Pred-G Ointment (gentamicin 0.3% / prednisolone 1%)

Elevated IOP: Prolonged corticosteroid use may result in glaucoma with optic nerve damage and defects in visual acuity and fields of vision; monitor IOP routinely when used 10 days or longer, and use with caution in the presence of glaucoma.

Posterior subcapsular cataract: Prolonged corticosteroid use may produce cataract formation.

Secondary ocular infection: Prolonged use suppresses the host immune response; acute purulent infection may be masked or enhanced, and secondary bacterial, fungal and viral infection has occurred with steroid and antimicrobial combinations.

Corneal epithelial toxicity: Ocular irritation and punctate keratitis are associated with use of this combination; in rabbits, gentamicin was among the most toxic of eight topical antibiotic solutions tested on corneal epithelial wound healing, though that study tested solutions and not an ointment vehicle.

Corneal and scleral thinning: Various ocular diseases and long-term topical corticosteroid use cause thinning, and use over thin tissue may lead to perforation.

Fungal invasion: Suspect fungal infection in any persistent corneal ulceration where a corticosteroid has been used or is in use, and take fungal cultures when appropriate.

Viral keratitis exacerbation: Ocular steroids may prolong the course and exacerbate the severity of many viral eye infections including herpes simplex; a history of herpes simplex demands great caution and frequent slit lamp microscopy.

Delayed healing after cataract surgery: Steroid use may delay healing and increase the incidence of bleb formation.