Special Warning : אזהרת שימוש

4.4 Special warnings and precautions for use
Not to be used without medical verification. To be prescribed and renewed only after examination by slit lamp biomicroscopy and a fluorescein test.

This medication is not effective in the treatment of Sjogren's keratoconjunctivitis.

Excessive and/or prolonged use of ophthalmic steroids increases the risk of ocular complications and could cause systemic side effects. If the inflannmatory condition does not respond within a reasonable period during the course of the therapy, other forms of therapy should be instituted to reduce these risks.

Prolonged use of ophthalmic steroids may result in ocular hypertension and/or glaucoma, with damage to the optic nerve, defects in visual acuity and field of vision, and posterior subcapsular cataract formation. A patient with a family or personal history of glaucoma has a higher risk of a corticosteroid-induced rise in intraocular pressure. If these products are used for 10 days or longer, intraocular pressure should be routinely monitored even though it may be difficult in children and uncooperative patients. Patients with glaucoma should be monitored weekly.

Corticosteroids may mask infection or exacerbate an existing infection. Prolonged use may suppress the immune response and thus increase the hazard of secondary ocular infection. Appropriate antibiotic therapy should be instituted for concurrent bacterial infections. The possibility of persistent fungal infections of the cornea should be considered after prolonged corticosteroid dosing.

Ocular herpes simplex has occurred in patients under systemic or local corticosteroid therapy for other conditions. Using corticosteroid medication in the treatment of herpes simplex other than epithelial herpes simplex keratitis, in which it is contraindicated, requires great caution; periodic slit-lamp microscopy is essential.

In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of topical corticosteroids.

The treatment should not be discontinued prematurely as a flare-up of the inflammatory condition may occur with the sudden interruption of highly dosed corticosteroids.
Wearing contact lenses (hard or soft) is discouraged during treatment with topical ophthalmic corticosteroids. Additionally, the preservative benzalkonium chloride can be adsorbed by soft contact lenses and may discolour lenses or cause eye irritation.
MAXIDEX should not be instilled while wearing contact lenses.

After application of the eye drops following measures are useful to reduce systemic resorption:
- Keep the eyelid closed for 2 minutes.
Close the lacrimal duct with the finger for 2 minutes.

Effects on Driving

4.7 Effects on ability to drive and use machines
As with any eye preparation, temporarily blurred vision or other visual disturbances may affect the ability to drive or use machines. If blurred vision occurs at instillation, the patient must wait until the vision clears before driving or using machinery.