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BETA-ADRENERGIC BLOCKERS

Propranolol HCl Use: Intraocular hypertension and chronic open-angle glaucoma.

Betaxolol HCl 0.25%, 0.5% soln Betoptic, Betoptic S		Adult: Topical 1 drop of 0.5% solution or 0.25% suspension in affected eye twice daily.
Carteolol HCl 1% soln Ocupress		Adult: Topical 1 drop b.i.d.
Levobetaxolol 0.5% susp Betaxon		Adult: Topical 1 drop b.i.d.
Levobunolol 0.25%, 0.5% soln Betagan		Adult: Topical 1–2 drops 1–2 times/d.
Metipranolol HCl 0.3% soln OptiPranolol		Adult: Topical 1 drop b.i.d.
Timolol maleate 0.25%, 0.5% soln Betimol, Timoptic, Timoptic XE		Adult: Topical 1 drop of 0.25–0.5% solution b.i.d.; may decrease to q.d. Apply gel q.d.

Adverse Effects/Clinical Implications: May cause mild ocular stinging and discomfort; tearing; may also have the adverse effects of systemic beta blockers. May mask symptoms of acute hypoglycemia in diabetic patients (tachycardia, tremor, but not sweating). May precipitate thyroid storm in patients with hyperthyroidism. Patients with impaired cardiac function and the elderly should report to physician signs and symptoms of CHF (see Appendix G). Monitor BP for hypotension and heart rate for bradycardia.

MIOTICS

Pilocarpine HCl Use: Open-angle and angle-closure glaucomasto reduce IOP and to protect the lens during surgery and laser iridotomyto counteract effects of mydriatics and cycloplegics following surgery or ophthalmoscopic examination

Apraclonidine HCl Iopidine		Intraoperative and Post-surgical Increase in IOP: Adult: Topical 1 drop of 1% solution in affected eye 1 h before surgery and 1 drop in same eye immediately after surgery. Open-angle Glaucoma: Adult: Topical 1 drop of 0.5% solution in affected eye q12h.
Brimonidine tartrate Alphagan P		Glaucoma: Adult: Topical 1 drop in affected eye(s) t.i.d. approximately 8 h apart
Brinzolamide Azopt		Ocular Hypertension or Open-angle Glaucoma: Adult: Topical 1 drop in affected eye(s) t.i.d.
Carbachol Isopto, Carbachol, Miostat		Adult: Topical 1–2 drops of 0.75–3% solution in lower conjunctival sac q4–8h. Intraocular 0.5 ml of 0.01% solution injected into anterior chamber of eye.
Demecarium bromide Humorsol		Glaucoma: Adult: Topical 1–2 drops of 0.125–0.25% solution 2 times/wk up to b.i.d. Convergent Strabismus: Child: 1 drop of 0.125% solution in each eye daily for 2–3 wk; then decrease to 1 drop q.o.d. for 2–8 wk; then 1 drop 2 times/wk.
Dorzolamide Trusopt		Ocular Hypertension or Open-angle Glaucoma: Adult: Topical 1 drop in affected eye(s) t.i.d.
Echothiophate iodide Phospholine Iodide		Glaucoma: Adult: Topical 1 drop of 0.03–0.25% solution in conjunctival sac 1–2 times/d. Accommodative Esotropia: Adult: Topical Diagnosis: 1 drop of 0.125% solution in both eyes once/d at bedtime for 2–3 wk. Treatment: 1 drop of 0.125% solution q.o.d. or 1 drop of 0.06% solution daily (max: 1 drop 0.125% solution daily).
Pilocarpine HCl Adsorbocarpine, Isopto Carpine, Minims, Pilocarpine, Miocarpine, Ocusert, Pilo		Acute Glaucoma: Adult: Topical 1 drop of 1–2% solution in affected eye q5–10min for 3–6 doses, then 1 drop q1–3h until IOP is reduced. Chronic Glaucoma: Adult: Topical 1 drop of 0.5–4% solution in affected eye q4–12h or 1 ocular system (Ocusert) q7d Miotic: Adult: Topical 1 drop of 1% solution in affected eye.

Adverse Effects/Clinical Implications: Ocular: Ciliary spasm with browache, twitching of eyelids, eye pain with change in eye focus, miosis, diminished vision in poorly illuminated areas, blurred vision, reduced visual acuity, sensitivity, contact allergy, lacrimation, follicular conjunctivitis, conjunctival irritation, cataract, retinal detachment. CNS: Headache, drowsiness, depression, syncope. GI: Abnormal taste, dry mouth. Clinical Implications: Wait 15 min after instillation before inserting soft contact lenses to avoid staining the lenses. Use with MAO inhibitors may have increased risk of hypertensive emergency. May increase the effects of beta blockers and other antihypertensives on blood pressure and heart rate. TCAs may reduce the effects of brimonidine. Brinzolamide is a carbonic anhydrase inhibitor (prototype: acetazolamide) and is a sulfonamide. It should not be used by patients with sulfa allergies. Demecarium bromide is capable of producing cumulative systemic effects. It is essential to adhere precisely to prescribed drug concentration, dosage schedule, and technique of administration. Reconstituted solutions of echothiophate remain stable for 1 mo at room temperature. Expiration date should appear on label. The length of time solutions remain stable under refrigeration varies with manufacturer. Echothiophate therapy is generally discontinued 2–6 wk before surgery. If necessary, alternate miotic therapy is substituted. Medication should be given in the evening. Give at least 5 min apart from other topical ophthalmic drugs. The patient with brown or hazel eyes may require a stronger ophthalmic solution or more frequent instillation of physostigmine for desired effects than the patient with blue eyes.

PROSTAGLANDINS

Latanoprost Use: Open-angle glaucoma and intraocular hypertension.

Bimatoprost Lumigan		Adult: Topical 1 drop in affected eye(s) once daily in the evening.
Latanoprost Xalatan		Adult: Topical 1 drop (1.5 mg) in affected eye(s) once daily in the evening.
Travaprost Travatan		Adult: Topical 1 drop in affected eye(s) once daily in the evening.
Unoprostone isopropyl Rescula		Adult: Topical 1 drop in affected eye(s) b.i.d.

Adverse Effects: Ocular: Conjunctival hyperemia, g rowth of eyelashes, ocular pruritus, ocular dryness, visual disturbance, ocular burning, foreign body sensation, eye pain, pigmentation of the periocular skin, blepharitis, cataract, superficial punctate keratitis, eyelid erythema, ocular irritation, eyelash darkening, eye discharge, tearing, photophobia, allergic conjunctivitis, increases in iris pigmentation (brown pigment), conjunctival edema. Body as a Whole: Headaches, abnormal liver function tests, asthenia, and hirsutism. Clinical Implications: Should instill in the evening. Wait 15 min after instillation before inserting soft contact lenses to avoid staining the lenses. Give at least 5 min apart from other topical ophthalmic drugs.

MYDRIATIC

Homatropine HBr Use: Mydriatic for ocular examination and as cycloplegic to measure errors of refraction. Also inflammatory conditions of uveal tract, ciliary spasm, as a cycloplegic and mydriatic in preoperative and postoperative conditions, and as an optical aid in select patients with axial lens opacities.

Cyclopentolate HCl AK-Pentolate, Cyclogyl, Pentalair		Cycloplegic Refraction: Adult: Topical 1 drop of 1% solution in eye 40–50 min before procedure, followed by 1 drop in 5 min; may need 2% solution in patients with darkly pigmented eyes Child: Topical 1 drop of 0.5–1% solution in eye 40–50 min before procedure, followed by 1 drop in 5 min; may need 2% solution in patients with darkly pigmented eyes.
Dipivefrin HCl Propine		Glaucoma: Adult: Topical 1 drop in eye q12h.
Epinephryl borate Epinal, Eppy/N		Adult: Topical 1–2 drops as needed.
Homatropine HBr AK-Homatropine, Homatrine, Isopto Homatropine		Cycloplegic Refraction: Adult: Topical 1–2 drops of 2% or 5% solution in eye repeated in 5–10 min if necessary. Ocular Inflammation: Adult: Topical 1–2 drops of 2% or 5% solution in eye up to q3–4h.
Hydroxyamphetamine HBr Paredrine
Hydroxyamphetamine HBr/Tropicamide Paremyd		Dilation of pupil: Adult: Topical 1–2 drops in conjunctival sac.
Phenylephrine HCl AK-Dilate Ophthalmic, Alconefrin, Isopto Frin, Mydfrin, Neo-Synephrine, Prefrin Liquifilm, Vacon		Ophthalmoscopy: Adult: Topical 1 drop of 2.5% or 10% solution before examination. Child: Topical 1 drop of 2.5% solution before examination Vasoconstrictor: Adult: Topical 2 drops of 0.12–0.15% solution q3–4h as necessary.
Tropicamide Mydriacyl, Tropicacyl		Refraction: Adult: Topical 1–2 drops of 1% solution in each eye, repeat in 5 min; if patient is not seen within 20–30 min, an additional drop may be instilled. Examination of Fundus: Adult: Topical 1–2 drops of 0.5% solution in each eye 15–20 min prior to examination; may repeat q30min if necessary.

Contraindicated in: Primary (narrow-angle) glaucoma or predisposition to glaucoma; children <6 y. Cautious use in: Increased IOP, infants, children, pregnancy (category C), the elderly or debilitated; hypertension; hyperthyroidism; diabetes; cardiac disease. Adverse Effects: Increased IOP, blurred vision, photophobia. Prolonged use: Local irritation, congestion, edema, eczema, follicular conjunctivitis. Excessive dosage/systemic absorption: Symptoms of atropine poisoning (flushing, dry skin, mouth, nose; decreased sweating; fever, rash, rapid/irregular pulse; abdominal and bladder distension; hallucinations, confusion). CNS: Psychotic reaction, behavior disturbances, ataxia, incoherent speech, restlessness, hallucinations, somnolence, disorientation, failure to recognize people, grand mal seizures. Clinical Implications: Carefully monitor cyclopentolate patients with seizure disorders, since systemic absorption may precipitate a seizure. Photophobia associated with mydriasis may require patient to wear dark glasses. Since drug causes blurred vision, supervision of activity may be indicated.

VASOCONSTRICTOR; DECONGESTANT

Naphazoline HCl Use: Ocular vasoconstrictor

Naphazoloine HCl AK-Con, Albalon, Allerest, Clear Eyes, Comfort, Degest-2, Muro's Opcon, Nafazair, Naphcon, Privine, VasoClear, Vasocon		Adult: Topical 1–3 drops of 0.1% solution q3–4h prn or 1–2 drops of a 0.01–0.03% solution q4h prn.
Tetrahydrozoline HCl Collyrium, Malazine, Murine Plus, Optigene, Soothe, Tyzine, Visine		Adult: Topical 1–2 drops of 0.05% solution in eye b.i.d. or t.i.d.

Contraindicated in: Narrow–angle glaucoma; concomitant use with MAO INHIBITORS or TRICYCLIC ANTIDEPRESSANTS Cautious use in: Hypertension, cardiac irregularities, advanced arteriosclerosis; diabetes; hyperthyroidism; elderly patients. Adverse Effects: Pupillary dilation, increased intraocular pressure, rebound redness of the eye, headache, hypertension, nausea, weakness, sweating. Overdosage: Drowsiness, hypothermia, bradycardia, shocklike hypotension, coma.

CORTICOSTEROID, ANTI-INFLAMMATORY

Hydrocortisone Use: Inflammation Unlabelled Uses: Anterior uveitis

Dexamethasone sodium phosphate Decadron, Maxidex		Adult: Topical 1–2 drops in conjunctival sac up to 4–6 times/d; may instill hourly for severe disease.
Fluorometholone Fluor-Op, FML Forte, FML Liquifilm		Adult and Child >2 y: Topical 1–2 drops of suspension in conjunctival sac q.h. for the first 24–48 h; then b.i.d. to q.i.d.; or a thin strip of ointment q4h for the first 24–48 h; then 1–3 times/d.
Loteprednol etabonate Alrex, Lotemax		Adult: Topical 1–2 drops in conjunctival sac q.i.d. during initial treatment, may increase to q1h if necessary.
Prenisolone sodium phosphate Inflamase, Inflamase Mild, Pred Mild, Inflamase Forte		Adult: Topical 1–2 drops in conjunctival sac q.h. during the day; then q2h at night; may decrease to 1 drop t.i.d. or q.i.d.
Rimexolone Vexol		Postoperative Ocular Inflammation: Adult: Topical 1–2 drops q.i.d. beginning 24 h after surgery, continue through first 2 wk postoperatively. Anterior Uveitis: Adult: Topical 1–2 drops in affected eye every hour while awake for first week, then q2h for second week, then taper frequency until uveitis resolves.

Contraindicated in: Ocular fungal diseases, herpes simplex keratitis, ocular infections, ocular mycobacterial infections, viral disease of cornea or conjunctiva such as vaccina, varicella. Adverse Effects: Ocular: Blurred vision, photophobia, conjunctival edema, corneal edema, erosion, eye discharge, dryness, irritation, pain; prolonged use: glaucoma, ocular hypertension, damage to optic nerve, defects in visual acuity and visual fields, posterior subcapsular cataract formation, secondary ocular infections. Other: Headache, taste perversion. Clinical Implications: Shake all products well before use.

OCULAR ANTIHISTAMINES

Use: Relief of signs and symptoms of allergic conjunctivitis

Azelastine HCl OPTIVAR		Adult and Child >3 y: Topical 1 drop in affected eye(s) b.i.d.
Cromolyn Sodium Crolom, Opticrom		Adult: Topical 1–2 drops in each eye 4–6 times/d.
Emedastine difumarate Emadine		Adult and Child >3 y: Topical 1 drop in affected eye(s) up to q.i.d.
Ketotifen fumarate Zaditor		Adult: Topical 1 drop in affected eye(s) q8–12h.
Lodoxamide Alomide		Adult and Child >2 mo: Topical 1>2 drop in affected eye(s) q.i.d. for up to 3 mo.
Levocabastine HCl Livostin		Adult: Topical 1 drop in affected eye(s) q.i.d., shake well before using.
Nedocromil sodium Alocril		Adult and Child >3 y: Topical 1–2 drops in affected eye(s) b.i.d.
Olopatadine HCl Patanol		Adult and Child >3 y: Topical 1–2 drops in affected eye(s) b.i.d. at least 6–8 h apart.
Pemirolast potassium Alamast		Adult: Topical 1–2 drops in affected eye(s) q.i.d.

Adverse Effects: Ocular: Allergic reactions, burning, stinging, discharge, dry eyes, eye pain, eyelid disorder, itching keratitis, lacrimation disorder, mydriasis, photophobia, rash. CNS: Drowsiness, fatigue, headache. Other: Dry mouth, cold syndrome, pharyngitis, rhinitis, sinusitis, taste perversion. Clinical Implications: Wait 10 min after instilling emedastine before inserting soft contact lenses; do not use levocabastine, olopatadine with soft contact lenses.