by Neil Bauman, Ph.D.
A man wrote:
I stumbled onto your web site while researching a very bizarre phenomenon that is affecting me right now. I am 56 years old with normal hearing except for perhaps a little age related high frequency loss (more so in my left ear.)
Recently my ophthalmologist wrote me a prescription for Lotemax; an eye drop that contains a steroid. I began using the drops that night and by the next day noticed pressure in my ears and very strange sensation of “distorted” sound; not from a person speaking directly at me but from reproduced sources, such as radio, TV, music, paging systems, and from overheard human voices, i.e. voices coming from another room or different part of the office at work.
The sound “wobbles” but not quite like the old “talking through a pipe” scenario in the old days of land line phones. It’s more like the pitch of the sound or music itself changes and moves. I looked on-line for side effects related to the drugs and nothing matched up. The pharmacy had no ideas either.
Typically, little is mentioned about ototoxicity, especially with the more “obscure” drugs such as Lotemax.
My drug reference books don’t list any ototoxic side effects for Lotemax either, but that doesn’t mean this drug isn’t ototoxic. For example, a bit of research turned up one lady that experienced an ear “disorder” whatever she meant by that after taking Lotemax. I also found tinnitus listed as a side effect of taking Lotemax. Therefore, even though it isn’t reported in the medical literature, it seems whatever is in Lotemax can affect the ears of some people.
The active ingredient in Lotemax is Loteprednol, and I can’t find any “official” source of ototoxic side effects for it. However, one of the “inactive” ingredients, Benzalkonium, can be ototoxic.
Thus, based on the above, it could well be that Lotemax is indeed “messing up” your ears as you describe it. Hopefully, your ears will return to normal when you stop taking the drug. However, there is not enough information available to know whether the side effects may be temporary or permanent.
Since the active ingredients is not causing ear problem and it is due to inactive ingredients. why don’t you check with the inactive ingredients of generic lotemax. Both brand and generic lotemax will have same active ingredients but inactive ingredients will be different so try out with generic lotemax, please confirm with your physician too. You can find info on generic lotemax at International Drug Mart
You can ever order generic lotemax at International Drug Mart and see the difference.
My son is taking Lotomax and is having the same problem
I took lotamax a year and a half ago. I have fullness in both ears, sometimes worse than others, periodic fluttering and they will plug up and ring a few tmes a week and quick sharp pains
I used Lotemax eye drops on the 5th day my ears started ringing. Thay was a year ago and they haven’t stop ringing.
I went to the ENT doctor he said he doesn’t know why there ringing and the eye doctor who gave me these drops said he never heard of this . Well it did to me.
I started taking prednisolone acetate 1.0% drops in my right eye 5 days ago. This morning my ear is plugged and I hear a static sound continually. I was to take the drops for 7 days but I stopped this morning. I have an appointment with my doctor in 2 days. I will report back if the static has subsided and what my doctor determines as the cause.
I am having the same problems and I am on the same medicine. I have seen 5 specialist and only one says it is possible while all the others say they have never heard of this.
Hi Diana, I am having a similar issue. have been on prednisolone ophtahmalic for over 4 months now following retinal detachment surgeries, and over the last few days my ear has become severly plugged and am wondering if this is related to the steroid. what’s happened with your situation? did it resolve?
Everyone thought I was crazy…but my eye drops caused a ringing sensation in my ears! I am glad to have found this site, I am suspending use until I can see a doctor.
I started lotemax a couple weeks ago and I have constant pressure and ringing in my ears. I called Bausch & Lomb to report the problem at 800-323-0000 and they said they would report my information to the FDA but they didn’t have any information to give me. maybe more people need to call and report it before it will get looked into?
I started taking Lotemax after i had cataract surgery 6 days ago. I already suffer from tinitus but now my ear is clogged and I can’t hear out of it,and the tinitus noise is much louder.
I HAVE TINNITUS FOR ABOUT SIX YEARS…I DID EXPERIENCE AND INCREASE IN VOLUME AND RINGING OF THE TINNITUS AFTER USING PREDNISOLONE AND FLUOROMETHOLONE…..they did help with the pain in my eyes but now the tinnitus is off the wall…what a tradeoff…..eye pain vs. ears ringing …. help anyone???? right now i have stopped using the eye drops, cant take the tinnitus ringing….no doubt the eye pain will be back…..cache 22….
Hi Kathleen:
I have no information indicating that Fluorometholone causes tinnitus, and it occurs rarely from taking Prednisolone. Is there any other possibilities that caused your tinnitus to increase?
What is your eye pain from?
Regards
Neil
I have had ringing in my ears for months now. I was away on vacation and ran out of Lotemax. It was supposed to be for allergies. The ringing suddenly stopped after the first day of not using these drops. I have not used it since, and no more tinnitus. So, yes, it causes tinnitus.
and to me. Usually, I research side effects of drugs. Never thought that eye drops could affect my ears! I will never use it again, Besides, when you check the website, it only talkes about using it for no more than a week. It has been about a year. Ringing is unbearable! The drops should come with warning!
Before that was given Prednisone, but could not tolerate it! The drops are next!
Hi Dr Neil…..thanks for responding to me..
i have been living with tinnitus for over six years…the ringing increased dramatically after using the Prednisolone…and also the FLM…
when i told my eye specialist dr i had been on prednisone for ten years after being diagnosed with autoimmune hepatitis disease, he thought we were on to something…that the prednisone i had been taking for ten years, kept the eye pain under control and after no longer needing the prednisone for the liver, the eye pain surfaced…
(my liver dr was able to take me off the prednisone after my enxemye numbers improved three years ago…i am currently taking 100 mg imuran, 300 mg of ursodial and 20 mg of omeprazole daily without any problem all these years…
after i complained about the increased tinnitus while using the prednisolone drops, my eye dr then prescribed the fluorometholone thinking it was somewhat “weaker” and may not exacerbate the tinnitus…the result was my eye problem was not as well treated…the pred did a much better job with that…unfortunately the FLM still raised the volume and level of the tinnitus..
i could no longer tolerate the high pitched ringing in my ears and no longer use either eyedrops until i see my eye dr again in three weeks.. i am right back where i started with the blurred vision and eye pain…
i did have cataract surgery one year ago but my eye dr said the new lenses are not the problem and are alright…i had the eye pain prior to the surgery and was hoping the cat surgery would solve my eye pain problem…
two eye drs (i moved to a different county), first treated me for dry eyes to no avail….thats when i was prescribed the prednosolone drops by my current specialist….
i have had an autoimmune illness…autoimmune hepatitis since 2000…we are now thinking/wondering if the eye pain is also from the autoimmune disease…
other than the two eyedrops mentioned here, there are no other possibilities i can think that made the tinnitus increase….
i hope my explanations make some sense to you…i am so looking forward to hearing from you again…thank you so much Doctor….
i really appreciate your trying to help me….i desperately want to go back to the prednisolone as it really helped with the eye pain, but i don’t want the agony of the high pitched ringing in the ears again…
what if anything, can i do next?????
thank you so much for your answer
Hi Kathleen:
If your tinnitus increases dramatically when you are taking the Prednisolone and drops when you go off it, that is proof enough to me that the Prednisolone is exacerbating your tinnitus.
If your hearing had also dropped, I’d wonder whether you also had Autoimmune Inner Ear Disease (AIED), which is another autoimmune problem.
Since Prednisolone is a problem and the Fluorometholone doesn’t work well, what about going back on Prednisone? Will it work for you and yet not make your tinnitus too loud?
Cordially,
Neil
i found prednisolone on the NVRC list of ototoxic drugs..on the internet
thank you so much for your help…i know my email was very lengthy…
i’d be willing to try the prednisone once more..its certainly worth a try…..maybe a small dose would help….
living with the pains in my eyes or living with the increase in the tinnitus is not a wonderful either/or option i would like…
i will see my eye specialist in two weeks and a new ENT at Loma Linda a week later….she has many qualifications and expertise, one mentioned in her profile is tinnitus….certainly, i will surely mention your thoughts about AIED to both drs…
thank you Dr Neil for being there and for all your knowledge and time you used to try to help me….
sincerely, kathleen
I have been taking Lotemax for 6 weeks for eye irritation. I also take Advil several times a week for various aches and pains and a baby aspirin daily. My tinnitus has dramatically increased over the past couple days. I plan to stop all of the above. Please tell me my tinnitus will recede.
Also – can restasis Impact tinnitus?
Hi Susan:
Lotemax (Loteprednol) has caused tinnitus in numbers of people. You could be one of them. However, you take Advil (Ibuprofen) several times a week. Advil causes tinnitus in many people, so that drug is a likely culprit.
One baby aspirin is highly unlikely to cause tinnitus unless you have salicilate sensitivity so this is probably not the culprit.
My money is on the Advil first and the Lotemax second. There are no guarantees that your tinnitus will go away or not. For some it does, for others it doesn’t.
Restasis (Cyclopsorine) is listed as causing tinnitus in 1 – 3% of the people taking it, so that is another possibility.
Cordially,
Neil
I had cataract surgery in the last 2 months. They used eye drops from a place called designer drugs and the eye drops were called Cataractive 3. I was supposed to take these drops in each eye for 3 days prior to surgery and 14 days after. The first surgery went fine and my eyesight was significantly improved the second surgery resulted in me being able to see the edge of the new lens that was inserted whenever I look to the right. Also after the second surgery, I developed tinnitus, a constant ringing in my ears that has not stopped now for 2 months. Is this related to the drops, or is this related to the second surgery? I certainly didn’t have these problems when they did the first surgery on the right eye and installed a new lens in that eye. Before I go to an ENT, I thought I would check here
Hi Jeff:
CatarActive3 is a combination of three drugs–Moxifloxacin, Bromfenac and Dexamethasone.
Moxifloxacin is one of the fluoroquinolone antibiotics. It is fairly ototoxic and causes hearing loss and tinnitus in numbers of people (plus a number of balance problems too). It could well be the culprit.
Bromfenac is not listed as being ototoxic as far as I know, but it is in the acetic acid family and most of the drugs in this class can cause hearing loss and tinnitus, so I wouldn’t be surprised in bromfenac can do the same.
Dexamethasone is not listed as causing tinnitus, but may cause hearing loss in a few people.
My money is on the Moxifloxacin component of this solution as the source of your tinnitus assuming you haven’t taken any other drugs or exposed your ears to loud sounds, etc.
Cordially,
Neil
THANK YOU DOCTOR, I RECENTLY USE AN EYES DROP CONTAINING Dexamethasone AND SINCE THEN, I HAVE BEEN HAVING PAIN IN MY LEFT EAR. PLEASE WHAT CAN I DO
Hi Aregbesola:
I hope you stopped taking the eye drops right away and reported what happened to your doctor. Do you know that the Dexamethasone caused your ear pain and it wasn’t coincidental or a result of your eye condition that also affected your ear. Talk it over with your doctor.
Cordially,
Neil
I was using Pred Forte for my dry eyes and I might have overused (I did what the DR said but….) because I have what feels like an ear infection, blocked sinus, and a bad headache, almost as though I had a flu. This is a side effect I was not made aware of and it has taken me a second to track down any mention of it. The companies need to be made aware!
Hi Niki:
Prednisolone (Pred Forte) can cause a number of ototoxic side effects. I’m sure the companies are well aware of the side effects of their drugs. They just don’t want you to be scared off so you won’t take their drugs so they typically downplay the side effects.
Cordially,
Neil
Hi Dr Neil,
I’ve been using various eye drops for dry eye which I believe has occurred as a result of laser eye surgery I had a number of years ago. I started with Thealoz & Med Forte. Then moved on to lacrilub & Hylo Forte. Recently I have developed an itchy ear with scab forming and sometime a little oozing from inside the ear. The only thing I have found to ease (but not cure ) this condition is fucidin ointmen t2/3 times a day. Any ideas. It’s like this thing keeps growing back.
Hi Harriette:
Fucidin is a brand that uses fusidic acid, an antibiotic, as its active ingredient. Obviously it is not working in your case. I don’t have any information on whether it is ototoxic or not. I suspect if it is ototoxic, it is just mildly ototoxic or I should have come across it by now.
You might want to try some natural solutions and see if they will work for you. For example, you can use apple cider vinegar mixed 50/50 with warm water.
Another solution is using 3% food grade hydrogen peroxide. It is an antimicrobial.
If the above don’t work, you should see your doctor to be sure it isn’t something bad happening there.
Cordially,
Neil
I had cataract surgery today. I have been using Cataractive3 since 3 days prior o surgery and today. I am concerned about the possibility of tinnitus and hearing loss after reading above comments. I have tinnitus prior to these drops so don’t want to. Increase that. What would be a better alternative to this medication? I also already had moderate hearing loss in same earas my tinnitus. I see the eye doctor tomorrow.
Hi Louree:
CatarActive3 is a combination of Moxifloxacin, Bromfenac and Dexamethasone. The only drug I’d be worried about is Moxifloxacin. Personally, I refuse fluoroquinolone drugs such as Moxifloxacin and Ciprofloxacin unless it is a matter of life and death. However, I don’t think that the amount of the drug they use is likely to affect either your tinnitus or your hearing.
I had cataract surgery on both eyes last year and just refused to take such drugs. I had no problems.
Cordially,
Neil
I have used Lotemax eyedrops in the past and felt my ear full and tinnitus. I stopped and it went away. Just had cataract surgery and the steroid eyedrops is causing a full in my ear and tinnitus. Here we go again.
Hi Charlene:
Why do you need to take these eye drops? Both my wife and I had cataract surgery and we didn’t have to take any eye drops after the surgery, so we didn’t have to worry about eye drops affecting our ears.
Cordially,
Neil
My doctor prescribed them. Not sure if I want to continue. I have been doing the steroid eyedrops now for almost 3 weeks. My right ear is clogged and ringing and my left ear is fine
Hi Charlene:
You need to ask your doctor why you need them and make him justify their benefits vs. the known side effects you are experiencing. I’ll bet you don’t REALLY need them–that’s its just their standard protocol. Then you can more easily make up your mind whether you want to continue with them or not.
Cordially,
Neil
Due to irritation and conjunctivitis in my right eye after a recent facial surgery, I was prescribed “Lotemax SM”. I used it 3 times over 16 hours in my right eye immediately prior to the onset of complete right-side deafness and vertigo, which have both persisted now for 13 days. Upon further research, many people have reported partial hearing loss and tinnitus after using Lotemax. Many are long-term, although I can’t find accounts of people becoming completely deaf like me. Lotemax does not list hearing damage on its list of potential side effects. Although they do state that it has toxicity and can damage the optic nerve with prolonged use. It may be possible that it damaged my Vestibulocochlear nerve (which transmits sound and equilibrium information from the inner ear to the brain). Has anyone else had an experience this severe with Lotemax?
Hi David:
Lotemax is a combination of the steroid Loteprednol and the anti-bacterial drug Benzalkonium. I suspect it is this latter drug that causes the hearing loss. And it doesn’t take much either. Ototoxicity can occur when Benzalkonium is applied to the middle ear in concentrations of only 0.1%.
So far, I have not encountered anyone that had total hearing loss from taking this drug.
Cordially,
Neil
Hello…. I am a male, 62 years old 9 days ago I used a generic eye drop in my eyes that had same active ingredient as Systane. I have used Systane quite often, but this is the first time I used this generic. Shortly after using the eye drops I started getting what I felt was an allergic reaction. My eyes started itching, and I had itching in my mouth and throat. Almost immediately I started getting a high pitched ringing in my ears. This ringing has been coming and going now for these past 9 days. Just so you know, I have never had symptoms of tinnitus until the exact moment I used those eye drops. I found out the generic eye drops had benzalknium chloride as an inactive ingredient, which the regular Systane eye drops did not. Could it be that I am still experiencing the effects of tinnitus after these 9 days? It comes and goes, but can last hours at a time. I definitely think I had an immediate allergic reaction to the generic drops.
Hi Stewart:
Systane has two active ingredients, Polyethylene Glycol and Propylene Glycol. It also has a number of inactive ingredients such as boric acid, calcium chloride, hydroxypropyl guar, magnesium chloride, polyquaternium-1, potassium chloride, purified water, sodium chloride, zinc chloride. May contain hydrochloric acid and/or sodium hydroxide.
Apparently none of these bothered you.
Exactly what generic eye drops did you use? I can’t find a generic for Systane. I’d like to see the exact ingredients in this “generic” you used.
One thing you need to know about “inactive ingredients” is that they are NOT inactive in themselves. They are just not the active ingredient for the condition you are being treated for.
For example, Benzalkonium is a drug in its own right and has side effects, thus to call it “inactive” isn’t really telling the truth. It truly IS an active ingredient–it’s an anti-bacterial drug. Furthermore it is ototoxic to some degree or other.
So it is possible that the Benzalkonium did cause your tinnitus, but if there were any other “inactive” ingredients, they may also be culprits.
All the itching sure indicates an allergic reaction, and it could be this allergic reaction that caused your tinnitus, not the Benzalkonium. It’s a possibility.
Cordially,
Neil
Thanks Dr Bauman! The brand of eye drops was a Target brand just called “ lubricant eye drops” and on the box it says “compare to active ingredient in Systane Balance Lubricant Eye Drops.” It was on the shelf next to the brand name Systane and a couple dollars cheaper. Stupid me lol! Anyway, the only active ingredient is propylene glycol. The inactive are: benzalkonium chloride, boric acid, castor oil, disodium edetate hydrate, polyoxyethylene sorbitan monooleate, potassium chloride, purified water, sodium borate, sodium chloride. And it may contain hydrochloric acid and or sodium hydroxide to adjust ph. Any way, I am in my 10 th day of off and on tinnitus, and I have never had tinnitus before in my 62 years, and it started exactly at the same time I was having some sort of allergic reaction right after using the eye drops. Is it possible that this tinnitus could still be going on as a result of the eye drop allergic reaction or affect of the Benzalkonium or other ingredient? The tinnitus was the loudest when I had the reaction that first night, and now it comes and goes with varying degrees of loudness. Could it have caused some sort of ongoing imbalance within my ears? Thanks so much!
Hi Stewart:
So this was not the same as the Systane as my information says Systane has two active ingredients–although they are somewhat similar compounds. Your “generic” is missing the Polyethylene glycol as an active ingredient.
You’ll notice the “inactive” ingredients did not include calcium chloride, hydroxypropyl guar, magnesium chloride, polyquaternium-1, zinc chloride that the brand name had.
Instead the “generic” one had benzalkonium chloride, castor oil, disodium edetate hydrate, polyoxyethylene sorbitan monooleate and sodium borate.
So your allergy itchiness could have been any of these 5 other ingredients. You can’t necessarily put all the blame on the benzalkonium–although it could be the culprit.
You tinnitus could have been the result of your allergic reaction, OR from the ototoxic effects of one of those 5 different ingredients.
I think that your tinnitus is going to go away since it comes and goes–hopefully more “goes” than “comes” in the coming days. Your best bet is just to ignore your tinnitus and focus on the loves of your life and let it disappear on its own. I don’t think it caused any “imbalance” in your ears. It just takes time to go.
Cordially,
Neil
This has been a very informative thread. Im taking Lotemax and Moxifloxacin eye drops for an eye infection. Ive since had worsening dizziness, eye tracking and body pain. I have Lyme disease (which is made worse with steroids) and a neck injury causing daily neurovestibular dysfuction. Im usually very cautious about taking any ototoxic drugs as I tend to get them (eg. Anti-malarials and migraine preventatives both caused significant worsening).
I assume that the Moxi is causing the worsening of my dizziness and the steroid is triggering the body pain from Lyme? Will I get better once I stop the eye drops? It’s a 10 day plan and I finish tomorrow.
Hi Karen:
Dizziness is a very common side effect of Moxifloxacin. Thousands of people have reported such to the FDA. If your dizziness is from the Moxi, I think that typically it will go away once you are off it and your body recovers. This may take a few days to a few weeks. So be hopeful.
Cordially,
Neil
Hi, I took 7 days of Gentamicin eye drops (.3% Gentamicin and benzalkonium) and 2 days of Maxitrol (Neo/Poly/Dex) and now have worsening tinnitus, especially in the left ear (left eye was the medicated eye.) The tinnitus didn’t seem worse until the 9th day, and I monitored potential tinnitus worsening while I was taking the Gentamicin.
Neither doc who prescribed these have heard of tinnitus or hearing loss as side effects of the eye drops. Anyone else experienced this with either of these eye drops?
Is this permanent? Since they’re aminoglycosides I’m thinking it is.
Since the tinnitus is louder now I’m becoming depressed and unable to focus and do my daily activities. I’m anxious all the time and frankly, I’m pissed that this happened to me.
Hi Megan:
You would think that eye drops would be safe for your ears, wouldn’t you? But that is not necessarily so. I’ve heard from numbers of people that have taken eye drops and had resulting hearing loss, tinnitus and balance problems–so it happens. The culprits are various aminoglycoside antibiotics–specifically Tobramycin, Neomycin and Gentamicin.
Typically, if you only need the eye drops in one eye, the ear on the same side as the eye needing the drops is affected. This is strong circumstantial evidence that the eye drops were the culprit.
The resulting hearing loss tends to be permanent, and since tinnitus almost always accompanies the hearing loss, the tinnitus tends to be permanent too.
Cordially,
Neil
I only took Lotemax Gel for 2 days, 4x a day in both eyes for treatment of redness and dry eyes as prescribed by my optometrist. After day one I experienced fullness in my right ear and a headache. On day two the fullness turned into tinnitus and I discontinued taking the drops immediately. Three days later I am still experiencing the ringing in my right ear. I have reported this to my optometrist and to Bausch and Lomb, after finding this site and realizing that there is obviously an issue with this medication. I have never had tinnitus before and the thought of dealing with this constant annoyance possibly for the rest of my life is very upsetting.
Hi Monika:
Tinnitus doesn’t have to be a lifetime sentence. It may go away in time, or fade into the background and not bother you. The secret is not to focus on your tinnitus. Rather, focus on the loves of your life and thereby ignore your tinnitus. This lets it slowly fade away.
Cordially,
Neil
I’m 58 . I was prescribe lotemax a year or so ago for my left eye . I took them periodically up until 4 weeks ago . I have developed problems with my left ear . Pressure and lost of hearing .
I didn’t Connect the problem with the drops . Only till recently I read up on the drug .
I’ve read up and I’m clear it’s has been caused by the eye drugs . What do I do . I’m A professional musician. My whole world has been turned up side down also my ear is getting worse even tho I stopped taking them a few weeks ago . I live in the U.K. . Should I go and see my solicitor/ lawyer .
Could this be permanent?
Hi Joe:
Loteprednol (Lotemax) can certainly cause a feeling of pressure or blocked feeling in your ears, as well as hearing loss and tinnitus.
Once the Loteprednol is out of your system, I wouldn’t think your hearing would continue to drop, but it may not come back. Some people seem to have temporary side effects, but for others it seems to be pretty much permanent.
You can see a lawyer if you want, but I doubt you’ll win any case. Drug companies have deep pockets, and it is most difficult to find a doctor that will stick his neck out and say that the Loteprednol is the culprit. And the guys with the deep pockets will find some experts that will say the opposite. So my advice is save your money, but learn from this. You need to do your due diligence before you take any drug. You need to look out for yourself because anyone that prescribes drugs isn’t going to be doing it for you.
Cordially,
Neil
How were you able to not use any drops after cataract surgery? Did your physician agree to it, or did you not tell him? My doctor won’t even discuss this. I realize inflammation and bacteria may be a problem with cataract surgery. I have severe tinnitus caused from medications I have had to take over the years, also surgeries, etc. Most all the physicians I have seen don’t even recognize that eye drops or other medications affect the ears or cause tinnitus. I need cataract surgery NOW, but I know I can’t live if tinnitus gets any worse. I have had it, and gradual hearing loss for 24 years, and have discovered many many substances that make it worse. Yes, you kind of learn to live with it, but there comes a point that will be impossible in my case. What to do, eventually go blind, or not want to live anymore because of additional permanent tinnitus caused by physician indifference? Sorry for the vent but breaks my heart to read what other people are going through, being told it is not the medications.
Hi Cara:
My eye surgeon put the antibiotics right inside my eyes when the lens was put in. That’s all she needs. So no mandatory pre– or post– cataract surgery antibiotics like a lot of doctors seem to use.
Note that the antibiotics she used were ototoxic, but I had no problems with them–as they were “trapped” right beside the new lens.
However, if you have post-cataract problems, then my doctor would prescribe an antibiotic. But I had no such problems. I did have a mild scratchy feeling and the follow-up doctor wanted to prescribe some eye-drops, but when I looked, they had antibiotics that I refuse to take in them, so in that case, I didn’t take them. The scratchiness went away in a few days without any treatment.
So there are new techniques that would largely eliminate your concerns. I’d find an eye surgeon that uses these new techniques–and you shouldn’t have any problems either.
Cordially,
Neil