I started ophthalmology residency confident that I was at the top of my game. So when my upper level told me to go “start the drops” on a new patient, I was humbled by my ignorance of the rainbow of little bottles. Why hadn’t this been covered in pharmacology?
This is an introduction to the most common drops you’ll encounter in the first few months of residency. It also includes indications as well as cautions. This is not a comprehensive list, nor should these descriptions be a substitute for medical advice or training. Eyedrops have multiple indications and side effects beyond what is listed here.
In the charts below, the brand name is listed in parentheses if it has not yet become generic.
Anesthetic Drops
Drug |
Lid Color
|
Duration |
Indications |
Cautions |
Proparicaine (Alcaine)
Tetracaine (Pontocaine) |
White |
10–30 min |
Topical anesthesia
Breaks down corneal epithelium ulcers
Speeds absorption of subsequent drops |
Long-term use causes corneal ulcers
Check corneal sensation before use in setting of ulcers |
Benoxinate + Fluorescein (Fluress) |
N/A, dropper |
10–20 min |
Applanation tonometry
Stains defects on corneal/conjunctival surface
Topical anesthesia |
Not for Seidel tests (use fluorescein paper strips)
Patients may see yellow when they blow their nose |
Dilation Drops
Drug |
Lid Color
|
Duration |
Indications |
Cautions |
Phenylephrine 2.5%, 10% (Neosynephrine) |
Red |
3 hours |
Use with tropicamide for adult dilation |
Avoid 10% in hypertensive crisis, pediatrics and the elderly |
Tropicamide 1% (Mydriacil) |
Red |
4–6 hours |
Use with phenylephrine for adult dilation |
|
Cyclopentolate 1%, 2% (Cyclogyl) |
Red |
24 hours |
Cycloplegic refractions |
|
Homatropine 2% |
Red |
1–2 days |
No longer manufactured |
|
Atropine 1% |
Red |
7–10 days |
Breaks posterior synechiae
Decreases ache from ocular inflammation
Fogging for amblyopia treatment |
Avoid in angle-closure glaucoma |
Glaucoma Drops
Drug |
Lid Color
|
Dosing |
Class |
Cautions |
Timolol 0.5% (Timoptic) |
Yellow |
BID |
Beta blocker |
Avoid in patients with asthma, COPD, CHF and bradycardia |
Brimonidine 0.1%, 0.15%, 0.2% (Alphagan) |
Purple |
BID-TID |
Alpha agonist |
Avoid in patients under 3 years of age
Avoid in nursing women (only class B med) |
Dorzolamide (Trusopt) |
Orange |
TID |
Carbonic anhydrase inhibitor |
Avoid in sulfa allergy
Avoid in sickle cell patients with hyphema (can induce sickling in anterior chamber)
Patients may complain of bitter or metallic taste |
Bimatoprost 0.01%, 0.03% (Lumigan)
Travoprost 0.004% (Travatan Z)
Latanoprost 0.005% (Xalatan) |
Teal green |
Qhs |
Prostaglandin agonist |
May reactivate herpes simplex virus keratitis
Darkens hazel irides
Conjunctival hyperemia is common
Avoid in uveitic glaucoma and pregnancy |
Dorzolamide/Timolol 0.5% (Cosopt) |
White with dark-blue strip |
BID |
Carbonic anhydrase inhibitor + beta blocker |
|
Brimonidine 0.2%/Timolol 0.5% (Combigan) |
Dark blue |
BID |
Alpha agonist + beta blocker |
|
Acetazolamide 250-mg tabs, 500-mg sequel (caps), slow release (Diamox) |
N/A |
BID |
Carbonic anhydrase inhibitor |
Avoid in sulfa allergy
Avoid in sickle cell patients with hyphema (can induce sickling in anterior chamber)
Avoid in patients with a history of kidney stones
Beware with potassium-losing diuretics or digitalis
Common side effects include peripheral limb tingling/weakness, bad taste with carbonated beverages and diarrhea |
Methazolamide 25-mg tabs (Neptazane) |
N/A |
BID- TID |
Carbonic anhydrase inhibitor |
Same as above, but less severe |
Steroid Drops
(In order from strongest to weakest)
Drug |
Lid Color
|
Indications |
Cautions |
Difluprednate 0.05% (Durezol) |
Pink |
Postoperative inflammation
Iritis |
Causes highest incidence of elevated IOP and cataracts compared with steroid drops below |
Prednisolone acetate 1% (PredForte) |
Pink/white |
Postoperative inflammation
Iritis |
Can cause elevated IOP and cataracts |
Fluorometholone 0.1% (FML)
Loteprednol 0.5% (Lotemax gel) |
Pink/white |
Ocular surface inflammation/dry eye
Postoperative inflammation |
Can cause elevated IOP and cataracts, but to a much lesser extent than the two above |
Loteprednol 0.2% (Alrex) |
Pink/white |
Seasonal allergies |
|
Antibiotic Drops
Drug |
Lid Color
|
Indications |
Cautions |
Moxifloxacin (Vigamox)
Gatifloxacin (Zymaxid) |
Tan |
Fourth-generation fluoroquinolone
Postoperative
Corneal ulcers |
|
Ofloxacin (Ocuflox) |
Tan |
Third-generation fluoroquinolone
Postoperative |
|
Erythromycin (Emycin) |
N/A, ointment/tube |
Macrolide
Bacterial conjunctivitis
Sterile cornea defects to prevent infection
Prevents ophthalmia neonatorum |
|
Bacitracin ointment (Bacitracin) |
N/A, ointment/tube |
Cationic polypeptide
Methicillin-resistant Staphylococcus aureus |
|
Tobramycin/ Dexamethasone ointment (Tobradex) |
N/A, ointment/tube |
Aminoglycoside
Gram negatives (Pseudomonas) |
|
Neomycin/ Polymyxin/ Dexamethasone ointment (Maxitrol) |
N/A, ointment/tube |
Aminoglycoside + cationic polypeptide + strongest topical steroid
Postoperative
Common gram positives |
Neomycin is the most common cause of contact dermatitis |
* * *
About the author: Natasha L. Herz, MD, is a cataract, corneal and refractive surgeon who works as a solo practitioner at Kensington Eye Center in Washington, D.C. Dr. Herz has been chair of YO Info’s editorial board since 2012. She is also a member of the Academy’s Communications Committee.