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Topical corticosteroid (ocular anti-inflammatory) Pregnancy: UK SPC section 4.6: insufficient data are available on the use of this eye drop in human pregnancy to assess possible harmful effects. Corticosteroids cross the placenta. Teratogenic effects have been observed in animals; however, there is no evidence to date that teratogenic effects are induced in humans. After systemic use of corticosteroids at higher doses, effects on the unborn/neonate (intrauterine growth inhibition, inhibition of the function of the adrenal cortex) have been reported, but these effects have not been reported for ocular use. As a precautionary measure, it is preferable to avoid use during pregnancy. Breast-feeding: it is not known whether the medicine is excreted in breast milk, but the total dose of dexamethasone is low and the product can be used during lactation. Fertility: there are no data on potential effects of dexamethasone 1mg/ml on fertility.

Dexamethasone 0.1% Eye Drops (Maxidex)

Brand names: Maxidex

Dexamethasone eye drops are a potent topical corticosteroid used to treat steroid-responsive ocular inflammation, including anterior uveitis and post-operative inflammation.

Adult dose

Dose: Non-infectious inflammatory conditions affecting the anterior segment of the eye: usual dose 1 drop 4 to 6 times daily in the affected eye. In severe cases treatment may be started with 1 drop every hour, reducing to 1 drop every 4 hours when a favourable response is observed. Duration of treatment generally varies from a few days to a maximum of 14 days; taper gradually to avoid relapse
Route: Topical ophthalmic (eye drops, solution) - ocular use only, under close ophthalmic supervision
Frequency: 1 drop 4 to 6 times daily; severe cases: 1 drop hourly initially, then 1 drop every 4 hours once responding
SOURCE SCOPE: UK SPC for Puradex 1mg/ml eye drops, solution (eMC product 14753) - 1 mg/ml is dexamethasone 0.1%, a preservative-free solution. The Maxidex brand named on this page is a different product and is not covered by this SPC. INDICATION (section 4.1, verbatim): 'For treatment of non-infectious inflammatory conditions affecting the anterior segment of the eye.' POSOLOGY (section 4.2, verbatim): 'The usual posology is of 1 drop 4 to 6 times daily in the affected eye. In severe cases, treatment may be started with 1 drop every hour but dosage should be reduced to one drop every 4 hours when favourable response is observed. Gradual tapering off is recommended in order to avoid a relapse. The duration of treatment will generally vary from a few days to a maximum of 14 days.' The 14 days is a limit on treatment DURATION, not a daily dose ceiling, so no maxDose is given. 'This product should be used only under close ophthalmic supervision.' ELDERLY: 'There has been wide experience with the use of dexamethasone eye drops in elderly patients. The dosage recommendations given above reflect the clinical data derived from this experience.' CHILDREN: 'Efficacy and safety has not been established in the paediatric population. In children, long-term continuous corticosteroid therapy should be avoided due to possible adrenal suppression.' No paediatric regimen is printed. METHOD: wash hands before instillation; avoid contact between the dispenser tip and the eye or eyelids; 'Nasolacrimal occlusion by compression of lacrimal ducts may reduce systemic absorption.' Space other eye drops by 15 minutes. Avoid wearing contact lenses during treatment (section 4.4). Topical steroids should never be given for an undiagnosed red eye.

Dose adjustments

Renal

No renal dose adjustment is stated in the UK SPC sections retrieved (section 4.2 gives none).

Hepatic

No hepatic dose adjustment is stated in the UK SPC sections retrieved (section 4.2 gives none).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Eye infections not controlled by anti-infectious treatment, such as: acute purulent bacterial infections including Pseudomonas and mycobacterial infections; fungal infections; epithelial Herpes simplex keratitis (dendritic keratitis), vaccinia, varicella zoster and most other viral infections of the cornea and conjunctiva; amoebic keratitis
  • Perforation, ulceration and injury of cornea with uncompleted epithelialisation
  • Known glucocorticosteroid-induced ocular hypertension
  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1

Side effects

  • Very common (>=1/10): increase of the intra-ocular pressure
  • Common (>=1/100 to <1/10): discomfort, irritation, burning, stinging, itching and blurred vision (usually mild and transient, frequently immediately after instillation)
  • Uncommon (>=1/1,000 to <1/100): allergic and hypersensitivity reactions, delayed wound healing, posterior capsular cataract, opportunistic infections, glaucoma
  • Very rare (<1/10,000, including isolated reports): conjunctivitis, mydriasis, facial oedema, ptosis, corticosteroid-induced uveitis, corneal calcifications, crystalline keratopathy, changes in corneal thickness, corneal oedema, corneal ulceration and corneal perforation
  • Not known: Cushing's syndrome, adrenal suppression (associated with systemic absorption, particularly with frequent dosing)
  • Prolonged use may result in ocular hypertension/glaucoma and cataract formation; children and elderly patients may be particularly susceptible to steroid-induced IOP rise, which has generally been observed within 2 weeks of treatment; diabetics are more prone to subcapsular cataract
  • Topical steroids could lead to perforation in diseases causing thinning of the cornea; corneal calcification has been reported very rarely with phosphate-containing eye drops in patients with significantly damaged corneas

Interactions

  • No interaction studies have been performed (SPC section 4.5)
  • With other eye drops, instillations should be spaced out by 15 minutes
  • Superficial stromal corneal precipitations of calcium phosphate have been reported under combined use of corticosteroids and topical beta-blockers
  • CYP3A4 inhibitors (including ritonavir and cobicistat) may decrease dexamethasone clearance, resulting in increased effects and adrenal suppression/Cushing's syndrome; avoid the combination unless the benefit outweighs the increased risk of systemic corticosteroid side-effects, in which case monitor for systemic corticosteroid effects

Monitoring

  • Patients should be monitored at frequent intervals during treatment with dexamethasone eye drops
  • Prolonged use: monitor for ocular hypertension/glaucoma (especially with previous steroid-induced IOP rise, pre-existing high IOP or glaucoma) and cataract formation, especially in children and the elderly
  • Opportunistic ocular infections: steroids may promote, aggravate or mask signs of infection; patients with an eye infection should receive local steroid only once the infection is controlled by effective anti-infectious treatment, with careful regular monitoring by an ophthalmologist
  • Corneal ulcer: generally avoid topical dexamethasone except when inflammation is the main cause of healing delay and appropriate aetiological treatment has been prescribed; monitor carefully and regularly by an ophthalmologist; thinning of the cornea and sclera increases perforation risk
  • Corneal calcification (phosphate content): at the first sign withdraw the drug and switch to a phosphate-free preparation
  • Cushing's syndrome and/or adrenal suppression after intensive or long-term continuous therapy in predisposed patients (including children and patients on CYP3A4 inhibitors): discontinue treatment progressively
  • Blurred vision or other visual disturbance: consider referral to an ophthalmologist for evaluation of possible causes (cataract, glaucoma, central serous chorioretinopathy)
  • Episcleritis: NSAIDs are first line; use dexamethasone only if NSAIDs are contra-indicated. Allergic conjunctivitis: only for severe forms not responding to standard therapy and only for a short period

Clinical monograph

How it works

Dexamethasone binds glucocorticoid receptors to suppress the inflammatory cascade, reducing leucocyte infiltration, vascular permeability and release of inflammatory mediators.

Prescribing in practice

  • Topical ocular corticosteroids can raise intraocular pressure and promote cataract formation with prolonged use, and may worsen or mask ocular infection, so they should be used under ophthalmic supervision.
  • They are contraindicated in untreated infective conditions such as herpes simplex keratitis (dendritic ulcer) and most acute purulent eye infections.
  • Treatment should generally be tapered rather than stopped abruptly after prolonged courses to avoid rebound inflammation.

Monitoring

Monitor intraocular pressure during prolonged use and review the eye for evidence of infection or lens changes.

Counselling the patient

  • Use the drops exactly as prescribed and do not extend the course without ophthalmic review.
  • Report any eye pain, reduced vision or worsening redness promptly.
  • Attend follow-up appointments so eye pressure can be checked.

Evidence & guidelines

Topical corticosteroids are standard therapy for steroid-responsive ocular inflammation, with use guided by the SPC and ophthalmic practice.

Reference: RCOphth Uveitis Guidelines; Maxidex SPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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