General Info: See for administration techniques for ophthalmic agents.

Consult health care professional regarding:

• Concurrent use of contact lenses (medication or additives may be absorbed by the lens).
• Concurrent administration of other ophthalmic agents (order and spacing may be important).

ADRs = adverse reactions.

Anesthetics

Uses: Provide brief local anesthesia to allow measurement of intraocular pressure, removal of foreign bodies, or other superficial procedures.

CAUTIONS: Repeated use may result in ↑ risk of CNS and cardiovascular toxicity; cross-sensitivity with some local anesthetics may occur.

Antihistamines

Uses: Various forms of allergic conjunctivitis.

DRUG NAME	DOSE	NOTES
alcaftadine(Lastacaft [OTC])	Adults and children 2 yr: 1 drop of 0.25% solution once daily.	ADRs: transient burning/stinging, headache
azelastine	Adults and children 3 yr: 1 drop of 0.05% solution twice daily.	ADRs: transient burning/stinging, headache, bitter taste
bepotastine(Bepreve)	Adults and children 2 yr: 1 drop of 1.5% solution twice daily.	ADRs: taste disturbance, headache, local irritation
cetirizine(Zerviate)	Adults and children 2 yr: 1 drop of 0.24% solution twice daily (given 8 hr apart).	ADRs: transient burning/stinging, ↓ visual acuity
epinastine	Adults and children 2 yr: 1 drop of 0.05% solution twice daily.	ADRs: headache, local irritation
ketotifen(Acuvue Theravision)(Alaway [OTC])(Zaditor)	Adults and children 3 yr: 1 drop of 0.025% solution twice daily (given 8–12 hr apart).Adults and children 11 yr: Drug-eluting contact lens: 1 lens in each eye once daily.	ADRs: local irritation, eye pain (contact lens)
olopatadine(Pataday [OTC])	Adults and children 2 yr: 0.1% solution: 1 drop twice daily (given 6–8 hr apart); 0.2% solution: 1 drop once daily; 0.7% solution: 1 drop once daily.	ADRs: headache, conjunctival irritation

Antibacterials

Uses: Localized superficial ophthalmic infections (e.g., bacterial conjunctivitis).

CAUTIONS: Small amounts may be absorbed and result in hypersensitivity reactions.

DRUG NAME	DOSE	NOTES
azithromycin(AzaSite)	Adults and children 1 yr: 1 drop of 1% solution twice daily (given 8–12 hr apart) for 2 days, then once daily for 5 more days.	When used to treat ocular chlamydial infections, concurrent systemic therapy is required ADRs: eye irritation
bacitracin	Adults and children: ¼–½-in. ointment strip every 3–4 hr for acute infections or 2–3 times daily for mild to moderate infections.	ADRs: eye irritation
besifloxacin(Besivance)	Adults and children 1 yr: 1 drop of 0.6% suspension 3 times daily (given 4–12 hr apart) for 7 days.	ADRs: headache, eye irritation
ciprofloxacin(Ciloxan)	Adults and children of all ages (solution) or 2 yr (ointment): Bacterial conjunctivitis: Solution: 1–2 drops of 0.3% solution every 2 hr while awake for 2 days, then every 4 hr while awake for 5 more days; Ointment: ½-in. strip 3 times daily for 2 days, then twice daily for 5 more days; Corneal ulcers: Solution: 2 drops of 0.3% solution every 15 min for 6 hr, then every 30 min while awake for rest of day, then every hr while awake for next 24 hr, then every 4 hr while awake for next 12 days or longer if re-epithelialization does not occur.	May cause harmless white crystalline precipitate that resolves over time ADRs: altered taste, systemic allergic reactions, photophobia, discomfort
erythromycin	Adults and children: Treatment of infections: ½-in. ointment strip 2–6 times daily. Infants: Prophylaxis of ophthalmia neonatorum: ½-in. ointment strip in each eye as a single dose.	ADRs: irritation
gatifloxacin(Zymaxid)	Adults and children 1 yr: 1 drop of 0.5% solution every 2 hr while awake (up to 8 times/day) for 1 day, then 2–4 times daily while awake for 6 more days.	ADRs: irritation, headache, ↓ visual acuity, taste disturbance
gentamicin	Adults and children: Solution: 1–2 drops of 0.3% solution every 2–4 hr.	ADRs: irritation, burning, stinging, blurred vision (ointment)
levofloxacin	Adults and children 6 yr: 1–2 drops of 0.5% solution every 2 hr while awake for 2 days (up to 8 times/day); then every 4 hr while awake for 5 more days (up to 4 times/day).	ADRs: altered taste, systemic allergic reactions, photophobia
moxifloxacin(Vigamox)	Adults and children: 1 drop of 0.5% solution 3 times daily for 7 days.	ADRs: irritation, ↓ visual acuity
ofloxacin(Ocuflox)	Adults and children 1 yr: Bacterial conjunctivitis: 1–2 drops of 0.3% solution every 2–4 hr while awake for 2 days, then 4 times daily for 5 more days; Corneal ulcer: 1–2 drops of 0.3% solution every 30 min while awake and every 4–6 hr while sleeping for 2 days, then every hr while awake for 4–6 more days, then 4 times daily until cured.	ADRs: altered taste, systemic allergic reactions, photophobia
sulfacetamide	Adults and children 2 mo: Solution: 1–2 drops of 10% solution every 2–3 hr while awake (less frequently at night) for 7–10 days; Ointment: ½-in. strip every 3–4 hr and at bedtime for 7–10 days.	Cross-sensitivity with other sulfonamides (including thiazides) may occur ADRs: local irritation
tobramycin(Tobrex)	Adults and children 2 mo: Solution: 1–2 drops of 0.3% solution every 2–4 hr depending on severity of infection; Ointment: ½-in. strip every 8–12 hr.	Ointment may retard corneal wound healing ADRs: irritation, burning, stinging, blurred vision (ointment)

Antifungal

Uses: Fungal blepharitis, conjunctivitis, and keratitis.

CAUTIONS: Small amounts may be absorbed and result in hypersensitivity reactions.

Antiparasitic

Uses: Demodex blepharitis.

Antivirals

Uses: Herpetic conjunctivitis and keratitis.

CAUTIONS: Small amounts may be absorbed and result in hypersensitivity reactions.

DRUG NAME	DOSE	NOTES
ganciclovir(Zirgan)	Adults and children 2 yr: 1 drop of 0.15% gel 5 times daily (every 3 hr while awake) until corneal ulcer heals, then 3 times daily for 7 days.	ADRs: blurred vision, irritation, keratopathy
trifluridine	Adults and children 6 yr: 1 drop of 1% solution every 2 hr while awake (up to 9 drops/day) until re-epithelialization occurs, then every 4 hr while awake for 7 more days (not to exceed 21 days).	ADRs: burning, stinging, keratopathy

Artificial Tears/Ocular Lubricants (sterile buffered isotonic solutions/ointments)

Uses: Artificial tears: keep the eyes moist with isotonic solutions and wetting agents in the management of dry eyes due to lack of tears; also provide lubrication for artificial eyes. Ocular lubricants: provide lubrication and protection in a variety of conditions including exposure keratitis, ↓ corneal sensitivity, corneal erosions, keratitis sicca, during/following ocular surgery or removal of a foreign body.

Beta Blockers

Uses: Treatment of open-angle glaucoma and other forms of ocular hypertension (↓ formation of aqueous humor).

CAUTIONS: Systemic absorption is minimal but may occur. Systemic absorption may result in additive adverse cardiovascular effects (bradycardia, hypotension), especially when used with other cardiovascular agents (antihypertensives, antiarrhythmics). Other systemic adverse reactions may occur, including bronchospasm or delirium (geriatric patients). Concurrent use with ophthalmic epinephrine may ↓ effectiveness.

Carbonic Anhydrase Inhibitors

Uses: Treatment of open-angle glaucoma and other forms of ocular hypertension (↓ formation of aqueous humor).

CAUTIONS: May exacerbate kidney stones; should not be used in patients with CCr <30 mL/min; may have cross-sensitivity with sulfonamides.

Cholinergics (direct-acting)

Uses: Treatment of open-angle glaucoma (facilitates the outflow of aqueous humor); also used to facilitate miosis after ophthalmic surgery or before examination (to counteract mydriatics). Pilocarpine (Vuity) used in treatment of presbyopia.

CAUTIONS: Conditions in which pupillary constriction occurs should be avoided. If significant systemic absorption occurs, bronchospasm, sweating, and ↑ urination and salivation may occur.

DRUG NAME	DOSE	NOTES
acetylcholine(Miochol-E)	Adults: 0.5–2 mL instilled into anterior chamber before or after securing one or more sutures.	ADRs: corneal edema, corneal clouding
carbachol(Miostat)	Adults: 0.5 mL instilled into anterior chamber before or after securing sutures.	ADRs: blurred vision, altered vision, stinging, eye pain
pilocarpine(Qlosi)(Vuity)	Adults: Presbyopia: Vuity: 1 drop of 1.25% solution once daily. An additional drop (in each eye) may be administered 3–6 hr after 1st dose; Qlosi: 1 drop of 0.4% solution once daily, or as needed, up to twice daily. An additional drop (in each eye) may be administered 2–3 hr after 1st dose.Adults and children 2 yr: Glaucoma: 1 drop of 1–4% solution up to 4 times daily; Counteracting mydriatic sympathomimetics: 1 drop of 1–4% solution (may be repeated prior to surgery).Children <2 yr: Glaucoma: 1 drop of 1% solution 3 times daily.	ADRs: blurred vision, altered vision, stinging, eye pain, headache

Cholinergics (cholinesterase inhibitors)

Uses: Treatment of open-angle glaucoma not controlled with short-acting miotics or other agents; also used in varying doses for accommodative esotropia (diagnosis and treatment).

CAUTIONS: Enhances neuromuscular blockade from succinylcholine; intensifies the actions of cocaine and some other local anesthetics; additive toxicity with antimyasthenics, anticholinergics, and cholinesterase inhibitors (including some pesticides). Use cautiously in patients with history or risk of retinal detachment.

Corticosteroids

Uses: Management of inflammatory eye conditions including allergic conjunctivitis, nonspecific superficial keratitis, anterior endogenous uveitis; management of infectious conjunctivitis (with anti-infectives); management of corneal injury; suppression of graft rejection following keratoplasty; management of postoperative inflammation; management of dry eye disease; management of macular edema.

CAUTIONS: Use cautiously in patients with infectious ocular processes (avoid in herpes simplex keratitis), especially fungal and viral ocular infections (may mask symptoms); diabetes, glaucoma, or epithelial compromise.

DRUG NAME	DOSE	NOTES
dexamethasone(Dextenza)(Dexycu)(Maxidex)(Ozurdex)	Adults and children: Solution: 1–2 drops of 0.1% solution every hr during the day and every 2 hr during the night, gradually ↓ the dose to 1 drop every 4 hr, then to 3–4 times daily; Suspension: 1–2 drops of 0.1% suspension up to 4–6 times daily; Implant — one 0.7-mg implant injected into affected eye; Insert: one 0.4-mg insert (releases 0.4 mg dose for up to 30 days); Suspension for injection: 0.005 mL of 9% suspension injected into posterior chamber at end of ocular surgery.	As condition improves, ↓ frequency of administration of ophthalmic solution/suspension ADRs: corneal thinning, ↑ intraocular pressure, irritation
difluprednate(Durezol)	Adults and children: Postoperative inflammation: 1 drop of 0.05% emulsion 4 times daily beginning 24 hr after surgery and continued for 2 wk, then 2 times daily for 1 wk, then taper; Uveitis: 1 drop of 0.05% emulsion 4 times daily for 14 days, then taper.	As condition improves, ↓ frequency of administration ADRs: blepharitis, photophobia, ↓ visual acuity
fluorometholone(Flarex)(FML)(FML Forte)	Adults and children 2 yr: Suspension: 1–2 drops of 0.1% suspension 4 times daily (up to 2 drops every 2 hr during initial 24–48 hr) or 1 drop of 0.25% suspension 2–4 times daily (up to 1 drop every 4 hr during initial 24–48 hr).	As condition improves, ↓ frequency of administration ADRs: corneal thinning, ↑ intraocular pressure, irritation
loteprednol(Alrex)(Eysuvis)(Inveltys)(Lotemax)(Lotemax SM)	Adults: Allergic conjunctivitis: Alrex: 1 drop of 0.2% suspension 4 times daily; Dry eye disease: Eysuvis: 1–2 drops of 0.25% suspension 4 times daily for up to 2 wk; Inflammatory conditions: Lotemax: 1–2 drops of 0.5% suspension 4 times daily (up to 1 drop every hr may be used in first wk); Postoperative inflammation/pain: Lotemax gel/suspension: 1–2 drops of 0.5% gel/suspension 4 times daily beginning 24 hr after surgery and continued for 2 wk or 1 drop of 0.38% gel 3 times daily beginning 24 hr after surgery and continued for 2 wk; Lotemax ointment: ½-in. strip 4 times daily beginning 24 hr after surgery and continued for 2 wk; Inveltys suspension: 1–2 drops of 1% suspension 2 times daily beginning 24 hr after surgery and continued for 2 wk.Children: Postoperative inflammation/pain: Lotemax gel: 1–2 drops of 0.5% gel 4 times daily beginning 24 hr after surgery and continued for 2 wk.	ADRs: corneal thinning, ↑ intraocular pressure, irritation
prednisolone(Pred Forte)(Pred Mild)	Adults and children: 1–2 drops of 0.12–1% solution/suspension 2–4 times daily.	As condition improves, ↓ frequency of administration ADRs: corneal thinning, ↑ intraocular pressure, irritation

Cycloplegic Mydriatics

Uses: Preparation for cycloplegic refraction; induction of mydriasis; management of uveitis (not tropicamide).

CAUTIONS: Use cautiously in patients with a history of glaucoma; systemic absorption may cause anticholinergic effects such as confusion, unusual behavior, flushing, hallucinations, slurred speech, drowsiness, swollen stomach (infants), tachycardia, or dry mouth.

DRUG NAME	DOSE	NOTES
atropine(Isopto Atropine)	Adults and children 3 mo: Cycloplegia/mydriasis: Solution: 1–2 drops of 1% solution 40 min before procedure; Ointment: 0.3–0.5 cm strip 1–2 times daily.	Effects on accommodation may last 6 days; mydriasis may last 12 days ADRs: irritation, blurred vision, photophobia
cyclopentolate(Cyclogyl)	Adults: 1–2 drops of 0.5–2% solution; may repeat in 5–10 min. Children: 1 drop of 0.5–2% solution; may be followed 5–10 min later by 1 drop of 0.5–1% solution.	Peak of cycloplegia is within 25–75 min and lasts 6–24 hr Peak of mydriasis is within 30–60 min and may last several days 2% solution used for heavily pigmented iris ADRs: irritation, blurred vision, photophobia
homatropine	Adults: Cycloplegic refraction: 1–2 drops of 2–5% solution, may repeat in 5–10 min for 2 more doses; Uveitis: 1–2 drops of 2–5% solution 2–3 times daily (up to every 4 hr). Children 3 mo: Cycloplegic refraction: 1–2 drops of 2% solution, may repeat in 10–15 min if needed; Uveitis: 1–2 drops of 2% solution 2–3 times daily (up to every 4 hr).	Cycloplegia and mydriasis may last for 24–72 hr ADRs: irritation, blurred vision, photophobia
tropicamide(Mydriacyl)	Adults and children: 1–2 drops of 0.5–1% solution.	Stronger solution/repeated dosing may be required in patients with dark irises Peak effect occurs in 20–40 min Cycloplegia lasts 2–6 hr; mydriasis lasts up to 7 hr ADRs: irritation, blurred vision, photophobia

Immunomodulators

Uses: Management of keratoconjunctivitis sicca and vernal keratoconjunctivitis.

CAUTIONS: Tear production is not ↑ during concurrent use of ophthalmic NSAIDs or punctal plugs.

DRUG NAME	DOSE	NOTES
cyclosporine(Cequa)(Restasis)(Verkazia)(Vevye)	Adults and children 16 yr: Keratoconjunctivitis sicca: Restasis: 1 drop of 0.05% emulsion every 12 hr.Adults: Keratoconjunctivitis sicca: Cequa: 1 drop of 0.09% solution every 12 hr; Vevye: 1 drop of 0.1% solution every 12 hr.Adults and children 4 yr: Vernal keratoconjunctivitis: Verkazia: 1 drop of 0.1% emulsion 4 times daily until signs/symptoms resolve.	Emulsion should be inverted to obtain uniform opaque appearance prior to use. ADRs: irritation, blurred vision, conjunctival hyperemia
lifitegrast(Xiidra)	Adults: 1 drop of 5% solution every 12 hr.	Emulsion should be inverted to obtain uniform opaque appearance prior to use. ADRs: headache, irritation, blurred vision, metallic taste

Mast Cell Stabilizers

Uses: Management of vernal keratoconjunctivitis and allergic conjunctivitis.

CAUTIONS: Require several days of treatment before effects are seen.

DRUG NAME	DOSE	NOTES
cromolyn	Adults and children 4 yr: 1–2 drops of 4% solution 4–6 times daily.	ADRs: irritation
lodoxamide(Alomide)	Adults and children 2 yr: 1–2 drops of 0.1% solution 4 times daily for up to 3 mo.	ADRs: blurred vision, foreign body sensation, irritation
nedocromil(Alocril)	Adults and children 3 yr: 1–2 drops of 2% solution twice daily throughout period of exposure to allergen.	ADRs: headache, ocular burning, unpleasant taste, nasal congestion

Nonsteroidal Anti-inflammatory Drugs

Uses: Management of pain/inflammation following surgery (bromfenac, diclofenac, ketorolac, nepafenac), allergic conjunctivitis (ketorolac), inhibition of perioperative miosis (flurbiprofen).

CAUTIONS: Cross-sensitivity with systemic NSAIDs may occur; concurrent use of anticoagulants, other NSAIDs, thrombolytics, some cephalosporins, and valproates may ↑ the risk of bleeding. May slow/delay healing. Avoid contact lens use.

DRUG NAME	DOSE	NOTES
bromfenac(Bromsite)(Prolensa)	Adults: Generic: 1 drop of 0.09% solution once daily starting 1 day before surgery and continued on day of surgery and for 2 wk after surgery; Bromsite: 1 drop of 0.075% solution twice daily starting 1 day before surgery and continued on day of surgery and for 2 wk after surgery; Prolensa: 1 drop of 0.07% solution once daily starting 1 day before surgery and continued on day of surgery and for 2 wk after surgery.	Contains sulfites ADRs: irritation, headache
diclofenac	Adults:Cataract surgery: 1 drop of 0.1% solution 4 times daily starting 24 hr after surgery and for 2 wk after surgery; Corneal refractive surgery: 1–2 drops of 0.1% solution within hour before surgery, within 15 min after surgery, then continue 4 times daily for up to 3 days.	ADRs: irritation, allergic reactions
flurbiprofen	Adults: 1 drop of 0.03% solution every 30 min, beginning 2 hr prior to surgery (4 drops total in each eye).	ADRs: irritation, allergic reactions
ketorolac(Acular)(Acular LS)(Acuvail)	Adults and children 2 yr: Allergic conjunctivitis: Acular: 1 drop of 0.5% solution 4 times daily; Postoperative pain/inflammation: Acular: 1 drop of 0.5% solution 4 times daily starting 24 hr after cataract surgery and for 2 wk after surgery; Acular LS: 1 drop of 0.4% solution 4 times daily for up to 4 days after corneal refractive surgery; Acuvail: 1 drop of 0.45% solution twice daily starting 1 day before cataract surgery and continued for 2 wk after surgery.	ADRs: irritation, allergic reactions
nepafenac(Ilevro)(Nevanac)	Adults and children 10 yr: Ilevro: 1 drop of 0.3% suspension once daily starting one day before cataract surgery and continued for 2 wk after surgery; instill 1 additional drop 30–120 min before surgery; Nevanac: 1 drop of 0.1% suspension 3 times daily starting one day before cataract surgery and continued for 2 wk after surgery.	ADRs: irritation, photophobia, headache, hypertension, nausea/vomiting

Ocular Decongestants/Vasoconstrictors

Uses: ↓ ocular congestion due to irritation by vasoconstricting conjunctival blood vessels; stronger solutions have mydriatic effects. Treatment of acquired blepharoptosis (Upneeq).

CAUTIONS: Systemic absorption may result in adverse cardiovascular effects; excessive/prolonged use may produce rebound hyperemia; use caution in patients at risk for acute angle-closure glaucoma; cardiovascular effects may be exaggerated by MAO inhibitors and dose adjustment may be required within 21 days of MAO inhibitors; ↑ risk of arrhythmias with inhalation anesthetics.

Prostaglandin Agonists

Uses: Treatment of open-angle glaucoma (↑ outflow of aqueous humor).

CAUTIONS: May change eye color to brown; will form precipitate with thimerosal-containing products; can be used with other agents to ↓ intraocular pressure.

DRUG NAME	DOSE	NOTES
bimatoprost(Durysta)(Lumigan)	Adults and children 16 yr: 1 drop of 0.01–0.03% solution once daily in the evening.Adults: One implant in anterior chamber of affected eye.	ADRs: local irritation, foreign body sensation, ↑ eyelash growth, ↑ brown pigmentation in iris
latanoprost(Iyuzeh)(Xalatan)(Xelpros)	Adults: 1 drop of 0.005% solution/emulsion once daily in the evening.	ADRs: local irritation, foreign body sensation, ↑ eyelash growth, ↑ brown pigmentation in iris
latanoprostene(Vyzulta)	Adults and children >16 yr: 1 drop of 0.024% solution once daily in the evening.	ADRs: conjunctival hyperemia, local irritation, eye pain, ↑ eyelash growth, ↑ brown pigmentation in iris
omidenepag isopropyl(Omlonti)	Adults: 1 drop of 0.002% solution once daily in the evening.	ADRs: conjunctival hyperemia, photophobia, blurred vision, dry eye, eye pain, headache, ↑ eyelash growth, ↑ brown pigmentation in iris
tafluprost(Zioptan)	Adults: 1 drop of 0.0015% solution once daily in the evening.	ADRs: local irritation, foreign body sensation, ↑ eyelash growth, ↑ brown pigmentation in iris
travoprost(Travatan Z)	Adults and children 16 yr: 1 drop of 0.004% solution once daily in the evening.	ADRs: local irritation, foreign body sensation, ↑ eyelash growth, ↑ brown pigmentation in iris

Rho Kinase Inhibitor

Uses: Treatment of open-angle glaucoma or ocular hypertension (↑ outflow of aqueous humor).

CAUTIONS: Can be used with other agents to ↓ intraocular pressure.

Semifluorinated Alkan

Uses: Dry eye disease.

Sympathomimetics

Uses: Treatment of open-angle glaucoma and other forms of intraocular hypertension (↓ formation of aqueous humor); brimonidine also available as over-the-counter product to ↓ ocular redness.

CAUTIONS: Systemic absorption may result in adverse cardiovascular and CNS reactions (especially in patients with cardiovascular disease); avoid use in patients predisposed to acute angle-closure glaucoma.

DRUG NAME	DOSE	NOTES
apraclonidine(Iopidine)	Adults: Open-angle glaucoma: 1–2 drops of 0.5% solution 3 times daily; Postoperative reduction of intraocular pressure: 1 drop of 1% solution 1 hr before surgery and upon completion of surgery.	A selective alpha-adrenergic agonist Monitor pulse and blood pressure Avoid concurrent use with MAO inhibitors ADRs: ophthalmic-irritation, mydriasis; systemic-allergic reactions, arrhythmias, bradycardia, drowsiness, dry nose, fainting, headache, nervousness, weakness
brimonidine(Alphagan P)(Lumify [OTC])	Adults and children 2 yr: Glaucoma: 1 drop of 0.1–0.2% solution 3 times daily (8 hr apart).Adults and children 5 yr: Ocular redness (Lumify): 1 drop of 0.025% solution every 6–8 hr as needed (up to 4 times daily).	A selective alpha-adrenergic agonist Avoid concurrent use with MAO inhibitors Tricyclic antidepressants may ↓ effectiveness; additive CNS depression may occur with other CNS depressants, additive adverse cardiovascular effects with other cardiovascular agents ADRs: ophthalmic–irritation; systemic–drowsiness, dizziness, dry mouth, headache, weakness, muscular pain