fluorometholone: clinical use

Prescribing considerations

• Confirm that inflammation is corticosteroid-responsive and exclude ocular infection before prescribing.
• Extended use requires ophthalmic surveillance because corticosteroids can raise intraocular pressure, cause cataract, delay healing and promote secondary infection.
• Use particular caution with glaucoma or previous herpes simplex keratitis; specialist follow-up and slit-lamp examination may be required.
• Assess persistent visual disturbance for cataract, glaucoma, corneal disease or central serous chorioretinopathy.

Contraindications and cautions

• Hypersensitivity to fluorometholone or an excipient.
• Most viral diseases of the cornea or conjunctiva, including epithelial herpes simplex keratitis, vaccinia and varicella.
• Mycobacterial, untreated bacterial or fungal ocular infection.
• An undiagnosed red eye, which may represent viral infection.

Monitoring

• Intraocular pressure during extended treatment or in susceptible patients.
• Visual acuity and fields, optic-nerve status and cataract development where clinically indicated.
• Corneal healing and evidence of masked, secondary or worsening infection.
• New blurred, distorted or otherwise disturbed vision.

Clinical pharmacology

Fluorometholone is a synthetic glucocorticoid that binds cytoplasmic receptors and modifies inflammatory-mediator synthesis. After topical administration, it penetrates the cornea and is partly metabolised within ocular tissues.

Formulation and product differences

• The selected product is a white multidose suspension and requires shaking.
• It contains benzalkonium chloride, which may irritate the eye and be absorbed by soft contact lenses.
• It contains phosphate buffers; very rare corneal calcification has occurred with phosphate-containing drops in severely damaged corneas.
• Discard the bottle 28 days after first opening and protect it from contamination.