Basic Information
Prednisolone is a synthetic corticosteroid that may be used systemically or topically. This monograph discuses the ophthalmic use of prednisolone acetate. Topical corticosteroids are used to treat inflammatory processes of the sclera, conjunctiva, cornea, and anterior chamber. Disorders of the posterior chamber and the eyelid are generally treated with systemic corticosteroids, as topical ophthalmic corticosteroids do not penetrate these structures adequately.
When choosing among ophthalmic corticosteroids, consideration should be given to relative potency, penetration, ease, and frequency of application. Prednisolone acetate has approximately four times the anti-inflammatory potency of cortisone. Dexamethasone is a more potent corticosteroid than prednisolone acetate, but prednisolone acetate has superior penetration into the anterior chamber. Prednisolone acetate is a liquid suspension which may be administered directly or through a sub-palpebral catheter.
Dogs and Cats
Prednisolone acetate is used in a wide variety of inflammatory conditions of the sclera and episclera, including scleritis, episcleritis, ocular nodular fasciitis, nodular granulomatous episclerokeratitis, proliferative keratoconjunctivitis of collies, and fibrous histiocytoma. Prednisolone acetate is used in non-ulcerative corneal disorders, including chronic superficial keratitis of dogs, and feline eosinophilic keratitis. It is the preferred orticosteroid for treatment of anterior uveitis in small animals due to the superior penetration in the anterior chamber when compared to dexamethasone.
Horses
Prednisolone acetate is used to treat anterior uveitis in the horse. Anterior uveitis or equine recurrent uveitis (ERU) is the most-common cause of blindness in the horse. The goals for medical treatment of ERU are to reduce pain and inflammation and to preserve vision. ERU flares should be treated aggressively with topical ophthalmic corticosteroids and system non-steroidal anti-inflammatory medications. Prednisolone acetate is, in many instances, the corticosteroid of choice due to the excellent ocular penetration and the ability to use it with sub-palpebral catheter.
Prednisolone acetate is also used to treat non-ulcerative corneal inflammatory diseases in the horse, including immune mediated keratophathies (IMMK) and eosinophilic keratitis. In addition to treatment with topical corticosteroids, horses with eosinophilic keratitis should be dewormed two times with Ivermectin, 10 days apart.
Side Effects
- Prednisolone acetate and other topical ophthalmic corticosteroids are generally not used in the presence of corneal ulceration. There are exceptions to this rule, but only with very careful monitoring.
- Topical ophthalmic corticosteroids may allow for corneal fungal overgrowth.
- Additional caution should be used with very small cats or dogs, as frequent topical application of corticosteroids may result in appreciable systemic absorption. Subconjunctival corticosteroids may also be absorbed systemically. Additional caution should be exercised in animal with pre-existing endocrine disease or those that are immune-suppressed.
- Prednisolone acetate and other corticosteroid ophthalmic preparations are not generally used to treat conjunctivitis in the cat. The most-common conjunctival pathogen in cats is herpes virus.
Drug Interactions
Topical ophthalmic prednisolone acetate may be used with topical ophthalmic non-steroidal anti-inflammatory drugs.
Overdose
There are no specific precautions regarding overdose with topical ophthalmic corticosteroids. Very small cats or dogs will be more susceptible to overdose.