Azasite and blepharitis

[Whitesmith]

I was wondering if any of the doctors here had started prescribing Azasite for blepharitis and if they'd had any success.
Also, I was going to start an azasite/lotemax combo regimen, has anyone been combining steroids with azasite with their patients?

[John C Hagan III, MD, FACS]

Main thing with blepharitis is lid hygeine. I think it very important to use regularly TheraTears Sterilid or Occusoft FOAM EYELID cleaner.

Azasite works good with lid hygeine. Lotemax generally is not used for longer than 3-6 weeks absoute max.

JCH II MD

[Whitesmith]

I respect your opinion on steroids, but my opth has monitored my IOP for 2 1/2 years of tobradex usage and i don't appear to be a steroid responder, although i realize that i'm always in danger of developing a problem. That's why i switched to Lotemax, so that there's even less risk involved in my using it for years to come.

[John C Hagan III, MD, FACS]

IOP is not the only problem with chronic steroids the next biggest problem would be steroid cataracts.  Others thinning of eyelid skin, decreased resistance to infection or trauma.  

For just about everyone chronic steroids for blepharitis in a bad deal.

JCH II MD

[PJophthalmology]

I know many ophthalmologists and optometrists experiencing success prescribing Azasite adjunctively with Lotemax.  It clears the lids more effectively than either one by itself.  In response to Lotemax’s long term useage.  Lotemax is a reengineered analog of prednisolone.  Its every-bit as potent at the prednisolone molecule.  Molecularly speaking the designers of the Lotepredenol Etabonate molecule (Lotemax's active ingredient) removed the Ketone group from prednisolone molecule and replaced it with an Ester carbon creating an Ester Corticosteroid also know as a site-specific corticosteroid.  What this means in terms of efficacy is that Lotemax is more more lipophilic and has better corticosteroid receptor binding affinity than its ketone steroid counter parts.  Additionally, once the drug enters the eye any unbound drug is instantly and predictably metabolized.  The side effect profile is superior as there is no unbound drug floating in the aqueous as there is with Ketone corticosteroids.  Ketone steroids have been linked to adverse events such as Cataract formation and increases in intraocular pressure.  If the patient suffers from a chronic ocular inflammatory condition,  Lotemax is the only steroid that can be prescribed for long term therapy.  Studys have shown no measurable system levels after chronic installation of Lotemax.  Of course prudent medicine stipulates the patient should be monitored.  Bottom line there is no potent ocular steroid available that offers the same potent efficacy and placebo like safety that Lotemax delivers.

[John C Hagan III, MD, FACS]

"Lotemax is the only steroid that can be prescribed for long term therapy"  This statement by PDophthalmology is incorrect.

Any steroid drop can be prescribed for long term use. The question is should they be and if they are needed what is the best choice.

First many conditions such as chronic uveitis require long term therapy of strong steroids such as pred forte, vexol, FML   As with any steroid taken long term side effects are common and close monitoring is important.

Second Alrex drops have been show to have minimal side effects for long term use, likely less than Lotemax.

There is much hope for the recently released steroid Durazol which is by far the strongest antiinflammatory, steroid drop on the market,  (perhaps as 6X as strong as pred forte), the first steroid drop licensed as pain reducing and less likely to raise intra ocular pressure.

JCH MD

[steve615]

Hello, I am not a Doctor I am a patient. I received Lasik surgery in mid December (last month). My recovery went well for the first week. At 6 days post-op I got an eye infection in my right eye and then my left eye a few days later. I had been prescribed Pred Forte in pretty frequent doses (everyday 5 times a day) immediately following the Lasik procedure. I went to a different doctor for the infection (I was traveling) and he told me the Pred Fotre doses seemed excessive and could have caused my infection. I went off Pred Forte for 2 weeks and now my Lasik Dr has prescribed I go back on them for the next 4 weeks! They also made my next appointment for March 16th (6 weeks away!). This seems excessive again and a long time between followup appointments. Any advise or opinions?

[John C Hagan III, MD, FACS]

Yes, discuss your concerns with the MD that did the lasik.

JCH MD