiotics. These include preparation of Dexamethasone, prednisolone , fluorometholone , hydrocortisone, betamethasone etc. Dexamethasone phosphate is usually available as 0.1% eye drop. Recent clinical trial by leading ophthalmologist have shown that low Dose Dexamethasone preparation (0.01)% has the same efficacy with reduced propensity for side effects.
Therationale

The dose of 10 times diluted Dexamethasone has the following adventurous

(1)Provides efficacy similar to the undiluted steroid preparation with reduced side effects
(2) Can be used for prolonged periods since the side effects are less.
The Drug
Dexamethasone is a synthetic analogue of naturally occurring glucocorticoids (hydrocortisone and cortisone ) . Dexamethasone sodium phosphate is a water solution, inorganic ester of Dexamethasone.
Contraindications

Epithelial herpes simplex keratitis (dendritic keratitis. )
Acute infection stages of vaccinia , varicella, and many other viral diseases of the cornea and conjunctiva .
Mycobacterial infection of the eye.
Fungal infection.
Hypersensitivity
Special precautions
Prolonged may result in ocular hypertension and /or glaucoma, with damage to the optic nerve, defects in visual acuity and fields of vision, and posterior subcapsular cataract formation. Prolonged use may suppress the host response and thus increase the hazards of secondary ocular infections. In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of typical corticosteroids. . In acute purulent conditions of the eye corticosteroids may mask infection or enhance existing infection. Employment of corticosteroid medication in the treatment of herpes simplex other than Epithelial herpes simplex keratitis, in which it is contraindicated, requires great caution, periodic slitlamp examination is essential.
INDICATION and Usage
Steroid responsive inflammatory conditions of the palpebral and bulbal conjunctiva, cornea and anterior segment of the globe, such as allergic conjunctivites , acne rosacea , superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis selected infective conjunctivitis when the inherent hazard of steroid use is accepted to obtain an advisable diminution in oedema and inflammation , corneal injury from chemical or thermal burns or penetration of foreign bodies.
Dosage and administration
The duration of the treatment will very with the type of lesion andmay extend from a few days to several weeks, according to therapeutic response. Relapses , more common in chronic active lesion then self limitedconditions usually respond to retreatment
Instill 1-2drop 3-4 times a day. When a favourable response is observed reduce the number of daily application to two and later to one a day as maintenance dose if sufficient control obtain