Can steroid eye drops worsen blepharitis symptoms?

Question

Hello Doctor,

I recently had a pink eye that did not improve with the first course of antibiotics. Later, an eye doctor diagnosed me with blepharitis and prescribed Oftan Dexa Chlora for a week, followed by Softacort. I switched to Softacort today. While I am not sure if my symptoms were 100 percent resolved before switching, I have noticed that Softacort (Hydrocortisone sodium phosphate) is making things worse my eyes are now more red, stingy, and extremely dry.

In addition to the prescribed drops, I have been using warm compresses and blepharitis-specific micellar water wipes to clean my eyes and lashes twice a day. Given the worsening symptoms, I’m planning to stop Softacort. However, I am wondering if I should continue tapering off with a lower dose of Oftan Dexa Chlora for a few more days since I understand that corticosteroids should not be stopped abruptly.

Kindly advise.

Answer 1

Hello,

Welcome to iCliniq.com.

I understand your concern.

Thank you for providing a detailed history it helps in assessing the situation. You are right to be cautious with steroid eye drops like Softacort and Oftan Dexa Chlora (Dexamethasone), especially when symptoms appear to worsen. Based on your description, it is advisable to stop using Softacort for now. The increased redness, stinging, and dryness suggest irritation or a possible sensitivity to the drop. Even though Softacort (hydrocortisone) is a milder steroid, adverse reactions can still occur. Since you were previously on Oftan Dexa Chlora for about a week, your eyes have already had some exposure to corticosteroids.

Regarding whether you need to taper Oftan Dexa Chlora if you used it for less than 10 days and not at a high frequency (for example, not hourly), tapering is generally not required. However, if you are using it more than three to four times daily and wish to be cautious, a short taper may help prevent rebound inflammation. You can follow a light tapering schedule like this: on day one, use it once in the morning and once at night; on day two, use it once in the morning only, then stop.

In addition to this, please continue with the supportive care measures you are already following, such as using warm compresses, blepharitis-specific micellar water eyelid wipes, and preservative-free artificial tears every few hours. Avoid contact lenses and eye makeup and reduce screen time until symptoms improve. If symptoms worsen, such as increased pain, vision changes, or discharge, do not wait until your Tuesday appointment and seek medical attention sooner.

Stop Softacort immediately due to worsening symptoms; no taper is needed for Oftan Dexa Chlora if used for less than 10 days and not frequently; a short two-day taper is optional if you have used it more often and want to be cautious; continue your current supportive measures and keep your scheduled eye appointment. I hope this clarifies your concerns.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.