Loteprednol (Lotemax, Eysuvis)

Loteprednol is a corticosteroid eye drop designed to treat eye inflammation with a lower risk of elevated eye pressure compared to traditional steroids like prednisolone or dexamethasone. It's available in several formulations for different uses.

How It Works

Loteprednol is a "retrometabolic" or "soft" steroid:

• Active in the eye where it reduces inflammation
• Rapidly converted to inactive metabolites
• Lower systemic absorption
• Lower risk of increasing eye pressure compared to other steroids

Available Formulations

Brand	Strength	Common Uses
Lotemax	0.5%	General inflammation, post-op
Lotemax SM	0.38% (gel)	Post-op inflammation
Lotemax Ointment	0.5%	Overnight use
Eysuvis	0.25%	Dry eye flares
Alrex	0.2%	Allergic conjunctivitis

Common Uses

• Post-operative inflammation (cataract surgery, LASIK)
• Allergic eye conditions
• Anterior uveitis (eye inflammation)
• Dry eye disease flares (Eysuvis)
• Lid margin treatment (blepharitis)
• Any eye inflammation requiring steroid treatment

How to Use

• Dosing: Varies by condition (typically 1-2 drops, 2-4 times daily)
• Shake well before use (suspension formulations)
• Contact lenses: Remove before use; wait 10-15 minutes before reinserting
• Duration: As prescribed—usually 1-2 weeks for most conditions
• Tapering: Often tapered rather than stopped abruptly

What to Expect

• Improvement in inflammation within days
• Complete course as prescribed
• May need taper rather than abrupt stop

Side Effects

Common

• Temporary stinging or burning
• Blurred vision (temporary)
• Eye discomfort
• Headache

Less Common (More Likely With Prolonged Use)

• Elevated eye pressure (less common than other steroids but possible)
• Cataract formation (with prolonged use)
• Secondary infection
• Delayed wound healing

Compared to Traditional Steroids

Loteprednol has lower risk of:

• Elevated intraocular pressure
• Cataract formation

However, these risks are not zero, especially with prolonged use.

Precautions

• Viral infections: Don't use for herpes simplex or other viral eye infections
• Fungal infections: Steroids can worsen these
• Glaucoma: Use with caution; monitor pressure
• Prolonged use: Requires monitoring even with "soft" steroid
• Contact lenses: Remove before use

Duration and Monitoring

Short-Term Use (1-2 Weeks)

• Usually doesn't require pressure monitoring
• Still complete course as prescribed
• May be tapered

Longer-Term Use

• Pressure checks recommended
• May still cause elevated IOP in susceptible patients
• Cataract risk with very prolonged use

Why "Soft" Steroid?

Traditional steroids (prednisolone, dexamethasone):

• Very effective but higher risk of elevated eye pressure
• Can cause "steroid response" in susceptible individuals

Loteprednol:

• Designed to be active in the eye, then rapidly inactivated
• Lower (but not zero) risk of pressure elevation
• May be preferred for patients with glaucoma risk

Frequently Asked Questions

Is loteprednol safer than other steroid drops?

Loteprednol has a lower risk of elevating eye pressure compared to prednisolone or dexamethasone. However, it's not risk-free, and monitoring is still important for extended use.

Can I use loteprednol long-term?

Loteprednol is designed for short-term use. While safer than some steroids for longer use, prolonged steroid exposure still carries risks. Discuss with your doctor.

What's the difference between Lotemax and Eysuvis?

Lotemax (0.5%) is for general inflammation and post-op use. Eysuvis (0.25%) is specifically approved for short-term treatment of dry eye disease flares.

Will loteprednol cure my eye condition?

Steroids reduce inflammation but don't cure underlying conditions. They're typically used to control acute inflammation while the underlying condition is addressed.

Can I stop loteprednol suddenly?

Often, steroids are tapered rather than stopped abruptly, especially after more than a week of use. Follow your doctor's instructions.

Should I be worried about using a steroid in my eye?

When used as prescribed for appropriate conditions, loteprednol is generally safe. The "soft" steroid design reduces risks. Follow your doctor's instructions and attend follow-up appointments.