Dexamethasone Ophthalmic Suspension for Eye Inflammation: An Overview

Overview:

Inflammation is a typical aftereffect of most ocular procedures, including cataract surgery, despite advancements in surgical methods and equipment. Untreated post-operative inflammation increases the risk of posterior capsule opacification, macular edema (fluid accumulates in the macula), secondary glaucoma (increased pressure in the eye), synechia development (abnormal adhesion between two normally separate body parts or structures), raised intraocular pressure, and photophobia (light sensitivity of the eyes). Corticosteroids are frequently used as the mainstay of care to manage pain and inflammation following surgery. One medicine used to treat various eye disorders, especially those involving inflammation, is Dexamethasone ophthalmic solution. The FDA (Food and Drug Administration) approved a Dexamethasone ophthalmic insert for the treatment of ocular pain recently on the 3rd of December 2018.

Drug Group: Corticosteroid (glucocorticoid) classification.

Available Doses and Dosage Forms:

Dexamethasone ophthalmic suspension is usually available in several strengths; the dose will depend on the ailment being treated and the degree of inflammation. Typical concentrations include the following:

• Dosage forms for 0.1 percent Dexamethasone ophthalmic suspension.

• Form: The most common form of Dexamethasone ophthalmic suspension is a liquid eye drop solution.

What Is Eye Inflammation?

Ocular inflammation, or eye inflammation, is the term used to describe the body's defensive reaction to an injury, infection, or eye irritation. It is a complicated biological process that involves the production of several inflammatory mediators and immune system activation. Common symptoms of eye inflammation include pain, redness, swelling, and discomfort. Several areas of the eye, including the conjunctiva (conjunctivitis), cornea (keratitis), and uvea (uveitis), can become inflamed. Several things, including autoimmune disorders, allergies, trauma, and infections, can cause ocular inflammation.

How Does Dexamethasone Ophthalmic Suspension Work?

The synthetic corticosteroid Dexamethasone has strong anti-inflammatory and immunosuppressive qualities. When administered topically as an ophthalmic solution, Dexamethasone functions as follows:

1. Suppressing Inflammation: Dexamethasone lowers the immune cells' activity in the inflammatory response and prevents the production of inflammatory mediators. This aids in reducing eye redness, swelling, and other inflammatory symptoms.

2. Inhibiting Immune Responses: Dexamethasone helps regulate immune-mediated processes that lead to inflammation by inhibiting the immune system in the eye. This is especially crucial when the immune system unintentionally attacks healthy eye tissues.

3. Relieving Symptoms: Dexamethasone ophthalmic solution is used to reduce discomfort and enhance the general health of the eye by easing the symptoms of several inflammatory eye disorders.

What Is the Dosage of Dexamethasone Ophthalmic Suspension?

Dexamethasone ophthalmic suspension is usually administered as eye drops. 0.1 percent is the typical concentration. Here are a few broad recommendations:

1. For Adults and Kids Over Two Years of Age:

• Drops: For the first several days, apply one to two drops to the afflicted eye every three to four hours. After that, taper off at a lesser frequency as the doctor prescribes.

• Ointment: Apply a tiny bit of ointment once or twice a day to the inside of the lower eyelid.

2. For Infants and Young Children: The doctor will establish the appropriate dosage for newborns and young children, which may be less than that of adults.

How Effective Is Dexamethasone Ophthalmic Suspension?

Dexamethasone ophthalmic suspension is a highly effective drug for treating inflammation of the eyes. It is one of the frequently preferred drugs for this ailment. It can considerably lessen ocular edema, redness, and irritation, which various studies prove. Depending on what is causing eye irritation, Dexamethasone ophthalmic solution may or may not be beneficial. It generally works best to alleviate inflammation brought on by allergies, ocular trauma, and certain eye disorders.

What Are the Things to Inform the Doctor Before Taking the Drug?

Before using Dexamethasone ophthalmic solution, it is crucial to inform the physician of:

1. Whatever allergies one may have, particularly those involving medications or preservatives.

2. Additional prescriptions, over-the-counter drugs, vitamins, and herbal supplements are used.

3. Any illnesses, particularly diabetes (elevated blood sugar level), cataracts (cloudy lens), or glaucoma (elevated eye pressure).

4. If nursing a baby, pregnant, or planning pregnancy.

5. Before prescribing it, the doctor will consider the advantages and disadvantages of Dexamethasone ophthalmic suspension.

How Is Dexamethasone Ophthalmic Suspension Administered?

The prescription form determines how Dexamethasone ophthalmic suspension is administered:

1. Drops:

• The hands should be well-cleaned.

• To make a pouch, tilt the head back and gently pull down the lower eyelid.

• Squeeze one or two drops into the pouch while holding the dropper above the eye.

• To disperse the medication, close the eyes and push firmly on the inner corner for a few seconds.

• Keep the dropper's tip away from eyes and other surfaces.

• Wash hands again.

2. Extra Advice:

• When taking the drug, do not use contact lenses.

• Never take more medicine than is recommended.

• Never give the drug to another person.

• The drug should be kept at room temperature.

• Once the drug has expired, throw it away if not used.

What Are the Side Effects of Dexamethasone Ophthalmic Suspension?

Drug combinations, including steroids and anti-infectives, have occasionally caused adverse responses that have been linked to either the combination, the anti-infective ingredient, or the steroid component. There are no precise incidence statistics available.

1. Common Side Effects:

• Burning or stinging of the eye (usually mild and temporary).

• Blurred vision (usually temporary).

• Eye irritation (redness, itching).

• Increased pressure in the eye (glaucoma) (risk increases with prolonged use).

• Cataract formation (risk increases with prolonged use).

2. Less Common Side Effects:

• Eye infection.

• Delayed wound healing.

• Skin rash around the eyes.

• Headache.

• Dry mouth.

3. Rare Side Effects:

• Increased risk of fungal infection.

• Hives.

• Swelling of the face, throat, or tongue.

• Difficulty breathing.

4. Dietary Considerations: Although Dexamethasone ophthalmic suspension does not require any particular dietary restrictions, a healthy and balanced diet is usually advised. Here are a few broad recommendations:

1. Eat many fruits and vegetables high in antioxidants and vitamins that promote general health and may help lower inflammation.

2. Select whole grains over processed grains because they include fiber, which improves intestinal health and helps control blood sugar levels.

3. Reduce processed meals, sugar-filled beverages, and unhealthy fat intake since they can aggravate inflammation and cause other health issues.

4. Excessive water consumption benefits general health and may alleviate dry eye, which is a possible adverse reaction to Dexamethasone ophthalmic solution.

5. Missed Dose:

Apply the medication as soon as remembered unless it is close to the next scheduled dose. If the next dose is imminent, skip the missed application and resume the regular schedule. Do not double-dose to compensate for a missed application. Consistent use of Dexamethasone ophthalmic suspension is crucial, so consult the doctor if frequently missed doses.

6. Overdose:

An overdose with Dexamethasone ophthalmic suspension is unlikely. Nonetheless, accidental application of excess medication might cause the following.

• Blurred vision.

• Increased eye pressure.

• Eye irritation.

Seek immediate medical attention if an overdose is suspected.

7. Storage

Store upright at eight degrees Celsius to 25 degrees Celsius (46 to 77 degrees Fahrenheit). Dexamethasone ophthalmic suspension is good until the bottle's expiration date after opening. To avoid contamination, keep the dropper tip away from any surface, especially the eyes. The dropper can introduce germs into the solution if it is contaminated.

For Doctors:

Indication:

Steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe, such as the following: corneal injury from chemical, radiation, or thermal burns; acne rosacea; allergic conjunctivitis; superficial punctate keratitis; herpes zoster keratitis; iritis; cyclitis; and selected infective conjunctivitis when the inherent risk of steroid use is accepted to obtain an appropriate diminution in edema and inflammation.

Dose:

The exact dosage of Dexamethasone ophthalmic suspension may change depending on the patient's unique circumstances, the ailment being treated, and the degree of inflammation. Usually, the dose is stated as the quantity of drops to be administered and how often.

Typically, 0.1 percent Dexamethasone ophthalmic solution is used as the standard concentration. One or two drops may be injected into the afflicted eye(s) a specified number of times daily as part of the standard dosage regimen.

Dosing Considerations:

• Customized Care: Depending on the patient's reaction to therapy, the particular eye disease, and any underlying medical issues, the dosage and length of treatment may be changed.

• Avoid Extended Use: Dexamethasone ophthalmic solution for an extended period might cause cataract development, elevated intraocular pressure, and other side effects. The length of the therapy is usually kept to a minimum to prevent these issues.

• Monitoring: To monitor the patient's development, evaluate the efficacy of the treatment, and make any required modifications to the dose or treatment plan, the healthcare practitioner may arrange for routine follow-up consultations.

• Contact Lenses: A patient who uses contact lenses may be told to take them out before administering the eye drops. The medicine may be absorbed via contact lenses, which would lessen its potency.

• Effects on the System: Dexamethasone ophthalmic solution is mainly intended for topical use, but some drugs may enter circulation. While topical ophthalmic treatments typically have very little absorption, medical professionals may consider systemic effects when prescribing them to certain patients.

What Are the Pharmacological Aspects of Dexamethasone Ophthalmic Suspension?

1. Pharmacodynamics:

• Anti-Inflammatory: Dexamethasone is a synthetic glucocorticoid with strong anti-inflammatory properties. By inhibiting several aspects of the inflammatory response, it lowers ocular inflammation in the setting of the ophthalmic solution.

• Immunosuppressive Activity: Due to its immunosuppressive qualities, Dexamethasone can reduce the activity of immune cells that contribute to inflammation. This aids in the management of inflammation in diseases like uveitis.

• Diminishment of Edema: Dexamethasone can diminish swelling by lowering blood vessel permeability, a characteristic of inflammation in general.

• Inhibition of Immune Mediators: Dexamethasone stops the inflammatory cascade by preventing the production of inflammatory mediators such as prostaglandins and cytokines.

2. Mechanism

• Glucocorticoid Receptor Binding: Using the glucocorticoid receptor binding mechanism, Dexamethasone interacts with intracellular glucocorticoid receptors in target cells. Thus, a steroid-receptor complex is formed.

• Transrepression and Transactivation: There are two ways in which the steroid-receptor complex can enter the cell nucleus and function: transrepression and transactivation. While transactivation entails directly activating anti-inflammatory genes, transrepression suppresses pro-inflammatory transcription factors.

• Inhibition of Inflammatory Gene Expression: Several genes implicated in the inflammatory response have their expression generally inhibited. This comprises enzymes manufacturing inflammatory mediators, genes encoding inflammatory cytokines, and other elements.

• Suppression of Immune Responses: By preventing immune cells that contribute to inflammation, such as T lymphocytes and macrophages, from activating, Dexamethasone can suppress immunological responses.

3. Pharmacokinetics

• Absorption: When Dexamethasone is given topically to the eye as an ophthalmic solution, it is absorbed via the cornea.

• Distribution: The medication acts locally by dispersing into the tissues of the eyes. Topical ophthalmic medication delivery results in very little systemic absorption.

• Metabolism: The hepatic metabolism of Dexamethasone results in inactive metabolites.

• Excretion: The medication passes mostly through the urine along with its metabolites.

• Half-Life: Dexamethasone has a comparatively short half-life in the eye, requiring many daily doses to maintain therapeutic benefits.

4. Toxicity:

• Increased Intraocular Pressure (IOP): Extended use of Dexamethasone and other corticosteroids can cause an increase in IOP. This is concerning, particularly in those who already have glaucoma. It is critical to check intraocular pressure regularly while receiving therapy.

• Cataract Formation: Long-term corticosteroid usage may be linked to cataract formation. Patients who have used Dexamethasone ophthalmic solution for a long time must closely check their cataract development.

• Corneal Thinning: In individuals whose corneal integrity is impaired, prolonged use of corticosteroids may result in corneal thinning.

• Secondary Infections: Because corticosteroids suppress the immune system, there may be a higher chance of secondary infections. Patients should be kept on the lookout for any indications of infection, and if one does develop, treatment plans may need to be modified.

• Systemic Absorption: Although Dexamethasone from ophthalmic formulations normally has very little systemic absorption, it can happen, particularly in those with impaired corneal integrity or after long-term treatment. Adrenal suppression is one of the systemic adverse effects that may result from this.

Clinical Studies:

The most often reported adverse effects in clinical trials using Dexamethasone ophthalmic solution were ocular pain, which affected about ten percent of patients, and eye irritation, which affected about one percent of patients. Less than one percent of the adverse responses seen in these investigations included keratitis, conjunctivitis, dry eye, photophobia, impaired vision, ocular pruritus, increased lacrimation, aberrant ocular sensation, crusting of the eyelid edge, and ocular hyperemia.

What Are the Contraindications of Dexamethasone Ophthalmic Suspension?

It is contraindicated to be used in cases of acute, untreated bacterial infections, mycobacterial ocular infections, epidermal herpes simplex (dendritic keratitis), fungal diseases of the ocular structures, varicella, vaccinia, and most other viral diseases of the cornea and conjunctiva, as well as in individuals who have demonstrated hypersensitivity to any of the preparation's ingredients.

Warnings and Precautions:

• Glaucoma: Increased intraocular pressure (IOP) from prolonged usage of Dexamethasone ophthalmic solution can cause glaucoma. It is advised to regularly measure IOP, particularly in those who already have glaucoma.

• Cataract Formation: Long-term usage of corticosteroids, such as Dexamethasone, may be linked to cataract formation. It is crucial to get regular eye exams to check for the development of cataracts.

• Infections: By inhibiting the immune system, corticosteroids raise the possibility of developing secondary infections. Patients should be kept an eye out for any indications of infection, and if one does emerge, corticosteroid dosage may need to be changed.

• Corneal Thinning: Prolonged usage may cause corneal thinning in patients with impaired corneal integrity.

• Contact Lenses: Preservatives in the ophthalmic solution may be absorbed by contact lenses. It is important to advise patients who wear contact lenses to take them out before administering the eye drops.

• Adrenal Suppression: Systemic absorption of Dexamethasone is possible, particularly in patients with impaired corneal integrity or after extended administration. This might result in adrenal suppression, especially under pressure. Potential systemic effects should be considered, particularly for people with diabetes or other medical problems.

• Use in Children: It is unclear if Dexamethasone ophthalmic suspension is safe or effective for children. It is advisable to employ caution and close supervision while working with minors.

What Are the Drug Interactions of Dexamethasone Ophthalmic Suspension?

Dexamethasone ophthalmic solution typically has a low systemic absorption rate when given topically to the eye. Interactions are still possible, though. Among the things to think about are:

• Other Ophthalmic drugs: There may be a higher chance of adverse effects if you use other ophthalmic drugs, particularly ones that contain corticosteroids.

• Systemic Corticosteroids: Using systemic corticosteroids concurrently may make systemic adverse effects more likely.

• CYP3A4 Inducers and Inhibitors: The hepatic enzyme CYP3A4 is responsible for the metabolism of Dexamethasone. Dexamethasone levels may be impacted by concurrent use of CYP3A4 inducers, which speed up metabolism, or inhibitors, which slow metabolism.

• Insulins and Oral Hypoglycemics: Corticosteroids can raise blood sugar levels. Antidiabetic drug dosage modifications may be necessary for diabetic individuals using insulin or oral hypoglycemics.

• Live Vaccines: The immune response to live vaccinations may be hampered by the immunosuppressive effects of corticosteroids. Do not get live vaccinations while using Dexamethasone ophthalmic suspension.

Specific Considerations:

1. Pregnancy: Using Dexamethasone ophthalmic suspension while pregnant is advised only in cases where the mother's possible benefits outweigh any possible risks to the developing fetus or embryo. There are no sufficiently researched expectant mothers. On the other hand, frequent or continuous use of corticoids during pregnancy has been linked to a higher risk of intrauterine growth retardation. Children born to moms who took high doses of corticosteroids throughout their pregnancies need to be closely monitored for hypoadrenal symptoms.

2. Nursing Mothers: Human milk contains corticosteroids that have been given systemically. These drugs may stunt growth, disrupt the body's natural synthesis of corticosteroids, or have other undesirable consequences. Whether systemic absorption of topical corticosteroids may be high enough to create measurable levels in human milk is unknown. Care should be taken while giving Dexamethasone ophthalmic suspension to a breastfeeding woman since a lot of medications are excreted in human milk.

3. Pediatric Patients: The efficacy and safety of Dexamethasone ophthalmic suspension have been demonstrated in pediatric patients. Evidence from appropriate and well-controlled studies of Dexamethasone ophthalmic suspension in adults and safety data from additional acceptable and well-controlled trials in pediatric patients supports using Dexamethasone ophthalmic suspension in all pediatric age groups.

4. Senior Usage: There have been no discernible general changes in safety or efficacy between older and younger patients.