Overview of eye drops

Medicines reconciliation is the process of accurately listing a person’s medicines. This often takes place when they’re admitted into a service and is an important day to day job of a junior doctor. It has been demonstrated that patients admitted to the hospital for non-ophthalmic reasons do not always receive their eye drops as prescribed. In addition, medications prescribed in the form of eye drops may also have adverse systemic effects that doctors need to be aware of and consider. This article, therefore, aims to give an overview of the common eyedrops you’ll encounter in the wards, their indications and cautions.

Overview

Eyedrops can be split into different categories according to the function they serve- glaucoma drops, antimicrobial drops, steroid drops, anaesthetic drops, dilatation drops, hydrating drops. Frequently, patients need more than one topical eye drop/ointment. If the patient needs more than one drop, they should be given at 5-minute intervals from each other. If there is a mixture of drops and ointments, drops should be instilled first.

Glaucoma drops

The function of glaucoma drops is to reduce intraocular pressure

DrugClass (function)CautionsSide effects
Timolol
0.5%
(Timoptic)
Beta-blocker
(decreases aqueous production)
Avoid in patients with:
Asthma
COPD
• Congestive Heart Failure
• Bradycardia
Hypotension
• Bradycardia,
• Bronchospasm
(due to systemic absorption)
Brimonidine
0.1%, 0.15%, 0.2%
(Alphagan)


Apraclonidine
Alpha agonist
(decreases aqueous production)
• Avoid in patients under 3 years of age
• Avoid in nursing women (only class B medicine)
Headache
• Dry mouth/nose
Dorzolamide


Acetazolamide
250-mg tabs,
500-mg sequel (caps),
slow release
(Diamox)


Methazolamide
25-mg tabs
(Neptazane)
Carbonic anhydrase inhibitor
(decreases aqueous production)
• Avoid in sulfa allergy
• Avoid in sickle cell patients with hyphema (can induce sickling in the anterior chamber)
• Parasthesia,
• Bitter/metallic taste
Bimatoprost 0.01%, 0.03%
(Lumigan)


Travoprost 0.004%
(Travatan Z)


Latanoprost 0.005%
(Xalatan)
Prostaglandin agonist
(Increases aqueous outflow)
• Avoid in uveitic glaucoma and pregnancy• Hypertrichosis (long eyelashes)
• Hyperpigmentation
• May reactivate herpes simplex virus keratitis
• Conjunctival hyperemia is common
PilocarpineCholinergic
(Increases aqueous outflow and causes miosis)
• Blurring of vision
• Flushing
Dorzolamide/Timolol 0.5%
(Cosopt)
Carbonic anhydrase inhibitor and beta-blocker
Brimonidine 0.2%/Timolol 0.5%
(Combigan)
Alpha agonist and beta-blocker
Glaucoma drops

Antimicrobial drops

DrugIndicationsCautions
Chloramphenicol• Abrasion
• Bacterial conjunctivitis
• Post-operative
• Pregnant
• Breast feeding
• Blood dyscrasia
Fusidic acid• Superficial eye infections• Breastfeeding
• Pregnant
Ofloxacin


Levofloxacin


Ciprofloxacin
• Fluoroquinolones
• Postoperative
• Keratitis
• Corneal ulcers
• Levofloxacin is not recommended for children less than 1 years
• Not recommended in patients with a previous history of convulsion, liver or kidney failure
Ganciclovir• Antiviral
• HSV corneal dendritic ulcer
• Stinging eyes
• Punctate keratitis
Antimicrobial drops

Steroid drops

DrugIndications (should be guided by ophthalmology)Cautions
Prednisolone acetate 1%


Dexamethasone 0.1%


Fluorometholone 0.1%
(FML)
• Postoperative inflammation
• Iritis
• Ocular surface inflammation/dry eye
• Can cause elevated IOP and cataracts
Steroid drops

Anaesthetic drops

DrugDurationIndicationsCautions
Lidocaine


Oxybuprocaine hydrochloride  


Tetracaine
10–30 min• Topical anaesthesia
• Ophthalmic surgery
• Long-term use causes corneal ulcers
• Check corneal sensation before use in the setting of ulcers
Anaesthetic drops

Dilatation drops

DrugDurationIndicationsCautions
Phenylephrine 
2.5%, 10%
3 hours• Adult dilation for examination• Avoid 10% in hypertensive crisis, paediatrics and the elderly
Tropicamide 
1%
6 hours• Adult dilation for examination 
Cyclopentolate 
0.5%, 1%
1 day• Cycloplegic refractions
• More common for examination in children
Atropine 
1%
7–10 days• Breaks posterior synechiae
• Decreases ache from ocular inflammation
• Fogging for amblyopia treatment
• Avoid in angle-closure glaucoma
Dilatation drops

Hydrating drops

DrugViscosityNotes
HypromelloseLow• Most frequently used for dry eye Initially can be used more often (i.e hourly) prior to reduction in frequency
Polyvinyl alcoholLow• Alternative to Hypromellose
Carbomer 980Medium• Less tolerated than Hypromellose because can blur vision
• Frequency can be reduced as higher viscosity
CarmelloseMedium• Usually for moderate to severe dry eyes
Sodium hyaluronate
0.1% or 0.2%
Medium• Usually for moderate to severe dry eyes
Liquid paraffinHigh• Blurring of vision ( therefore used usually at night before sleep)
• Not when wearing contact lenses
Hydrating drops

Edited by: Mudassar Khan (Y4 Medical Student)

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