Comprehensive Drop Guide

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The eye presents a unique organ for diagnosis and treatment in that it is readily examined by the physician, and it can be treated locally in the form of eye drops. There are a plethora of drops that can be overwhelming for the beginning ophthalmologist.

This guide aims to delineate the majority of drugs available in drop form along with their brand names, uses, dosing schedules, side effects, etc.

Antibiotics

DRUG	GTT/UNG	CONCENTRATION %	BRAND	COST	TOP COLOR	CLASS	NOTES & USES	COVERAGE	SIDE EFFECTS	TYPICAL ADULT DOSING
Moxifloxacin	gtt	0.5	Vigamox/Moxeza	$$	Tan	Fluoroquinolone	Corneal Ulcers, especially contact lens related, refractory infections.	++Gram(+) +Gram(-)	Toxicity with long term use	TID-QID
Ciprofloxacin	gtt/ung	0.3	CILOXAN	$	Tan/White	Fluoroquinolone	Corneal ulcers, bacterial conjunctivitis	+Gram(+) +++Gram(-)	Local irritation	q15min-q2h initially
Levofloxacin	gtt	0.5	IQUIX, QUIXIN		Tan	Fluoroquinolone	Bacterial conjunctivitis		Local irritation	q2h-q4h
Ofloxacin	gtt	0.3	OCUFLOX		Tan	Fluoroquinolone	Corneal ulcers, bacterial conjunctivitis		Local irritation	q30min-q4h initially
Besifloxacin	gtt	0.6	BESIVANCE		Tan	Fluoroquinolone	Bacterial conjunctivitis		Conjunctival injection	TID
Gatifloxacin	gtt	0.5	ZYMAR, ZYMAXID		Tan	Fluoroquinolone	Bacterial conjunctivitis		Conjunctival hemorrhage, hypersensitivity, Stevens-Johnson syndrome	q2h
Azithromycin	gtt	1	AZASITE		White	Macrolide	Bacterial conjunctivitis		Hypersensitivity, K erosion	BID
Gentamicin	gtt/ung	0.3	GENOPTIC/SOP, GARAMYCIN, GENTAK, GENTACIDIN, GENTAFAIR, GENTASOL, OCU-MYCIN		White	Aminoglycoside	Bacterial conjunctivitis, post-op and post-injury infection prophylaxis		Local irritation	q1-q4h
Tobramycin	gtt/ung	0.3	TOBREX, TOBRASOL, AKTOB		White	Aminoglycoside	External ocular infections		Delayed corneal wound healing, hypersensitivity, local irritation	q4h-BID
Erythromycin	ung	0.5	ILOTYCIN		Black	Macrolide	Superficial bacterial ocular infections, prophylaxis		Local irritation	QD-6x/day
Bacitracin	ung	500 units/gram	AK-TRACIN, OCU-TRACIN		Black	Polypeptide	Superficial bacterial ocular infections, prophylaxis		Hypersensitivity, contact dermatitis	q3-4h
Polymyxin B-Trimethoprim	gtt	10,000 units/1 mg per mL	POLYTRIM		White	Mixture	Superficial bacterial ocular infections		Periocular rash, local irritation	q3h-QID
Neomycin-Polymyxin B-Gramicidin	gtt	Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin 0.025 mg per 1 mL	NEOCIDIN, NEOSPORIN OPH, OCU-SPOR-G		Clear	Mixture	Superficial bacterial ocular infections		Anaphylaxis, local pruritis, local irritation	q4h
Neomycin-Polymyxin B-Bacitracin	ung	400 units/3.5 mg/10,000 units per g	NEO-POLYCIN		Black	Mixture	Superficial bacterial ocular infections		Anaphylaxis, local pruritis, local irritation	q3-4h
Bacitracin-Polymyxin B	ung	500 units/10,000 units per g	POLYSPORIN, AK-POLY-BAC, POLYCIN		Black	Mixture	Superficial bacterial ocular infections		Anaphylaxis, local pruritis, local irritation	q3-4h
Sulfacetamide	gtt/ung	10	BLEPH-10	$	White	Sulfa	Superficial bacterial ocular infections, trachoma as adjunct therapy to systemic sulfonamide	++Gram(+) no Gram(-)	Stevens-Johnson syndrome, blood dyscrasias, corneal wound healing delay	q2-3h

Steroids and NSAIDs

Steroids listed in ascending order of potency.

DRUG	gtt/ung	BRAND	COLOR	CLASS	USES	SIDE EFFECTS	CONCENTRATION %	TYPICAL ADULT DOSING
Fluorometholone		FML	White	Corticosteroid
Loteprednol	gtt/ung	ALREX 0.2%, LOTEMAX 0.5%, INVELTYS 1%		Corticosteroid
Rimexolone		VEXOL		Corticosteroid
Prenisolone		PREDFORTE, PREDMILD	Pink or white	Corticosteroid	Intraocular inflammation	Cataract, elevated intraocular pressure	1%, 0.12%
Difluprednate		DUREZOL	Pink	Corticosteroid	Intraocular inflammation	Cataract, elevated intraocular pressure	0.05%	QD-QID

Combination Steroid-Antibiotic

DRUG	gtt/ung	BRAND
Tobramycin-Loteprednol	gtt	Zylet
Sulfacetamide sodium-Prednisolone	gtt/ung	Blephamide
Neomycin-Bacitracin-Hydrocortisone	gtt/ung	Corticosporin
Neomycin-Polymyxin B-Dexamethasone	gtt/ung	Maxitrol
Tobramycin-Dexamethasone	gtt/ung	Tobradex

Antimicrobials

DRUG	BRAND	CLASS
Natamycin	Natacyn	Antifungal
Ganciclovir	Zirgan	Antiviral
Trifluiridine	Viroptic	Antiviral
Cysteamine	Cystaran	Anti-cystinosis
Cenegermin-bkbj	Oxervate	Nerve-regenerant

Pressure Regulators

Listed by medication class, side effects are similar between drugs of the same class.

DRUG	BRAND	COLOR	CLASS	USES	SIDE EFFECTS	CONCENTRATION %	TYPICAL ADULT DOSING
Brimonidine	Alphagan	Purple	Alpha agonist	decrease production of fluid and increase drainage	contraindicated in infants and small children due to risk of respiratory depression, burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, relatively higher likelihood of allergic reaction	0.1 , 0.15, 0.2	TID
Apraclonidine	Iopidine	clear vials	Alpha agonist	laser peripheral iridotomy		0.5, 1	TID
Dorzolamide	Trusopt	Orange	Carbonic Anhydrase Inhibitor	decreasing the production of intraocular fluid	stinging, burning, eye discomfort	2	TID
Brinzolamide	Azopt	White/Orange	Carbonic Anhydrase Inhibitor	decreasing the production of intraocular fluid	stinging, burning, eye discomfort	1	TID
Timolol	Timoptic/Istalol/Betimol	Yellow	Beta blocker	decreasing production of intraocular fluid	low blood pressure, reduced pulse rate, fatigue, shortness of breath; rarely: reduced libido, depression	0.25, 0.5	BID
Betaxolol	Betoptic	White	Beta blocker	decreasing the production of intraocular fluid	low blood pressure, reduced pulse rate, fatigue, shortness of breath; rarely: reduced libido, depression	0.25, 0.5	BID
Levobunolol	Betagan	Yellow/light Green	Beta blocker	decreasing the production of intraocular fluid	low blood pressure, reduced pulse rate, fatigue, shortness of breath; rarely: reduced libido, depression	0.25, 0.5	BID
Metipranolol	Optipranolol	Yellow/White	Beta blocker	decreasing the production of intraocular fluid	low blood pressure, reduced pulse rate, fatigue, shortness of breath; rarely: reduced libido, depression	0.3	BID
Latanoprost	Xalatan	Green	Prostoglandin Analog	Increase aqueous outflow in open-angle glaucoma	eye color change, darkening of eyelid skin, eyelash growth, droopy eyelids, sunken eyes, stinging, eye redness, and itching	0.005	QHS
Bimatoprost	Lumigan	Turqouise/White	Prostoglandin Analog	Increase aqueous outflow in open-angle glaucoma	eye color change, darkening of eyelid skin, eyelash growth, droopy eyelids, sunken eyes, stinging, eye redness, and itching	0.01, 0.03	QHS
Travoprost	Travatan	Turqouise/White	Prostoglandin Analog	Increase aqueous outflow in open-angle glaucoma	eye color change, darkening of eyelid skin, eyelash growth, droopy eyelids, sunken eyes, stinging, eye redness, and itching	0.004	QHS
Tafluprost	Zioptan	clear vials	Prostoglandin Analog	Preservative free	eye color change, darkening of eyelid skin, eyelash growth, droopy eyelids, sunken eyes, stinging, eye redness, and itching	0.0015	QHS
Latanoprostene	Vyzulta	Turqouise	Prostoglandin Analog	Increase aqueous outflow in open-angle glaucoma	eye color change, darkening of eyelid skin, eyelash growth, droopy eyelids, sunken eyes, stinging, eye redness, and itching	0.024	QHS
Pilocarpine	Isopto Carpine, Pilopine	Green	Cholinergic	acute angle closure glaucoma to decrease crowding at the angle, increasing the drainage of intraocular fluid through the trabecular meshwork	dim vision, especially at night or in darkened areas such as movie theaters, secondary to small pupil size	1, 2, 4	q15-60min x 2-4 doses for acute angle closure TID-QID
Carbachol	Isopto Carbachol	Green	Cholinergic	intraoperative miosis	dim vision, especially at night or in darkened areas such as movie theaters, secondary to small pupil size	0.75, 1.5, 3
Netarsudil	Rhopressa	White	Rho Kinase Inhibitor	increase drainage of intraocular fluid by improving outflow of the trabecular meshwork	eye redness, corneal deposits, stinging, and small bleeds on the white of the eye		QHS
Brimonidine + Timolol	Combigan	Dark Blue	Alpha agonist + Beta blocker	for patients who need multiple medications for intraocular pressure control, convenient and often financial advantage	see above		BID
Dorzolamide + Timolol	Cosopt	Dark Blue	Carbonic anhydrase inhibitor + Beta blocker	for patients who need multiple medications for intraocular pressure control, convenient and often financial advantage	see above		BID
Brimonidine + Brinzolamide	Simbrinza	Light Green, White	Alpha agonist + Carbonic anhydrase inhibitor	for patients who need multiple medications for intraocular pressure control, convenient and often financial advantage	see above	0.2, 1	TID

Dilation and Cycloplegia

Listed by class and in approximate order of decreasing length of effect.

DRUG	BRAND	COLOR	CLASS	USES	SIDE EFFECTS	CONCENTRATION %	TYPICAL ADULT DOSING
Atropine	Isopto Atropine, Atropisol	Red	Anticholinergic/ Parasympatholytic	7-12 days of effect suspected accommodative esotropia, amblyopia penalization, hyphema to paralyze the ciliary muscle	common: burning, photophobia, blurred vision, ocular irritation, eyelid edema, hyperemia, increased IOP, conjunctivitis, behavioral disturbance, confusion dry mouth/skin, tachycardia, disorientation, seizures, hypotension, psychosis, respiratory depression, fever due to CNS effects on the hypothalamus	0.5-3	QD-BID
Scopolamine	Isopto Hyoscine	Red	Anticholinergic/ Parasympatholytic	3-7 days use in patients allergic to other agents	easily crosses blood brain barrier, CNS effects more common common: burning, photophobia, blurred vision, ocular irritation, eyelid edema, hyperemia, increased IOP, conjunctivitis, behavioral disturbance, confusion serious: psychosis, seizures, tachycardia, hypotension, respiratory depression, hallucinations	0.25
Homatropine	Isopto/AK Homatropine	Red	Anticholinergic/ Parasympatholytic	1-3 days useful in uveitis	common: burning, photophobia, blurred vision, ocular irritation, eyelid edema, hyperemia, increased IOP, conjunctivitis, behavioral disturbance, confusion serious: psychosis, seizures, tachycardia, hypotension, respiratory depression, hallucinations	2-5	BID-TID
Cyclopentolate	Cyclogyl, AK Pentolate	Red	Anticholinergic/ Parasympatholytic	1 day cycloplegic refraction uveitis	common: burning, photophobia, blurred vision, ocular irritation, eyelid edema, hyperemia, increased IOP, conjunctivitis, behavioral disturbance, confusion serious: psychosis, seizures, tachycardia, hypotension, respiratory depression, hallucinations		TID
Tropicamide	Mydriacyl, Tropicacyl	Red	Anticholinergic/ Parasympatholytic	6-24 hours dilated fundus exam	common: burning, photophobia, blurred vision, ocular irritation, eyelid edema, hyperemia, increased IOP, conjunctivitis, behavioral disturbance, confusion serious: psychosis, seizures, tachycardia, hypotension, respiratory depression, hallucinations	0.5, 1	PRN
Phenylephrine		Red	Adrenergic	6 hours	contraindicated in patients taking MAO inhibitors, tricyclic antidepressants, reserpine, guanethidine, or methyldopa mild stinging, pigmented aqueous floaters, acute systemic hypertension, ventricular arrhythmia, tachycardia, subarachnoid hemorrhage, death with 10% reported adrenochrome deposits	2.5, 10	PRN
Hydroxyamphetamine	Paremyd +Tropicamide (0.25%)	Red	Adrenergic	localizing lesion in Horner's syndrome		1	PRN

Allergy and Lubrication

These medications are available to patients without a prescription over the counter.

There are an immense variety and number of lubricants, this is a list of some commonly available formulations. Recommendations for patients vary depending on physician preference and local supply.

DRUG	BRAND	COLOR	GTT/UNG	CLASS	USES	SIDE EFFECTS	CONCENTRATION %	TYPICAL ADULT DOSING
				lubricant
				allergy

References

https://www.glaucoma.org/gleams/glaucoma-medications-and-their-side-effects.php

https://optometrysmeeting.org/documents/handouts/2019/P450.pdf

https://www.epocrates.com/