As a medical student and intern, you memorized hundreds of medications, drug classes and mechanisms of action. But now you’ve entered a new realm of medication memorization and management: eye drops and cap colors.
As a new ophthalmology resident, you’ll inevitably get a phone call in the middle of the night asking for a refill of an eye drop. Many times, the only detail the patient may have is the color of the cap.
The chart below is an introduction to the most common drops you will come across in your first months of residency. Although this is not a complete list of uses or complications, it’s a starting point and may serve as a good reference on those late-night consults.
In the charts below, the branded name is listed in parentheses.
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 |
|
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 |
|
| Atropine 1% |
Red |
7–10 days |
Breaks posterior synechiae
Decreases ache from ocular inflammation
Fogging for amblyopia treatment |
Avoid in angle-closure glaucoma |
| Cyclopentolate 0.2%/Phenylephrine 1% (Cyclomydril) |
Red |
24 hours |
Cycloplegic refraction, dilated exam in infants (lower concentration may require repeat dosing) |
Bradycardia, apnea in neonates |
Anesthetic Drops
| Drug |
Lid Color
|
Duration |
Indications |
Cautions |
Proparacaine
(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 or other corneal pathology |
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 |
Glaucoma Drops
| Drug |
Lid Color
|
Dosing |
Class |
Cautions |
Timolol 0.5%
(Timoptic) + several others |
Yellow |
QAM or 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 women who are nursing or who are near their delivery date (though it is the only class B glaucoma drop) |
|
Dorzolamide
(Trusopt)
Brinzolamide 1%
(Azopt)
|
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)
Tafluprost 0.0015%
(Zioptan)
These drops come in single-use vials, so there is no lid color.
|
Teal green |
QHS |
Prostaglandin agonist |
May reactivate herpes simplex virus keratitis
Darkens hazel irides
Increases eyelash length, amount
Conjunctival hyperemia is common
Avoid in uveitic glaucoma and late pregnancy (may induce labor) |
Dorzolamide 2%/Timolol 0.5%
(Cosopt) |
White with dark-blue strip or solid dark blue |
BID |
Carbonic anhydrase inhibitor + beta blocker |
|
Brimonidine 0.2%/Timolol 0.5%
(Combigan) |
Dark blue |
BID |
Alpha agonist + beta blocker |
|
| Latanoprostene bunod 0.024% |
Teal green |
QHS |
Nitric oxide donating prostaglandin analog |
|
| Netarsudil 0.02% (Rhopressa) |
White |
QHS |
Rho kinase inhibitor |
Conjunctival hyperemia is common |
Acetazolamide
250-mg,
500-mg extended release
(Diamox) |
N/A |
BID-QID |
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
(Neptazane) |
N/A |
BID- TID |
Carbonic anhydrase inhibitor |
Same as above, but less severe |
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 |
|
Tobramycin/
Dexamethasone ointment
(Tobradex) |
Pink/white, also available as 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 |
* * *
Bradley S. Henriksen, MD, joined the YO Info editorial board in 2022. He is a pediatric ophthalmologist in Provo, UT, who completed his residency and fellowship at Oregon Health Science University, Casey Eye Institute, in Portland, OR.