EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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April 2012 EW CORNEA 63 servative "may counteract the posi- tive anti-inflammatory effects" of the topical medication. "When I'm referred patients with major irritation in the eye, the first thing I want to know is what they've been treated with," he said. His group studied a cohort of 31 patients with chronic ocular surface disease who had been treated with preserved steroids, topical cy- closporine 0.05%, or both.1 In this study of recalcitrant ocular irrita- tion, patients were switched to a "very weak unpreserved steroid— 0.01% dexamethasone." Only four patients (13%) reported no improve- ment in symptoms, with most (n=20; 65%) showing 50-100% improvement. "Just by switching to an unpre- served steroid—and an extremely weak one at that—patients had huge improvements in their symptoms," Dr. Udell said. Stepwise treatments Lubricating eye drops will likely be a starting point for many clinicians, Dr. Udell said. Next, he suggests using a combination antihistamine/ mast cell stabilizer. If the first combi- nation drug is unsuccessful, Dr. Udell recommended switching to another combination drug. "But a short pulse of steroids in a very severe case for a short time is fine," he said. "If combination drugs aren't working, I'll move them to a steroid and taper quickly to get them on a safer drug." He tries to avoid vasoconstrictor drugs—"the chronic use of them is almost as bad as drops with BAK be- cause of the rebound effect," he said. On a routine basis, Dr. Bielory prefers drops with once- or twice- daily dosing. "Once-daily drops—even those that are preserved—are better than those that are twice- or four-times daily," he said. But preservatives will continue to be a "double-edged sword," he said. "They prevent the active ingre- dient from being contaminated with microbial organisms, which would cause a secondary inflammation or infection, but the preservative used may in and of itself cause the chronic irritation," he said. And because using preservatives keeps the costs down, Dr. Bielory believes preservatives will continue to be present in most allergy medications. For those patients with more severe chronic forms or for those who can't tolerate the preservative, single-unit dosing (and therefore, non-pre- served dosing) may be preferable. EW Reference 1. Jonisch J, Steiner M, Udell IJ. Preservative- free low-dose dexamethasone for the treat- ment of chronic ocular surface disease refractory to standard therapy. Cornea. 2010;29(7):723-6. Editors' note: Dr. Bielory consults for ophthalmology. Dr. Udell has financial interests with Merck (Whitehouse Station, N.J.). Contact information Bielory: Bielory@envsci.Rutgers.edu Udell: nrubinst@nshs.edu Your ASCRS membership now lets you take the ASCRS Symposium home. With the new ASCRS MediaCenter all the highlights of ASCRS 2011 are now right on your computer. Films, papers and posters exactly as they were presented in an easy-to-use and fully-searchable format. See what you missed or re-visit what you liked most. Search by topic, presenter or key-word. It's the best of ASCRS without leaving home. Log in at www.ascrs.org and click on ASCRS MediaCenter in the left-hand column for complete access. Make your ASCRS membership work harder! Begin learning today!