Fluorometholone acetate: Safe, effective for mild to moderate inflammation

Issue: March 1998

ByBobby Christensen, OD FAAO

Flarex (fluorometholone acetate 0.1%, Alcon) and eFLone (fluorometholone, Ciba Vision Ophthalmics) are useful when inflammation is mild to moderate and the risk of the inflammation escalating is minimal. Anterior uveitis from trauma, mild chemical inflammation and postoperative treatment of photorefractive keratectomy (PRK) are specific cases for which I would consider using this steroid.

Flarex/eFLone is supplied in 2.5 mL, 5 mL and 10 mL eye drop dispensers and is preserved with 0.01% benzalkonium chloride. Patients should be directed to shake the bottle for 10 to 15 seconds before instilling the drop, because it is a suspension.

As with any steroid, be cautious if you suspect the patient may have a viral or fungal infection. It can be used in conjunction with an antibiotic for patients with a bacterial infection if the inflammation warrants the use of a steroid. When possible, I would rather hold off on the steroid use until the bacterial infection is under control.

Treating specific conditions

For mild to moderate anterior uveitis, use one drop 4 times daily with homatropine 2% twice daily for 5 to 7 days. Clinical judgment is needed here. If the eye is mildly inflamed, use one drop 4 times daily; however, if symptoms and objective findings are significant, you may use one drop as often as every 2 hours. Then re-examine, and if the eye is calm, discontinue the homatropine and taper the Flarex/eFLone over the next 3 to 5 days.
For grade 3 to 4 giant papillary conjunctivitis, use one drop four times daily for 5 to 7 days, Crolom (cromolyn sodium, Bausch & Lomb) four times daily for 2 weeks, saline rinses twice daily for 1 week and cold compresses twice daily for 10- to 15-minute applications until the itch subsides. Also, discontinue contact lens wear. After the first week, taper the fluorometholone acetate over the next 3 to 5 days, and continue the Crolom twice daily for 2 weeks. Discontinue the saline rinses when matter ceases to accumulate in the nasal canthus.
For ultraviolet or mild chemical burn, use one drop four times daily for 2 to 7 days, depending on the extent of the injury. Homatropine may be added to reduce ciliary spasm and the chance of secondary anterior uveitis. Use lubrications as often as every hour initially.
For vernal conjunctivitis (third choice), pulse dose every 2 hours for 1 to 2 days, then four times daily for 7 to 14 days and taper over the next 7 days.
For postoperative treatment of PRK, the dosage varies depending on the surgeon and the patient's healing response. Flarex/eFLone may be used the first month, and FML 0.1% (fluorometholone, Allergan) or Fluor-Op (fluorometholone ophthalmic suspension, Ciba Vision) may then be substituted for treatment during the next 3 months.
For nodular episcleritis, use one drop four times daily for 7 to 14 days and taper.

Low risk of elevated IOP

Flarex/eFLone is the steroid of choice for inflammatory conditions requiring less aggressive treatment. Clinical studies demonstrated less risk of increased intraocular pressure (IOP) during short-term treatment with fluorometholone acetate when compared to dexamethasone. Patients with glaucoma requiring treatment with a steroid may have less chance of IOP increase with the use of fluorometholone acetate. If IOP increases while using Pred Forte (prednisolone acetate, Allergan), consider switching to Flarex/eFLone.

If you note grade 1 or 2 cells or flare in the anterior chamber after trauma, Flarex or eFLone in conjunction with homatropine 2% will usually calm the eye within 2 to 4 days, depending on the extent of trauma. When an intermediate-strength steroid is needed, Flarex or eFLone is my choice.

For Your Information:

Flarex is available from Alcon Laboratories, 6201 South Freeway, Fort Worth, TX 76134; (800) 757-9195; fax: (817) 551-8893.

eFLone is available from Ciba Vision Ophthalmics, 11460 Johns Creek Parkway, Duluth, GA 30097-1556.