ER doc with question: Hydrocortisone cream for eyelids?

[Angry Birds]

ER doctor here... Could use your expert opinion here. I know eye steroids are a big no-no without an ophthalmologist. But, what about hydrocortisone cream 1% for eyelid swelling (which I am assuming is blepharitis)? Considering it's only 1% and it's on the eyelid, not on the eyeball, is there a problem with this even if given for a longer period of time?

(Keep in mind my question is less about the treatment for blepharitis and more about the risk of hydrocortisone 1% cream to the eyelids.)

Thanks for your input.

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[foureyes]

Although medical advice is forbidden TOS, this is an educational question so I'll chime in. I would forgo the non-ophthalmic hydrocortisone ointment. A better choice would be something like FML ophthalmic ointment or Lotemax ophthalmic ointment (preservative free). However, since both are brandname, could be costly depending on the patient's pharmacy coverage.

An additional benefit of lotemax (ester-based corticosteroid) is less prone to causing eye pressure issues and early cataracts in the appropriate uses that the ketone type of corticosteroids.

 

[doctalaughs]

Protopic and elidel are your friends.


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[wildcat07]

ER doctor here... Could use your expert opinion here. I know eye steroids are a big no-no without an ophthalmologist. But, what about hydrocortisone cream 1% for eyelid swelling (which I am assuming is blepharitis)? Considering it's only 1% and it's on the eyelid, not on the eyeball, is there a problem with this even if given for a longer period of time?

(Keep in mind my question is less about the treatment for blepharitis and more about the risk of hydrocortisone 1% cream to the eyelids.)

Thanks for your input.

What foureyes said but it should be emphasized that using steroid creams and ointments on or around the eyelids can definitely make the pressure go up so be careful

 

[ocularis]

1. Can increase eye pressure when used over an extended period, so should not be given not monitored.
2. Correct me if I'm wrong, but it's not how we treat blepharitis .. so makes me wonder what your indication is. I have rarely seen it used in practice.

 

[MstaKing10]

Blepharitis is rarely an emergency. I would shy away from prescribing topical steroids for a chronic condition in an ER setting and defer to an ophthalmologist for treatment. I would expand my differential for eyelid swelling, especially acute edema to include infection, allergies, etc for which topical steroids are rarely indicated (maybe even contraindicated).

 

[Angry Birds]

Hey guys, thanks so much for the incredibly valuable input. This person's eyelid swelling would disappear with hydrocortisone cream and/or Prednisone, but it kept returning whenever he was off of it. When I heard this, my fear was IOP, and you guys have confirmed the risk of this.

But, I guess you are right about needing ophtho referral!

Also, on that note, I must admit that I don't know what the diagnosis is in this case. There is very significant bilateral eyelid swelling, which goes away with steroids. I called it "blepharitis" but don't know if that's correct.

And of course, all of this is for educational purposes only as that patient is long gone...

 

[DrZeke]

I don't think it's blepharitis and like mstaking10 said I would shy away from treating. In general as an ER provider I would err on the side of caution about prescribing steroids for anything eye related unless you have a very strong relationship with Ophtho on call and they trust and know your exam.

Another reason to avoid steroids is that steroid treatment should not go without follow up and many patients in our population won't follow up once they feel better... 🙂

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