These eye drops and ointments contain a combination of a steroid and one or more types of antibiotic for treatment of infection and inflammation of the eye. The steroid reduces inflammation while the antibiotic treats or prevents infection which may be the cause of the infection. Examples of steroids that are used in these eye drops are hydrocortisone, loteprednol, prednisolone, and dexamethasone . Examples of antibiotics used in these formulations include tobramycin, neomycin, bacitracin, polymixin B, and gentamycin. These antibiotics have different mechanisms of action and two or three may be combined in one formulation.
Conditions which augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings. Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid.
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.