Problems stopping FML drops

[alifml]

Dear Doctor

I am a 34 year old female. In April (approx 4 months ago) I was prescribed FML 0.1% steroid drops for inflammation associated with contact lense use. The specialist  noted some punctate keratopathy on the surface of the cornea and market conjunctival infection, which has settled with FML. I was initially taking them 3 times per day for the first month, and then 2 times per day.

I  was not advised that I would have to taper off slowly, so when I felt better, I stopped taking them. Each time I tried this, I got terrible headaches, the whole area surrounding my eye would feel swollen, and my thinking and cognitive functioning were affected. This has happened a few times, when I tried to stop/reduce the dosage. Eventually on the advice of my optometrist, I found another specialist, and have learnt that I must taper off.

About 2-3 weeks ago, I managed to reduce the dose to 1 drop every 2-3 days. I thought this was infrequent enough, so decided to stop. This was a big mistake, and the headaches/swelling came back after about 5 days. My new specialist advised that I might have to go back to 2 drops per day, which I have done.

Thankfully I am nearly feeling normal again, but I really don't like this, as I feel my eyes have become dependent on the steroids and I can't get off. I'm a bit worried also because I've been on FML for so long, and want to get off due to the risks related to long-term use.

Can you please offer some advice as to the best way to wean myself off this FML drug. Obviously stopping too quickly is not good for me, but I am worried I am becoming addicted through overuse. In the past, when I was on 2 drops per day for about 1-2 months, then reduced to 1 drop per day for 1-2 months. Would you recommend taking it so slowly again? Also, I have extremely dry eyes. Should I use saline eyedrops concurrently with FML?(I have Thera Tears, which was recommended by my optometrist)

[alifml]

Dear Dr Feldman

Thank you for your reply. It helps a bit to know what sort of timeframe I am looking at, although this is not great news for me that it can take a while to taper completely. I am not too sure though, if you're thinking 1 month, or more like 3-4 months at 1 drop per day? (These both seem long to me, so I'm just wondering how long is long).

The earliest appointment I can get with my eye specialist is in November! I will try to get some advice on a timeframe via the phone, but I really hate to be a nuisance.

Thanks, Dr.

[Sandy Feldman, MD, MS]

Dear Alifml,

I would recommend that you undergo evaluations and assistance from the eyeMD in the tapering process. Sometimes, it is hard for individuals to be tapered completely off of the steroid eyedrop.  You might need to continue once a day for quite awhile before complete taper is possible.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California