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SENSORY ORGANS › OPHTHALMOLOGICALS › ANTIINFLAMMATORY AGENTS › Corticosteroids and mydriatics in combination
fluorometholone and mydriatics
S01BB03
Forms & Strengths
- Fluorometholone ophthalmic suspension 0.1% (single‑agent)
- Fluorometholone ophthalmic ointment 0.1% (single‑agent)
- Combination eye drops containing Fluorometholone 0.1% + Mydriatic (e.g., Phenylephrine 2.5% or Tropicamide 0.5%)
Adult Dosing
- Fluorometholone 0.1%: 1‑2 drops to the affected eye(s) QID; taper after 1‑2 weeks
- Combination (steroid + mydriatic): 1 drop QID for post‑operative inflammation with pupil dilation
- Mydriatic component: single dose of 1 drop, may repeat in 15 min for adequate dilation
Pediatric Dosing
- Fluorometholone 0.1%: 1 drop BID in children ≥2 years; avoid prolonged use
- Combination drops: 1 drop BID; discontinue if IOP rises
- Mydriatics (tropicamide 0.5%): single dose; monitor for systemic anticholinergic effects
Indications
- Post‑operative ocular inflammation
- Allergic conjunctivitis
- Anterior uveitis/iritis
- Corneal epithelial defects with inflammation
- Diagnostic pupil dilation and cycloplegia for slit‑lamp examination
- Pre‑ and post‑intraocular surgery to prevent synechiae
Mechanism of Action
- Fluorometholone: binds glucocorticoid receptor → ↓ phospholipase A2, ↓ prostaglandin & cytokine synthesis
- Mydriatic (tropicamide): competitive muscarinic antagonist → iris sphincter relaxation
- Mydriatic (phenylephrine): α1‑adrenergic agonist → iris dilator muscle contraction
Contraindications
- Active ocular viral, fungal, or tubercular infection
- Known hypersensitivity to fluorometholone or the mydriatic agent
- Uncontrolled glaucoma or ocular hypertension
- Recent corneal ulcer without adequate antimicrobial coverage
- Systemic corticosteroid contraindication (e.g., systemic fungal infection) for steroid component
Adverse Reactions
- Elevated intra‑ocular pressure
- Cataract formation with long‑term use
- Delayed wound healing
- Transient stinging, burning, or blurred vision
- Allergic contact dermatitis
- Secondary ocular infection
- Systemic anticholinergic effects (dry mouth, tachycardia) from mydriatics
Drug Interactions
- Systemic CYP3A4 inhibitors may increase steroid exposure
- Topical NSAIDs may increase risk of corneal melt when combined
- Phenylephrine may potentiate hypertensive crisis with MAO inhibitors or tricyclic antidepressants
- Anticholinergic drugs may enhance cycloplegic effect
- β‑blocker eye drops may diminish phenylephrine‑induced mydriasis
Curated Content: Needs Vetting Before Put to Clinical Use