AMH Summary: Chapter 11 – Eye Drugs 1

AMH SUMMARY: Chapter 11 – EYE DRUGS

- Eye Infections -
 Bacterial conjunctivitis (rapid onset, mucus discharge): use antibacterials. Usually self-limited
and lasts for 2-3 days.
 Viral infections (watery discharge, recent URTI): infectious; use artificial tears and cool
compresses
 Allergic conjunctivitis (water discharge, itching)
 Seborrhoeic blepharitis (greasy scales on lid margin): apply warm compresses. scrub lids with
a damp cotton bud soaked in mild soap (eg. 1:10 diluted baby shampoo or Lidcare) or dilute
sodium bicarbonate (1 teaspoon per 250ml hot tap water) twice daily.
 Staphylococcal blepharitis (crusts and ulceration of eyelash base): scrub lids as above,
followed by an antibacterial eye ointment, massaged with a clean finger into base of eyelashes
bd for 10-14 days.
 Stye (infection of eyelash follicle – swelling and pain): hot water compresses 3-4 times daily.
 Herpetic eye infection/keratitis (ulceration of cornea – foreign body sensation, photophobia,
tearing): antiviral
 Cellulitis (acute bacterial inflammation/infection): systemic antibacterials

AMINOGLYCOSIDES
 FRAMYCETIN (eye) – Soframycin
Dosage: 1 drop every 2–4 hours for 2 days; then if there is improvement, 1 drop 4 times daily for
5 days.

 GENTAMICIN (eye) – Genoptic; Minims

- gentamicin should be reserved for use by ophthalmologists and for serious infections not
responding to treatment with other topical antibacterials (after taking sample for microbiological
culture)
- can be used as prophylaxis after surgery.

Dosage: 1 drop every 2–4 hours for 2 days; then if there is improvement, 1 drop 4 times daily for
5 days.
For prophylaxis: 1 drop 4 times daily until epithelium healed (rarely >4 days).

 TOBRAMYCIN (eye)- Tobrex

- tobramycin should be reserved for use by ophthalmologists and for serious infections not
responding to treatment with other topical antibacterials (after taking sample for microbiological
culture)
- can be use as prophylaxis after surgery

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AMH Summary: Chapter 11 – Eye Drugs 2

Dosage: 1 drop every 2–4 hours for 2 days; then if there is improvement, 1 drop 4 times daily for
5 days. Ointment may be used as an adjunct to drops at night, or as a single agent 3 times daily,
eg in children.
Prophylaxis: 1 drop 4 times daily until epithelium healed (rarely >4 days).

QUINOLONES
Side Effects: mild transient ocular irritation, lid margin crusting and scaling, unpleasant taste

- Ofloxacin and ciprofloxacin have similar efficacy to tobramycin

- Quinolones should be reserved for specialist treatment of bacterial keratitis and other
antibacterials are preferred for conjunctivitis, to slow emerging resistance.
- Marketed for severe conjunctivitis or keratitis.

 CIPROFLOXACIN (eye) – Ciloxan

Dosage: Conjunctivitis - 1 drop every 2–4 hours for 2 days; then if there is improvement, 1 drop
4 times daily for 5 days. Keratitis - 1 drop every 5 minutes for the first hour, then once every hour
until there is improvement; decrease frequency according to clinical response (only under
supervision of ophthalmologist).

 OFLOXACIN (eye) – Ocuflox

Dosage: as above.

OTHER ANTIBACTERIALS
 CHLORAMPHENICOL (eye) – Chlorsig, Chloromycetin
Dosage:
Blepharitis - Massage ointment into lid margin 2–3 times daily.
Conjunctivitis - 1 drop every 2–4 hours for 2 days; then if there is improvement, 1 drop 4 times
daily for 5 days. Ointment may be used at night as an adjunct to drops, or as a single agent
3 times daily, e.g. in children.

 PROPAMIDINE – Brolene
Side Effects: stinging and burning after instillation
Dosage: Keratitis - 1 drop every hour until there is improvement, then gradually reduce frequency
according to clinical response (treatment duration is usually months). It can also be used for acute
conjunctivitis.

 SULFACETAMIDE – Bleph-10
- use is not recommended as it is an irritant.

Dosage:
Blepharitis - Massage 2 drops into lid margin 2–3 times daily.

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AMH Summary: Chapter 11 – Eye Drugs 3

Conjunctivitis - 1 drop every 2–4 hours for 2 days; then if there is improvement, 1 drop 4 times
daily for 5 days.

ANTIVIRALS
 ACICLOVIR (eye) – Zovirax
Indications: Herpes Simplex Keratitis
Side Effects: transient mild stinging after instillation
Dosage: Apply about 1 cm of ointment into the lower conjunctival sac 5 times daily for 14 days, or
for 3 days after corneal epithelium healed, whichever is shorter.

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AMH Summary: Chapter 11 – Eye Drugs 4

- Glaucoma-
- Prostaglandin analogues (bimatoprost, latanoprost, travoprost) are first line agents over beta
blockers.
- Brimonidine or carbonic anhydrase inhibitors (brinzolamide, dorzolamide) are third line.
- Pilocarpine tend to be useful as an adjunct.
- Separate eye drops by at least 5 minutes.

BETA-BLOCKERS
- timolol is nonselective; betaxolol are selective beta1 blockers.

Contraindications: Asthma (cardioselective agents i.e. betaxolol may be used); Bradyarrhythmia.

Avoid combination with verapamil as bradycardia may occur.

Side Effects (systemic): stinging on instillation (especially betaxolol solution), bradycardia

 BETAXOLOL – Betoptic
Dosage: 1 bd

 TIMOLOL – Tenopt, Timoptol; Timoptol-XE; (+brimonidine = Combigan); (+dorzolamide =

Cosopt); (+latanoprost = Xalacom); (+travoprost = DuoTrav)
Dosage: 1 daily (Timoptol-XE, Xalacom, DuoTrav) or 1 bd (Timoptol, Combigan, Cosopt)

PROSTAGLANDIN ANALOGUES
Side Effects: gradual (over months to years), usually irreversible increase in iris pigmentation in
treated eyes, especially those of mixed colour, eg blue/brown; darkening, lengthening and thickening
of the eyelashes, conjunctival hyperaemia (usually transient)

Dosage: 1 drop at night

 BIMATOPROST – Lumigan
Side Effects: ocular itch, superficial punctate keratitis, blepharitis, conjunctival oedema, dry eyes,
headache

 LATANOPROST – Xalatan
Side Effects: ocular irritation (preservative benzalkonium chloride), blepharitis, punctate corneal
epithelial erosions, bitter taste, rash

 TRAVOPROST – Travatan
Side Effects: itch, keratitis, headache

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AMH Summary: Chapter 11 – Eye Drugs 5

ALPHA2 AGONISTS

 APRACLONIDINE – Iopidine
- The effect of apraclonidine usually declines after a month; it is indicated for short term use (up
to 3 months).

Side Effects: ocular irritation, especially allergic blepharoconjunctivitis (with >3 months use), dry
mouth and nose, altered taste perception

Dosage: 1 drop 2–3 times daily.

 BRIMONIDINE – Alphagan
Side Effects: ocular irritation, ocular allergic reaction, conjunctival blanching, lid retraction,
blepharitis, dry mouth and nose, taste disturbance, fatigue, headache, drowsiness, dizziness

Dosage: 1 drop 2–3 times daily.

CARBONIC ANHYDRASE INHIBITORS

Side Effects: ocular irritation, foreign body sensation, bitter taste

 BRINZOLAMIDE – Azopt
Side Effects: blurred vision
Dosage: 1 bd

 DORZOLAMIDE – Trusopt
Side Effects: conjunctivitis and lid reactions
Dosage: 1 drop 3 times daily.

OTHER DRUGS FOR GLAUCOMA

 ACETAZOLAMIDE – Diamox
- systemic carbonic anhydrase inhibitor (reduces aqueous humour secretion); also acts as a
diuretic by alkalinizing the urine.

Indications: glaucoma, epilepsy (absence seizures)

Precautions: gout, sulfur allergy.

Side Effects: paraesthesia (of hands, face, feet or mucocutaneous junctions), fatigue, drowsiness,
depression, decreased libido, bitter or metallic taste, nausea, vomiting, abdominal cramps,
diarrhoea, black faeces, polyuria, renal stones, metabolic acidosis, electrolyte changes
(hypokalaemia, hyponatraemia)

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AMH Summary: Chapter 11 – Eye Drugs 6

Dosage: 125 mg twice daily, increase to a maximum of 250 mg 4 times daily. Take with food.
 MANNITOL – Osmitrol inj
Indications: acute closed angle glaucoma

Side Effects: nausea, vomiting, local pain, skin necrosis and thrombophlebitis (injection site), chills,
dizziness, urticaria, hypotension, tachycardia, fever, angina-like chest pains. Fluid and/or
electrolyte shift can produce pulmonary congestion, acidosis, electrolyte loss, dry mouth, thirst,
oedema, headache, blurred vision, seizures and heart failure.

Dosage: IV 1–2 g/kg (5–10 mL/kg of 20% solution) over 30 minutes.

 PILOCARPINE – Pilopt, PV Carpine

Indications: acute and chronic glaucoma

Side Effects: fluctuating blurred vision, accommodative spasm and frontal headache in people
<40 years (usually decreasing after 2–4 weeks; simple analgesics may reduce pain), miosis,
ocular irritation, follicular conjunctivitis.

Dosage: Chronic open angle glaucoma – 1 drops of 2% qid.

- if using more than one eyedrop, instill pilocarpine last.

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AMH Summary: Chapter 11 – Eye Drugs 7

- Allergic and Inflammatory Eye Conditions -

Allergic conjunctivitis: itchy, red, watery eyes with oedema.
Treatment:
- Mild symptoms: irrigate with saline bd & use artificial tears 4-8 times daily and cold water
compresses.
- Moderate symptoms: use topical drugs (ketorolac, levocabastine, ketotifen, olopatadine). Long
term use of topical vasoconstrictor-antihistamine combinations are not recommended due to
rebound conjunctivitis.
-Severe symptoms: seek specialist advice; topical corticosteroids may be required.
-Recurrent disease: use cromoglycate as a preventative.

VASOCONSTRICTORS
Indications: mild ocular congestion

Side Effects: rebound hyperaemia, stinging on instillation

Note: Do not use regularly for more than 5 days. Although advertised as being useful for relieving eye
redness due to minor irritations such as dust, smoke and contact lens wear, a cool compress is as
beneficial and is safer. Using drops like this for too long can cause symptoms similar to red eyes.
 NAPHAZOLINE – Murine Clear Eyes, Albalon, Naphcon Forte; (+antazoline = Antistine-
Privine); (+phenramine = Naphcon-A or Visine Allergy)

Dosage: 1 drop every 6–12 hours as required.

 PHENYLEPHRINE (eye) – Albalon Relief; Prefrin

Dosage: 1 drop every 3–4 hours as required.

 TETRAHYDROZOLINE – Murine Sore Eyes; Visine Advanced Relief

Dosage: 1 drop every 6–12 hours as required.

ANTIHISTAMINES
 AZELASTINE (eye) – EyeZep
Dosage: 1 bd then increase to 1 qid

 LEVOCABASTINE (eye) – Livostin

Side Effects: Drowsiness
Dosage: 1 drop twice daily, increasing to 3–4 times daily if necessary.

 KETOTIFEN – Zaditen
Dosage: 1 bd

 OLOPATADINE – Patanol
Side Effects: hyperaemia, keratitis, dry eye
Dosage: 1 bd

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AMH Summary: Chapter 11 – Eye Drugs 8

NSAIDS
 DICLOFENAC (eye) – Voltaren Optha
Indications: inhibition of miosis during cataract surgery & prevention of inflammation after.
Side Effects: delayed epithelial growth and wound healing, persistent epithelial defects following
keratoplasty.
Dosage: 1 drop 3-5 times daily.

 FLURBIPROFEN – Ocufen
Indication: inhibition of miosis during cataract surgery
Dosage: as above.

 KETOROLAC (eye) – Acular

Indication: short term (2-4 weeks) treatment of seasonal allergic conjunctivitis; prevention and
reduction of inflammation after cataract surgery.
Side Effects: local allergic reactions, superficial keratitis
Dosage: 1 drop qid. May start 24 hours before cataract surgery.

CORTICOSTEROIDS
Side Effects: ocular hypertension (usually reversible) proportional to dose, potency, penetration and
duration of treatment; retarded corneal healing, rebound inflammation

 DEXAMETHASONE (eye) – Maxidex

Dosage: 1 drop 2-4 times daily

 FLUOROMETHOLONE – Flucon, FML; Flarex

Dosage: as above

 HYDROCORTISONE (eye) – Hycor ointment

Dosage: Apply 2–4 times daily.

 PREDNISOLONE (eye) - Minims; (+phenylephrine = Prednefrin Forte)

Dosage: 1 drop 2-4 times daily

OTHER DRUGS FOR ALLERGIC EYE CONDITONS

 CROMOGLYCATE (eye) – Opticrom
- delayed onset of action; may take 3-6 weeks to see effect.

Indications: seasonal allergic conjunctivitis

Side Effects: transient stinging on instillation
Dosage: 1 drop 4–6 times daily.

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AMH Summary: Chapter 11 – Eye Drugs 9

- Dry Eyes -
Use Artificial Tears to provide symptomatic relief.

Eye drops
Preservative: Refresh Tears, Visine, Genteal, Tears Naturale, Systane, Liquifilm, Viscotears
Use these if eye drops are used infrequently. Polytears and Genteal contain a less irritant preservative
so use it in more frequent users.

Preservative-free: Theratears, Cellufresh, Celluvisc, Lacri-lube

Non-irritant but more expensive and packaged in single dose containers. Most useful if patients use
drops 4-6 times per day, wears contacts or has an allergy to a preservative. Single use vials can be
used more than once if refrigerated up to 24hours.

Eye Ointments: use before bedtime if symptoms interrupt sleep or occur on awakening.

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AMH Summary: Chapter 11 – Eye Drugs 10

- Eye Examinations& Procedures -

ANTICHOLINERGICS
Indications: Mydriasis (pupil dilation) for the examination of peripheral lens and retina; Cycloplegia
(paralysis of accommodation).

Side Effects: intolerance to bright light (glare), stinging on instillation (especially 1% cyclopentolate),
blurred vision (especially near vision), transient intraocular pressure elevation (especially in pre-
existing ocular hypertension)

 ATROPINE (eye) – Atropt

Dosage: Diagnostic Use – 1 drop every 5 minutes prn; Uveitis – 1 drop tds to qid.

 CYCLOPENTOLATE – Cyclogyl
Dosage: 1 drop repeated after 5 minutes if necessary. Examine after 20 minutes.

 HOMATROPINE – Isopto Homatropine

Dosage: Diagnostic – 1 drop every 5 minutes; Uveitis (inflammation of inner eye) – 1 drop q4h

 TROPICAMIDE – Mydriacyl
Dosage: 1 drop every 5 minutes prn. Examine after 20 minutes.

OTHER DRUGS FOR MYDRIASIS

 PHENYLEPHRINE (eye)
Indications: pupil dilator with duration of action of 5-7 hours. Maximal mydriasis occurs after 60-90
minutes.
Diagnostic mydriasis, relief of ocular congestion.

Precautions: recent MI, angina, insulin-dependent diabetes – BP elevation

Side Effects: rebound miosis, hyperaemia, stinging on instillation

Dosage: generally as an adjunct

Mydriasis – 1 drop once; Uveitis – 10% 1 drop tds.

LOCAL ANAESTHETICS
 AMETHOCAINE (eye)
 OXYBUPROCAINE
 PROXYMETACAINE

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AMH Summary: Chapter 11 – Eye Drugs 11

Reference

Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011

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