dexamethasone ophthalmic

Action and Spectrum

Actions and Spectrum: 

dexamethasone ophthalmic is a medication that belongs to the class of corticosteroids. It is majorly used to treat inflammation and swelling in the eyes, which various conditions, including allergies, infections, or surgery, can cause. 

The action of dexamethasone ophthalmic involves suppressing the activity of immune cells and reducing the release of inflammatory mediators, like prostaglandins and leukotrienes. This leads to decreased swelling, redness, and pain associated with inflammation. 

The spectrum of dexamethasone ophthalmic refers to the range of conditions it can treat. dexamethasone ophthalmic can treat various eye conditions, including allergic conjunctivitis, iritis, uveitis, scleritis, and postoperative inflammation. Although, it should be noted that this medication is not effective against all eye conditions, and a healthcare professional should determine its use. 

Drug Interaction

Adverse Reaction

Frequency defined 

<1% 

Burning 

Stinging 

Ocular discharge 

Hyperemia 

Pruritus 

Blurring 

Sticky sensation 

Lid margin crusting 

Increased fibrin 

Corneal staining 

Tearing 

Keratitis 

Browache 

Corneal edema 

Mydriasis 

Epithelial punctate keratitis 

Ptosis 

Scleral malacia 

Frequency not defined 

Ocular hypertension 

Cataract 

Optic nerve damage 

Open-angle glaucoma 

Black Box Warning

Black Box Warning: 

The black box warning associated with the use of dexamethasone ophthalmic states that this medication may increase the risk of developing glaucoma, leading to irreversible vision loss. 

Prolonged use of corticosteroids, including dexamethasone ophthalmic, has been associated with an enhanced risk of glaucoma, cataracts, and secondary eye infections. The risk of these complications is more significant with higher doses, prolonged use, and in patients with a history of ocular diseases. 

Therefore, dexamethasone ophthalmic should only be used under the close observation of a healthcare professional and for the lower duration necessary to treat the condition.

Patients using this medication should check their eye pressure regularly and be monitored for signs of glaucoma, cataracts, or other ocular infections. If any of these complications occur, dexamethasone ophthalmic should be discontinued immediately. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

There are contraindications to the use of dexamethasone ophthalmic, including: 

• Viral eye infections: dexamethasone ophthalmic should not be used in patients with viral eye infections, such as herpes simplex keratitis or vaccinia. 
• Fungal eye infections: dexamethasone ophthalmic should not be used in fungal eye infections like fungal keratitis patients. 
• Mycobacterial eye infections: dexamethasone ophthalmic should not be used in patients with mycobacterial eye infections, such as tuberculosis or leprosy. 
• Hypersensitivity: dexamethasone ophthalmic should not be used in patients with a known hypersensitivity to dexamethasone or any of the components of the medication. 
• Corneal ulcers: dexamethasone ophthalmic should not be used in patients with corneal ulcers, as it may delay healing and worsen the condition. 
• Conjunctivitis caused by allergens: dexamethasone ophthalmic should not be used in patients with conjunctivitis caused by allergens, as it may worsen the condition. 
• Pediatric patients: dexamethasone ophthalmic is not recommended for use in pediatric patients, as its safety and efficacy are not established in this population. 

It is key to note that this list is not exhaustive, and other contraindications to dexamethasone ophthalmic use depend on the patient’s medical history and condition. Therefore, it is always essential to consult with a healthcare professional before using any medication. 

Caution 

There are cautions that should be taken into consideration when using dexamethasone ophthalmic. These include: 

• Glaucoma: dexamethasone ophthalmic can increase intraocular pressure in some patients, which may lead to the development or worsening of glaucoma.  
• Cataracts: Prolonged use of dexamethasone ophthalmic can lead to the development of cataracts, especially in patients with preexisting cataracts or risk factors for cataract formation. 
• Infections: dexamethasone ophthalmic can increase the risk of secondary eye infections, especially in patients with a history of herpes simplex keratitis or immunocompromised. 
• Wound healing: dexamethasone ophthalmic may delay wound healing, particularly in patients with corneal ulcers or other ocular injuries. 
• Pregnancy and breastfeeding: The safety of dexamethasone ophthalmic during pregnancy condition and breastfeeding has not been established, and its use in these populations should be carefully weighed against the potential risks. 
• Systemic absorption: dexamethasone ophthalmic can be absorbed systemically and may affect other body parts.  

It is essential to discuss these cautions with a healthcare professional before using dexamethasone ophthalmic and to follow their instructions closely during treatment. 

Pregnancy / Lactation

Pregnancy consideration:  

AU TGA pregnancy category: B3
US FDA pregnancy category: C 

Lactation:   

Excreted into human milk: Yes 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    
• Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

dexamethasone ophthalmic is a corticosteroid medication that exerts its pharmacological effects through various mechanisms. Here is an overview of its pharmacology: 

• Anti-inflammatory activity: dexamethasone is a potent anti-inflammatory agent. It acts by inhibiting the release of inflammatory mediators, such as prostaglandins, leukotrienes, and histamines. By suppressing the activity of the immune cells and reducing the production of these inflammatory substances, dexamethasone helps to control inflammation and its associated symptoms. 
• Immunosuppressive effects: dexamethasone has immunosuppressive properties, which means it can suppress the immune system’s response. This action is beneficial in treating certain eye conditions where an overactive immune response contributes to inflammation and tissue damage. By dampening immune activity, dexamethasone helps to diminish inflammation and stops further damage to the affected eye tissues. 
• Vasoconstrictive effects: dexamethasone ophthalmic can cause vasoconstriction, narrowing the blood vessels. This effect helps reduce blood flow to the inflamed area, thereby reducing swelling and preventing fluid leakage into the surrounding tissues. 
• Stabilization of cell membranes: dexamethasone stabilizes cell membranes by inhibiting the production of phospholipase A2, an enzyme responsible for releasing inflammatory mediators. By maintaining the integrity of cell membranes, dexamethasone helps limit immune cell infiltration into inflamed tissue and reduces the release of pro-inflammatory substances. 
• Retention of anti-inflammatory proteins: dexamethasone increases the production of lipocortins. These lipocortins inhibit the activity of phospholipase A2 and prevent the formation of inflammatory mediators. By promoting the retention of lipocortins, dexamethasone enhances the anti-inflammatory effects within the eye. 

Pharmacodynamics: 

Mechanism of action: The action involves inhibiting the inflammatory response to chemical, mechanical, or immunologic agents. 

Corticosteroids specifically inhibit various components of the acute inflammatory response, including edema formation, capillary dilatation, fibrin deposition, and the migration of phagocytes and leukocytes. 

Pharmacokinetics: 

Absorption 

After installing dexamethasone ophthalmic eye drops, the medication is absorbed across the conjunctiva and cornea into the intraocular tissues. The absorption can be influenced by factors such as the concentration of the eye drops, duration of contact with the eye, and the presence of ocular conditions affecting the integrity of the ocular surface. 

Distribution 

Dexamethasone, upon absorption, can distribute within the intraocular tissues, including the anterior and posterior eye segments. The drug may also penetrate the aqueous and vitreous humor, reaching therapeutic concentrations at the site of inflammation. 

Metabolism 

dexamethasone undergoes metabolism in the liver, primarily by the enzyme cytochrome P450 (CYP3A4). However, systemic metabolism is limited since dexamethasone ophthalmic is administered topically to the eye. The metabolism of dexamethasone in the eye itself needs to be better characterized. 

Elimination and Excretion 

The excretion of dexamethasone and its metabolites occurs primarily through the kidneys. However, due to the localized nature of dexamethasone ophthalmic administration, the amount of drug that reaches systemic circulation is minimal, and excretion through the kidneys is not a significant route. 

Adminstartion

Administration: 

Ophthalmic administration  

dexamethasone ophthalmic is typically administered as eye drops, and the dosage and frequency of administration may vary depending on the patient’s condition and response to treatment. Here are some general guidelines for the administration of dexamethasone ophthalmic: 

• Wash your hands thoroughly before administering the eye drops. 
• To create a small pocket, tilt your head back and slowly pull down your lower eyelid. 
• Hold the dropper tip close to your eye, but without touching it, and gently squeeze the bottle to release one drop into the pocket formed by the lower eyelid. 
• Close your eye and gently press on the inner corner of eye with your finger for 1 to 2 minutes. This helps prevent the medication from draining out of your eye. 
• If you need an addition to one drop, wait at least 5 minutes between drops. 
• Replace the cap on the dropper bottle immediately after use. 
• Avoid touching the tip of the dropper bottle to any surface, including your eye or your fingers, to prevent contamination. 
• Follow your healthcare professional’s instructions carefully for the duration of treatment, and consult them before using the medication. 

It is key to note that the administration of dexamethasone ophthalmic may vary depending on the patient’s individual needs, and these instructions should be used as a general guideline only. Always follow your healthcare professional’s specific instructions for using and administering this medication. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: dexamethasone ophthalmic 

Pronounced: [ DEX-a-METH-a-sone-off-THAL-mik ] 

Why do we use dexamethasone ophthalmic? 

dexamethasone ophthalmic is primarily used to treat various eye conditions characterized by inflammation and swelling. Some common uses of dexamethasone ophthalmic include: 

• Allergic conjunctivitis: dexamethasone ophthalmic can be prescribed to alleviate the inflammation and itching associated with allergic conjunctivitis, an allergic reaction affecting the conjunctiva. 
• Postoperative inflammation: After certain eye surgeries, such as cataract extraction, corneal transplantation, or refractive surgery, dexamethasone ophthalmic may reduce postoperative inflammation and promote healing. 
• Uveitis: It refers to inflammation of the uvea, the eye’s middle layer. dexamethasone ophthalmic can help manage uveitis by reducing inflammation and minimizing associated symptoms like eye pain, redness, and blurred vision. 
• Iritis: It is inflammation of the iris, the colored part of the eye. dexamethasone ophthalmic may be prescribed to control inflammation and relieve symptoms of iritis, such as eye redness, light sensitivity, and discomfort. 
• Scleritis: It is inflammation of the sclera, the white outer layer of the eye. dexamethasone ophthalmic can help reduce scleral inflammation, alleviate pain, and improve symptoms associated with scleritis. 

It’s important to note that a healthcare professional should determine the use of dexamethasone ophthalmic, and the specific condition being treated may require different dosages and treatment durations.