Ophthalmic Drops 101

Numb the patient, dilate, start IOP-lowering drops make sure theyre not allergic, then
call me back, said my senior resident. It was July, and my pockets were filled with a
rainbow of eyedrops. Which one was I to avoid in babies? Why did I need to check sickle
cell prep? And as my patients always asked, What are the side effects? Why are my eyes
still dilated?
To help you get a quicker start to understanding the eyedrops you need while on call,
here is a list of the most common drops and some clinical pearls. This is not a
comprehensive list, nor should these descriptions substitute for medical advice or
training. Eyedrops have multiple indications and side effects beyond what is listed here.
This is an introduction to the most common drops encountered while in your first few
months of residency.
In the charts below, the brand name is listed in parenthesis if it has not yet become
generic.
Anesthetic Drops
Drug

Lid
Color

Duratio Indication
n

Cautions

Proparicaine
(Alcaine)

White

1030
min

Long-term use causes

corneal ulcers

Tetracaine
(Pontocaine)

Topical anesthesia
Breaks down corneal
epithelium ulcers
Speeds absorption of
subsequent drops

Fluress
(Benoxinate +
fluorescein)

n/a
white
dropper

1020
min

Applanation tonometry
Stains defects on
corneal/conjunctival
surface

Check corneal sensation

before use in setting of
ulcers
Not for Seidel tests (use
fluorescein paper strips)
Patients may see yellow
when they blow their
nose

Topical anesthesia
Dilation Drops
Drug

Lid
Duratio Indication
Color n

Cautions

Phenylephri Red
ne
2.5%, 10%
(Neosynephrin
e)

3 hours Use with tropicamide for Avoid 10% in hypertensive

adult dilation
crisis, pediatrics and the elderly

Tropicamide Red
1%
(Mydriacil)

46
hours

Use with phenylephrine

for adult dilation

Cyclopentola Red
te
1%, 2%
(Cyclogyl)

24
hours

Cycloplegic refractions

Homatropine Red
2%

12
days

No longer manufactured

Atropine 1% Red

710
days

Break posterior
synechiae

Avoid in angle-closure glaucoma

Decrease ache from

ocular inflammation
Fogging for amblyopia
treatment
Glaucoma Drops
Drug

Lid
Color

Dosing Class

Cautions

Timolol 0.5%
(Timoptic)

Yellow

BID

Beta blocker

Avoid in patients with asthma,

COPD, CHF and bradycardia

Brimonidine0.1%, Purple
0.15%, 0.25%
(Alphagan)

TID

Alpha agonist

Avoid in patients under age of 3

Dorzolamide
(Trusopt)

TID

Orange

Avoid in nursing women (only class

B med)
Carbonic
anhydrase
inhibitor

Avoid in sulfa allergy

Avoid in sickle cell patients with
hyphema (can induce sickling in
anterior chamber)
Patients may complain of bitter or
metallic taste

Bimatoprost0.01 Teal
%, 0.03%
green
(Lumigan)

Qhs

Prostaglandin
agonist

Darkens hazel irides

Travoprost0.004
%
(Travatan Z)

Conjunctival hyperemia common

Avoid in uveitic glaucoma and
pregnancy

Latanoprost0.005
%
(Xalatan)
Cosopt

May reactivate herpes simplex

virus keratitis

White or BID
Dark
blue

Combo of
Dark blue
timolol +
dorzolamide

Combigan

Dark
blue

BID

Combo of
timolol +
brimonidine

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

n/a

PO
BID

Carbonic
anhydrase
inhibitor

Avoid in sulfa allergy

Avoid in sickle cell patients with
hyphema (can induce sickling in
anterior chamber)
Beware with potassium-losing
diuretics or digitalis
Common side effects: peripheral
limb tingling/weakness; bad taste
with carbonated beverages;
diarrhea

Methazolamide
25mg tabs
(Neptazane)

n/a

PO
BID
TID

Carbonic
anhydrase
inhibitor

Same as above but less severe

Steroid Drops
Drug

Lid
Color

Prednisolone
acetate
1% (PredForte)

White or Postoperative
Pink
inflammation

Fluorometholo White
ne
0.1% (FML)

Indication

Cautions
Can cause elevated IOP and cataracts

Iritis
Ocular surface
inflammation/dry eye

Can cause elevated IOP and

cataracts, but to a much lesser extent
than above

Antibiotic Drops
Drug

Lid
Indication
Color

Moxifloxacin
(Vigamox)

Tan

Gatifloxacin
(Zymaxid)

4th generation
fluoroquinolone
Postoperative
Corneal ulcers

Ofloxacin
(Ocuflox)

Tan

3rd generation
fluoroquinolone
Postoperative

Erythromycin ointment
(Emycin)

n/a
tube

Bacterial conjunctivitis

Cautions

Sterile cornea defects to

prevent infection
Prevent ophthalmia
neonatorum
Bacitracin ointment
(Bacitracin)

n/a
tube

MethicillinresistantStaphylococcus
aureus

Tobramycin
Dexamethasone
ointment (Tobradex)

n/a
tube

Gram negatives
(Pseudomonas)

Neomycin, Polymyxin
Dexamethasone
ointment (Maxitrol)

n/a
tube

Postoperative
Common gram positives

Neomycin is the most

common cause of
contact dermatitis