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Topical corticosteroid (ocular anti-inflammatory) Pregnancy: Use with caution; avoid prolonged use. Minimal systemic absorption from topical route.

Dexamethasone 0.1% Eye Drops (Maxidex)

Brand names: Maxidex

Adult dose

Dose: 1–2 drops every 1–2 hours initially (acute), reducing to every 4–6 hours as inflammation settles
Route: Ophthalmic
Frequency: Hourly to 4 times daily depending on severity
Max: 2 drops per application; frequency per clinical need
Ocular inflammation (uveitis, post-operative, allergic keratoconjunctivitis): 1–2 drops hourly in acute phase, reducing frequency as inflammation improves. Do NOT use in suspected infectious (bacterial, viral, fungal) conjunctivitis without antimicrobial cover. Taper slowly on discontinuation after prolonged use.

Paediatric dose

Route: Ophthalmic
Frequency: As per adult
Max: Same as adult; use shortest effective duration
Use under ophthalmology specialist guidance. Particular caution for IOP monitoring in children as steroid-response glaucoma may present insidiously.

Dose adjustments

Renal

No systemic dose adjustment for ophthalmic use.

Hepatic

No systemic dose adjustment for ophthalmic use.

Clinical pearls

  • Always perform slit lamp examination before prescribing — herpes simplex keratitis (branching dendrite) is an absolute contraindication
  • IOP monitoring required at 1–2 weeks on treatment; check again if continuing beyond 4 weeks
  • Posterior subcapsular cataracts can develop with as little as 4–6 weeks of 4x/day dosing
  • Taper gradually — abrupt withdrawal after prolonged use can cause rebound uveitis
  • Maxidex also available as ointment — useful for night application in anterior uveitis

Contraindications

  • Herpes simplex keratitis (dendritic ulcer) — steroids cause rapid progression
  • Bacterial conjunctivitis without antibiotic cover
  • Fungal or mycobacterial ocular infection
  • Acute purulent untreated ocular infection
  • Hypersensitivity to dexamethasone

Side effects

  • Raised intraocular pressure (steroid-response — up to 30% of patients; more common with prolonged use)
  • Posterior subcapsular cataract (with prolonged use)
  • Delayed wound healing
  • Masking of infection
  • Ocular stinging and discomfort
  • HPA axis suppression (rare with topical ocular — more relevant in children)

Interactions

  • NSAIDs (topical) — additive anti-inflammatory effect; may combine post-operatively
  • Ritonavir and strong CYP3A4 inhibitors — increased systemic dexamethasone exposure (even topical)

Monitoring

  • IOP (baseline and 2 weeks into treatment)
  • Visual acuity
  • Slit lamp (exclude herpetic disease before starting)

Reference: BNFc; BNF; RCOphth Uveitis Guidelines; Maxidex SPC. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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