Compare FML Forte (Fluorometholone) with Alternatives for Eye Inflammation

FML Forte is a prescription steroid eye drop used to treat inflammation in the eye. Its active ingredient, fluorometholone, is a corticosteroid that reduces redness, swelling, and itching caused by allergies, infections, or surgery. But it’s not the only option. If your doctor prescribed FML Forte and you’re wondering if there are better, safer, or cheaper alternatives, you’re not alone. Many patients ask the same thing-especially when they’ve heard about side effects like increased eye pressure or cataracts from long-term steroid use.

How FML Forte Works

FML Forte contains 0.1% fluorometholone, a synthetic corticosteroid designed to be less potent than older steroids like prednisolone but still effective. It works by blocking the body’s inflammatory response at the cellular level. This makes it useful for conditions like allergic conjunctivitis, uveitis, and post-surgical inflammation after cataract or LASIK surgery.

Unlike some stronger steroids, fluorometholone is metabolized quickly in the eye, which lowers the risk of side effects. But that doesn’t mean it’s risk-free. Using FML Forte for more than 10 days without monitoring can raise intraocular pressure, especially in people who are already at risk for glaucoma. About 5-10% of users experience a rise in eye pressure, and in rare cases, this can lead to permanent vision damage.

Common Alternatives to FML Forte

There are several other steroid eye drops that doctors prescribe when FML Forte isn’t the right fit. Here are the most common ones, compared by strength, safety, and typical use cases.

Lotemax and Alrex both use loteprednol etabonate, a newer steroid designed to break down quickly after it works. This makes them safer for longer-term use. In clinical studies, patients using loteprednol had significantly lower rates of elevated eye pressure compared to those using fluorometholone. For many, especially those with a history of glaucoma, Lotemax is now the go-to steroid.

Prednisolone acetate (1%) is stronger than FML Forte but comes with higher risks. It’s often used in severe cases like viral keratitis or autoimmune uveitis-but only for short bursts, usually under 7-10 days. Doctors avoid prescribing it for routine allergies because the side effect profile is too steep.

Then there’s Ketorolac (Acular), which isn’t a steroid at all. It’s an NSAID eye drop. It doesn’t suppress the immune system like steroids do. Instead, it blocks prostaglandins, the chemicals that cause pain and swelling. It’s great for mild allergic reactions or after minor eye surgery. But it won’t work for deep inflammation like uveitis. And it can cause stinging or dryness in some users.

When to Choose FML Forte Over Alternatives

FML Forte isn’t outdated-it’s just not always the best first choice. Here’s when it still makes sense:

• You have moderate inflammation and no history of glaucoma.
• Your doctor has used it successfully with you before.
• You’re on a tight budget-FML Forte is often cheaper than Lotemax or Alrex.
• You need a balance between effectiveness and safety for short-term use (under 2 weeks).

For example, if you had LASIK surgery last week and your eye is still red and irritated, FML Forte is a reasonable option for the next 7-10 days. But if you’re managing seasonal allergies year after year, switching to Alrex or even Ketorolac might be smarter long-term.

When to Avoid FML Forte

There are clear red flags that mean you should skip FML Forte entirely:

• You’ve been diagnosed with open-angle glaucoma or have a family history of it.
• Your eye pressure has ever been above 21 mmHg during an exam.
• You’re using it for more than 10 days without a follow-up.
• You have a corneal ulcer or active viral infection (like herpes simplex). Steroids can make these worse.
• You’re pregnant or breastfeeding-steroid eye drops aren’t well studied in these cases, and alternatives are preferred.

If any of these apply to you, talk to your eye doctor about Lotemax, Alrex, or Ketorolac. They’re safer in these situations and just as effective for many conditions.

Non-Steroid Options You Might Not Know About

Steroids aren’t the only way to calm eye inflammation. For mild to moderate cases, especially allergies, non-steroid options are gaining popularity because they’re safer for long-term use.

Two big ones are cyclosporine (Restasis, Cequa) and lifitegrast (Xiidra). These are usually used for dry eye, but they also reduce inflammation caused by chronic allergic reactions. They take weeks to work-not days-but they don’t raise eye pressure or cause cataracts. If you’ve been on steroid drops for months and your eye keeps flaring up, your doctor might switch you to one of these to break the cycle.

There’s also Olopatadine (Patanol, Pataday), an antihistamine/mast cell stabilizer. It’s available over-the-counter in lower strengths and by prescription in higher ones. It’s great for itching and redness from allergies and can be used daily without the risks of steroids.

Cost and Accessibility

FML Forte is usually cheaper than newer alternatives. A 5ml bottle costs around $40-$60 without insurance. Lotemax can run $80-$120. Alrex is often priced similarly to FML Forte. Ketorolac is usually mid-range at $50-$70.

But cost isn’t just about the sticker price. If FML Forte causes elevated eye pressure and you need extra visits, tests, or glaucoma medication, you’re spending more in the long run. Many insurance plans now prefer Lotemax or Alrex because of their safety profile-even if they cost more upfront.

Always check with your pharmacy or use GoodRx. Generic fluorometholone is available and often under $20 with coupons. But make sure it’s the same concentration (0.1%) as FML Forte.

What Your Eye Doctor Won’t Always Tell You

Most eye doctors don’t have time to explain all the options. They pick what’s fastest, most familiar, or covered by your insurance. But you have a right to know your choices.

Here’s what to ask next time:

• “Is this steroid necessary, or could an antihistamine or NSAID work instead?”
• “What’s the risk of eye pressure rising if I use this for 2 weeks?”
• “Do you recommend a follow-up pressure check?”
• “Is there a non-steroid option I can use long-term?”

Doctors appreciate patients who ask these questions. It leads to better decisions.

Bottom Line: What Should You Use?

There’s no single best steroid eye drop. The right choice depends on your condition, medical history, and how long you need treatment.

For short-term, moderate inflammation (under 10 days): FML Forte is fine if you’re healthy and have no eye pressure issues.

For long-term or high-risk patients: Switch to Lotemax or Alrex. They’re safer and just as effective.

For allergies only: Try Olopatadine (Patanol) or Ketorolac. No steroids needed.

For chronic inflammation or dry eye: Consider cyclosporine or lifitegrast. They fix the root cause, not just the symptoms.

The goal isn’t just to reduce redness-it’s to protect your vision for the long term. Don’t assume FML Forte is the only or best option. Ask questions. Get a second opinion if needed. Your eyes deserve more than a default prescription.