SLK - Corticosteroid therapy: Which regimen is described for SLK?

• A. Loteprednol 0.5% QID for 1 week
• B. Prednisolone acetate 1% QID for 2 weeks
• C. Dexamethasone 0.1% BID
• D. Fluorometholone 0.1% QD.

Answer: (A)

In SLK, you want a corticosteroid that is potent enough to quell the surface inflammation but has a safer profile to minimize steroid-related side effects, especially with short, frequent dosing. Loteprednol etabonate is a “soft” steroid designed to be rapidly inactivated in ocular tissues, so it provides strong anti-inflammatory effect while lowering the risk of elevating intraocular pressure and delaying healing. Using it four times a day for about a week gives effective control of the lid-margin and ocular-surface inflammation typical of SLK, after which you can taper to avoid rebound. The other regimens use either stronger steroids with higher risk of steroid response (prednisolone acetate or dexamethasone) or a weaker steroid (fluorometholone) that may not adequately control active SLK, making them less ideal as initial therapy.