THERAPEUTIC FOCUS

Loteprednol Ointment

This drug represents a new approach to inflammatory eye conditions.

Ron Melton, O.D., F.A.A.O., and Randall Thomas, O.D., M.P.H., F.A.A.O.

From time to time, a new formulation of an existing drug comes to market which enables a new dimension of therapeutic approaches. Such is the case with loteprednol etabonate ophthalmic ointment 0.5% (Lotemax, Bausch + Lomb), which is now available in a preservative-free ointment form. Having an ester-based, preservative-free ophthalmologic corticosteroid ointment available provides a unique opportunity to redefine a wide variety of therapeutic options.

While this product is specifically FDA-approved to treat postoperative inflammation and pain, practitioners will appreciate its clinical application across a broad-spectrum of clinical conditions. Some that we envision as being of practical application are as follows:

Dry eye

Rather than have a patient instill both Lotemax drops and a lipid-based artificial tear during the day (which we have very successfully done for many years), consider a simpler approach where you would have the patient instill a one-quarter inch ribbon of Lotemax ointment at bedtime only. This would provide good overnight lubrication while concurrently suppressing the inflammatory component. Also, doing so would diminish the daytime burden of instilling two different drops. Like the drop formulation, we would prescribe Lotemax ointment for a month, then have the patient return for a follow-up visit, which would include an assessment of intraocular pressure (IOP). Depending upon the clinical response, we would direct the patient to either stop the ointment, or continue it every other night for another month, while encouraging the patient to consistently use the artificial tears daily, usually three or four times a day.

Ocular allergies

When signs, such as conjunctival hyperemia, chemosis and eyelid edema accompany symptomatic itching, a topical corticosteroid may best serve the patient. As with any other condition, such as dry eye, blepharitis, etc., clinical studies have shown ester-based loteprednol is well tolerated and lessens the risk of cataract or induced elevations in IOP. Rather than using drops by day, perhaps just using Lotemax ointment at bedtime would be a better approach. This approach of shifting diurnal topical therapy to nocturnal therapy could be a major advantage to many patients.

Other conditions

Some other conditions that may benefit from nocturnal Lotemax therapy vs. diurnal drop therapy include giant papillary conjunctivitis, stromal herpes keratitis, chronic uveitis, prevention of corneal transplant rejection, Thygeson's superficial punctate keratopathy, inflammatory blepharitis, recurrent corneal erosion, contact blepharodermatitis, episcleritis, supplemental therapy for advanced cases of acute uveitis, instillation following topical Betadine therapy for acute epidemic keratoconjunctivitis and similar chronic, and/or recurrent inflammatory conditions.

Due to the safety profile of this ester-based formulation, there are other inflammatory eye conditions in which Lotemax can play an important chemotherapeutic role.

Be ever vigilant in looking for new and improved therapeutic approaches to enhance patient care. We hope these observations will stimulate you to innovative approaches in your patient care. OM

The authors report no financial relationship with Bausch + Lomb.

Dr. Melton is in a group practice in Charlotte, N.C. He has staff privileges at Presbyterian Hospital and is an adjunct faculty member at the Indiana University School of Optometry, in Bloomington, Ind. Dr. Thomas is in a group practice in Concord, N.C. He is the Ophthalmic Drug Consultant for the Pharmacy and Therapeutics Committee of North Carolina Blue Cross and Blue Shield. Both doctors have authored many articles. Send comments to optometricmanagement@gmail.com.