Betamethasone for eyes, ears and nose

Generic Name

Betamethasone sodium phosphate (most common ophthalmic and otic formulation)

Brand Names

Betnesol Eye/Ear/Nose Drops

Celestone (certain regions)

Multiple generics available as ophthalmic, otic, and nasal drops

Drug Class

Potent topical corticosteroid

Glucocorticoid receptor agonist

Anti-inflammatory and immunosuppressive agent

Mechanism of Action

Betamethasone suppresses inflammation by modulating the expression of pro-inflammatory genes in local tissues

It inhibits leukocyte migration and stabilizes lysosomal membranes, reducing local tissue damage

Suppresses capillary dilation, fibroblast activity, and collagen formation

By acting on mucosal and epithelial tissues of the eye, ear, or nose, it reduces swelling, itching, redness, and discharge

It acts locally with minimal systemic absorption unless used in excess or across compromised membranes

FORMULATIONS & ROUTES

Ophthalmic

Eye drops (e.g., Betnesol Eye Drops 0.1%)

Used in inflammatory eye diseases

Otic

Ear drops (e.g., Betnesol-N: betamethasone + neomycin)

Used in inflammatory and infective ear conditions

Nasal

Nose drops (aqueous solution)

Used short-term in severe nasal inflammation not responding to standard sprays

INDICATIONS

Eye

Non-infectious inflammatory conditions of the anterior segment:

– Uveitis

– Iritis

– Allergic conjunctivitis

– Postoperative inflammation

– Scleritis

– Episcleritis

– Severe superficial ocular allergy (when antihistamines are ineffective)

Ear

Inflammatory ear conditions:

– Otitis externa (without tympanic membrane perforation)

– Eczematous dermatitis of the ear canal

– Allergic otitis externa

In combination with antibiotic for suspected or confirmed secondary infection

Nose

Severe rhinitis (non-infectious)

Nasal polyps (symptom control)

Vasomotor rhinitis

Intractable allergic rhinitis when intranasal steroids fail

Often used short-term only

DOSING AND ADMINISTRATION

Eyes

Apply 1 to 2 drops into the affected eye(s) every 1–2 hours initially

Taper frequency as inflammation subsides

Do not wear contact lenses during treatment

Apply gentle pressure on the inner canthus (nasolacrimal occlusion) after instillation

Ears

Apply 2–3 drops into the affected ear 2–3 times daily

Instruct patient to lie on side for a few minutes post-instillation

Use only when tympanic membrane is intact unless under ENT guidance

Nose

Instill 2–3 drops into each nostril 2–3 times daily

Patient should lie down with head tilted back and remain in that position briefly

Duration

Treatment duration should be limited to the shortest period necessary

Avoid extended use without medical supervision, particularly in the eye

Long-term or unsupervised use can lead to serious complications

CONTRAINDICATIONS

Absolute

Active untreated bacterial, viral (e.g., herpes simplex), or fungal infections of the eye, ear, or nose

Hypersensitivity to betamethasone or excipients

Perforated tympanic membrane (for otic use unless under ENT care)

Glaucoma or ocular hypertension (without monitoring)

Nasal surgery or trauma until healing is complete

PRECAUTIONS

Eyes

Monitor for raised intraocular pressure with prolonged use

Avoid use in herpes simplex keratitis or viral conjunctivitis

Use cautiously in patients with history of glaucoma or cataracts

Prolonged use may increase risk of secondary infection or delayed wound healing

Ears

Risk of ototoxicity if combined with aminoglycoside (e.g., neomycin) and tympanic membrane is perforated

Limit duration to minimize systemic absorption

Nose

Prolonged use may cause mucosal atrophy or nasal septal perforation

Systemic absorption possible in children and elderly

SIDE EFFECTS

Local (Eyes)

Blurred vision immediately after use

Eye irritation or burning

Conjunctival hyperemia

Increased intraocular pressure

Posterior subcapsular cataracts

Herpes simplex keratitis exacerbation

Superinfection (fungal, viral, bacterial)

Local (Ears)

Itching or discomfort

Secondary fungal overgrowth

Ear canal thinning or irritation

Potential ototoxicity (with aminoglycoside combinations)

Local (Nose)

Nasal irritation or stinging

Epistaxis (nosebleeds)

Mucosal dryness

Nasal septum damage (with excessive use)

Systemic (Rare)

Adrenal suppression (especially in children with prolonged or high-frequency use)

Growth suppression in pediatric patients

Cushingoid features in excessive topical corticosteroid use

PREGNANCY AND LACTATION

Pregnancy

Use only if clearly needed

Topical use reduces systemic risk, but caution is required if used over long periods or large areas

Ophthalmic and otic drops are generally safe when used short-term

Lactation

Minimal systemic absorption makes it compatible

Avoid direct application to the nipple or breast

Monitor infant for any systemic steroid effects with prolonged maternal use

SPECIAL POPULATIONS

Children

Use with caution

More susceptible to systemic effects such as adrenal suppression

Avoid prolonged courses

Elderly

Increased risk of skin thinning and ocular hypertension

Require regular monitoring during long-term use

DRUG INTERACTIONS

Ophthalmic and Otic

Limited systemic absorption means few interactions

Concurrent use with other ocular agents (e.g., antiglaucoma drops) may require timing adjustment

Do not combine with other corticosteroid drops unless instructed

Nasal

Co-use with CYP3A4 inhibitors (e.g., ketoconazole) may theoretically increase systemic steroid levels

Live vaccines should be delayed if systemic absorption is suspected

PATIENT COUNSELING POINTS

Shake bottle well before each use

Avoid touching the dropper to the eye, ear, or any surface

Use drops as directed and do not exceed the prescribed frequency

Do not share the drops with others

For the eye, remove contact lenses before use and wait at least 15 minutes to reinsert

If using multiple eye/ear medications, separate them by at least 5–10 minutes

Inform your healthcare provider if vision changes, eye pain, or signs of infection occur

Report persistent nasal bleeding, irritation, or crusting

Discard open bottles after 28 days unless otherwise instructed

Store in a cool, dry place away from direct light

Keep out of reach of children and avoid accidental oral ingestion in children

STORAGE

Store at 2°C to 25°C (36°F to 77°F)

Protect from freezing and direct sunlight

Discard any remaining solution 28 days after opening unless stated otherwise by the manufacturer