Alrex safety long-term

[CMVconcern]

one doctor was kind enough to respond briefly in the free forum but I was looking for a bit a more substantive answer if possible.

I have ocular rosacea along with eye allergies. They seem to wax and wane, in that it'll be a big issue for a point in time, and then it will just sort of...resolve, without my doing much of anything. Unfortunately it's come back. I've used Alrex on and off with some regularity for the past years, ever since being first prescribed it by an eye doc in 2007 or so. I've gone in regularly every few months for eye exams, pressure check, etc--never any problem.

I went back to an eye doc and he wanted to wean me off the Alrex and onto Lastacaft. The problem is that Lastacaft does nothing, and Alrex continues to be my silver bullet--it fixes the eye pain (which can make it difficult to read at night, etc), and it also clears up the redness, which is socially a real obstacle.

I don't want to give up the ONE thing that I;v'e found that works, for no reason! I spent a great deal of time looking up studies online, and so far the main one I've found (which is also cross-referenced and discussed in many other places, as recently as two years ago) is this one:
http://www.ncbi.nlm.nih.gov/pubmed/14722462
and here:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/modernmedicine/modern-medicine-feature-articles/steroid-safe-first-line-ther
Seems to me Alrex actually is a 'safe' / 'soft' steroid that doesn't cause glaucoma, raised IOP, or cataracts any more than placebo would?! I've also changed my diet significantly, started drinking tons of water, cut out alcohol, all with no noticeable effect on the ocular rosacea.
Anyone have professional feedback one way or the other? Based on what I've found *I* would be comfortable using Alrex regularly while this continues to be a problem, whether that's months or even years--say once a day, each eye, twice on terrible days...along with, say, every-3-months check-ups...

[CMVconcern]

Or, in the case of potential cataract formation, if this is something that could be measured early on via regular check-ups, and therefore I would quit the Alrex at that point...

[CMVconcern]

Thanks Doreen! I most certainly would go to get all of this checked however often he thinks is best, even once a month. I don't want to mess around with my eye health (but I also don't want to walk around with crazy red eyes all day and night!)

I guess the only lurking fear I had is whether any damage might be done through use that wouldn't be 'caught' through even regular check-ups. Like, say I used Alrex for 6 months, and then the rosacea got better and I stopped...and during those 6 months I was 'all clear' re: pressure, cataracts, etc...could those problems arise months or years later, as a result of the Alrex use? Or is this just paranoia on my part ;)

[Doreen Fazio, M.D.]

As long as you are being monitored for the side effects of chronic steroid use (elevated eye pressure, cataracts, infection), I do not feel it would be harmful to continue on Alrex.  It is a safer steroid, metabolized quickly, and thus has a lower propensity to cause the problems mentioned above.  You should be monitored carefully by an ophthalmologist.

[CMVconcern]

I guess the real question also is this:
I'm not asking for 100% assurance that Alrex never causes any of these things, in any case (though that study is fairly reassuring on this point).
BUT, provided I was willing to go see the doc every 3 months while using Alrex for all related tests re: eye health, would this be considered a 'safe' course? Obviously if anything like elevated pressure, etc, seemed apparent, I would stop the Alrex cold. But if I get myself monitored while using it, and this is not happening, would I then be in the clear (small pun intended)?