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.
Contents
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
| Drug | Class (function) | Cautions | Side 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 |
| Pilocarpine | Cholinergic (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 |
Antimicrobial drops
| Drug | Indications | Cautions |
|---|---|---|
| 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 |
Steroid drops
| Drug | Indications (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 |
Anaesthetic drops
| Drug | Duration | Indications | Cautions |
|---|---|---|---|
| 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 |
Dilatation drops
| Drug | Duration | Indications | Cautions |
|---|---|---|---|
| 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 |
Hydrating drops
| Drug | Viscosity | Notes |
|---|---|---|
| Hypromellose | Low | • Most frequently used for dry eye Initially can be used more often (i.e hourly) prior to reduction in frequency |
| Polyvinyl alcohol | Low | • Alternative to Hypromellose |
| Carbomer 980 | Medium | • Less tolerated than Hypromellose because can blur vision • Frequency can be reduced as higher viscosity |
| Carmellose | Medium | • Usually for moderate to severe dry eyes |
| Sodium hyaluronate 0.1% or 0.2% | Medium | • Usually for moderate to severe dry eyes |
| Liquid paraffin | High | • Blurring of vision ( therefore used usually at night before sleep) • Not when wearing contact lenses |
Edited by: Mudassar Khan (Y4 Medical Student)
