Fluorometholone (FML Forte) vs Other Eye Steroid Drops - Comparison Guide

When your eye gets inflamed after surgery or an injury, a quick‑acting steroid drop can make the difference between speedy recovery and lingering discomfort. Fluorometholone is a mid‑potency ophthalmic corticosteroid marketed in the UK as FML Forte. It’s praised for its low risk of raising intra‑ocular pressure, but it’s not the only game‑player on the shelf.

Key Takeaways

• Fluorometholone offers moderate anti‑inflammatory power with a relatively benign side‑effect profile.
• Stronger drops like dexamethasone work faster but carry higher pressure‑rise risk.
• Weaker options such as hydrocortisone are safe for children but may need longer courses.
• Cost and prescribing guidelines vary; the British National Formulary (BNF) lists each under different NHS tariffs.
• Choosing the right drop hinges on inflammation severity, patient age, and glaucoma risk.

What Is Fluorometholone and When Is It Used?

Fluorometholone belongs to the class of ophthalmic corticosteroids that suppress the cascade of inflammatory mediators in the eye. Its main job is to reduce redness, swelling, and pain after procedures like cataract extraction or laser trabeculoplasty. Typical dosing is one drop four times a day for five to seven days, then taper based on clinician judgment.

How Does It Stack Up Against Other Common Eye Steroids?

When to Choose Fluorometholone Over Stronger Drops

If your patient has a history of glaucoma or is on other intra‑ocular pressure‑raising meds, you’ll want a steroid that’s less likely to tip the pressure scale. Fluorometholone’s medium potency hits the sweet spot: it quenches inflammation quickly enough for most post‑surgical eyes while keeping the pressure surge under 5% in the majority of cases. In contrast, Prednisolone acetate or Dexamethasone can push pressure up 10‑20%.

Scenarios Where a Different Steroid May Be Better

• Severe uveitis or rapid‑onset keratitis: A high‑potency agent such as prednisolone acetate or dexamethasone can blunt the inflammatory surge within hours.
• Children or steroid‑sensitive patients: Hydrocortisone ophthalmic is gentle enough for the developing eye.
• Patients with known steroid‑induced cataract risk: Loteprednol etabonate’s soft‑drug design limits cataract acceleration.

Prescribing Guidelines and the British National Formulary (BNF)

The BNF lists fluorometholone (FML Forte) under Section4.6.2 as a “moderate‑strength corticosteroid”. Recommended dosage for post‑operative inflammation is 0.1% w/v, one drop four times daily, tapering over 1‑2weeks. For prednisolone acetate, the BNF suggests an initial regime of 1% w/v, five times daily, then taper based on IOP monitoring. Dexamethasone is flagged as a “high‑risk” steroid requiring weekly pressure checks.

Cost Considerations for NHS Patients

Pricing is often a decisive factor in primary‑care prescribing. Fluorometholone sits at about £10 for a standard 10mL bottle, making it comparable to loteprednol but cheaper than dexamethasone. Hydrocortisone is the most affordable option, but its low potency may mean longer treatment courses, offsetting the price advantage.

Managing Side Effects and What to Watch For

All ocular steroids share a common set of potential side effects: raised intra‑ocular pressure, delayed epithelial healing, and rare cataract formation. The key is to match potency with risk. With fluorometholone, schedule an IOP check after the first week if the patient has glaucoma risk factors. If pressure climbs above 21mmHg, consider switching to Loteprednol etabonate or taper faster.

Practical Decision‑Tree for Clinicians

1. Assess severity of inflammation (mild, moderate, severe).
2. Check patient history for glaucoma, cataract, or steroid sensitivity.
3. If moderate and no glaucoma → choose Fluorometholone (FML Forte).
4. If severe → start with prednisolone acetate or dexamethasone, monitor IOP closely.
5. If patient is a child or steroid‑sensitive → opt for hydrocortisone or loteprednol.
6. Re‑evaluate after 7days; adjust potency or taper based on response.

Frequently Asked Questions

What makes fluorometholone less likely to raise eye pressure?

Fluorometholone has a lower affinity for glucocorticoid receptors in the trabecular meshwork, which translates into a smaller impact on aqueous outflow. Clinical trials in the UK report pressure spikes in only about 5% of users, compared with 15‑20% for stronger steroids.

Can I use fluorometholone for allergic conjunctivitis?

Yes, for moderate allergic reactions fluoro‑metholone works well. For very mild cases, many clinicians prefer Loteprednol etabonate because it has an even lower pressure‑rise profile.

How long should a typical course last?

A standard post‑operative course is five to seven days of full‑strength dosing, followed by a gradual taper over another week. The exact length depends on the surgeon’s assessment and the patient’s IOP readings.

Is fluorometholone available over the counter?

No, it’s a prescription‑only medicine in the UK. The NHS formulary lists it as a specialist‑prescribed drop, usually issued by ophthalmologists or GPs with a valid eye‑care justification.

What should I do if I experience a burning sensation after the drop?

Mild stinging is common with the first few doses. If the sensation persists beyond 48hours or is accompanied by redness, stop the drop and contact your eye‑care professional. Sometimes switching to a preservative‑free formulation helps.