Comprehensive Drop Guide

From EyeWiki


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 COLOR CLASS USES SIDE EFFECTS CONCENTRATION % TYPICAL ADULT DOSING
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 COLOR CLASS USES SIDE EFFECTS CONCENTRATION % TYPICAL ADULT DOSING
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/