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Emily Eye Care, LLC
Lily Yeh, OD
Aaron Lewis, OD

Home » Newsletters » Pulse Dosing in Dry Eye Treatment

Pulse Dosing in Dry Eye Treatment

You have prescribed a medicine known as Lotemax (Loteprednol), which comes as a gel drop or as an ointment.  The gel drop is a thick drop, so wait a few seconds after instilation before blinking.  Then after several blinks, the brief blur will clear.  No shaking of the bottle is required.  

Lotemax is used off-label to treat the inflammatory component of dry eye disease.  Suppressing the ocular surface inflammation is a key step in the stage for the artificial tears and fish oil to provide the most help.  We ask that you use the medicine in the following way:  

For the gel drops formulation, use one drop in each eye 4 times a day for 2 weeks, then just in the morning and evening for 4 more weeks, then stop.  It is best to turn your face straight up toward the ceiling when instilling eye drops.  

For the ointment formulation, instill a 1/4 to 1/2 inch strip into the inside of your lower eye lids at bedtime for 2 weeks, then just every other night for 2 weeks , then stop.

It takes a few weeks to get the inflammotory component of your dry eye disease controlled.  From this point, you may go for many weeks or many months where your eyes feels better.  It is very important to consistently use your artificial tears and fish oil as directed every day.

Now, after weeks or months, your eyes may become uncomfortable again.  This is called "symptomatic breakthrough."  If or when this occurs, use the eye drops 4 times a day for one week, then stop.  Or, if using the ointment, instill at bedtime for a week, then stop.  This therapeutic maneuver is called "pulse dosing," and has been shown to be very beneficial in regaining control of dry eye symptoms.  Most patients need to do this oly once or twice a year.  

Lotemax is a relatively safe corticosteroid, especially when used as describede above.  There is a slight risk that Lotemax can increase the preesure inside your eyes.  For this reason, we will monitor your eye pressure from time to time, just to be completely safe.

Always call us if you have any questions.