Appendix A-1
OCULAR MEDICATIONS:

BETA-ADRENERGIC BLOCKERS

Prototype for classification: Propranolol HCl     Use: Intraocular hypertension and chronic open-angle glaucoma

Betaxolol HCl
0.25%, 0.5% soln
Betoptic, Betoptic S 		  Adult: Topical 1 drop of 0.5% solution or 0.25% suspension in affected eye twice daily.
Carteolol HCl
1% soln
Ocupress 		  Adult: Topical 1 drop b.i.d.
Levobetaxolol
0.5% susp
Betaxon 		  Adult: Topical 1 drop b.i.d.
Levobunolol
0.25%, 0.5% soln
Betagan 		  Adult: Topical 1–2 drops 1–2 times/d.
Metipranolol HCl
0.3% soln
OptiPranolol 		  Adult: Topical 1 drop b.i.d.
Timolol maleate
0.25%, 0.5% soln
Betimol, Timoptic, Timoptic XE, Istalol 		  Adult: Topical 1 drop of 0.25–0.5% solution b.i.d.; may decrease to q.d. Apply gel q.d. Apply Istalol solution once daily.
Adverse Effects/Clinical Implications: May cause mild ocular stinging and discomfort; tearing; may also have the adverse effects of systemic beta blockers. May mask symptoms of acute hypoglycemia in diabetic patients (tachycardia, tremor, but not sweating). May precipitate thyroid storm in patients with hyperthyroidism. Patients with impaired cardiac function and the elderly should report to physician signs and symptoms of CHF (see Appendix G). Monitor BP for hypotension and heart rate for bradycardia.

MIOTICS

Prototype for classification: Pilocarpine HCl     Use: Open-angle and angle-closure glaucomas to reduce IOP and to protect the lens during surgery and laser iridotomy to counteract effects of mydriatics and cycloplegics following surgery or ophthalmoscopic examination

Apraclonidine HCl
Iopidine 		  Intraoperative and Post-surgical Increase in IOP:
Adult: Topical 1 drop of 1% solution in affected eye 1 h before surgery and 1 drop in same eye immediately after surgery.
Open-angle Glaucoma:
Adult: Topical 1 drop of 0.5% solution in affected eye q12h.
Brimonidine tartrate
Alphagan P 		  Glaucoma:
Adult: Topical 1 drop in affected eye(s) t.i.d. approximately 8 h apart.
Brinzolamide
Azopt 		  Ocular Hypertension or Open-angle Glaucoma:
Adult: Topical 1 drop in affected eye(s) t.i.d.
Carbachol
Isopto, Carbachol, Miostat 		  Adult: Topical 1–2 drops of 0.75–3% solution in lower conjunctival sac q4–8h.
Intraocular 0.5 ml of 0.01% solution injected into anterior chamber of eye.
Demecarium bromide
Humorsol 		  Glaucoma:
Adult: Topical 1–2 drops of 0.125–0.25% solution 2 times/wk up to b.i.d.
Convergent Strabismus:
Child: 1 drop of 0.125% solution in each eye daily for 2–3 wk; then decrease to 1 drop q.o.d. for 2–8 wk; then 1 drop 2 times/wk.
Dorzolamide
Trusopt 		  Ocular Hypertension or Open-angle Glaucoma:
Adult/Child: Topical 1 drop in affected eye(s) t.i.d.
Echothiophate iodide
Phospholine Iodide 		  Glaucoma:
Adult: Topical 1 drop of 0.03–0.25% solution in conjunctival sac 1–2 times/d.
Accommodative Esotropia:
Adult: Topical Diagnosis: 1 drop of 0.125% solution in both eyes once/d at bedtime for 2–3 wk. Treatment: 1 drop of 0.125% solution q.o.d. or 1 drop of 0.06% solution daily (max: 1 drop 0.125% solution daily).
Pilocarpine HCl
Adsorbocarpine, Isopto Carpine, Minims, Pilocarpine, Miocarpine, Ocusert, Pilo 		  Acute Glaucoma:
Adult: Topical 1 drop of 1–2% solution in affected eye q5–10min for 3–6 doses, then 1 drop q1–3h until IOP is reduced.
Chronic Glaucoma:
Adult: Topical 1 drop of 0.5–4% solution in affected eye q4–12h or 1 ocular system (Ocusert) q7d
Miotic:
Adult: Topical 1 drop of 1% solution in affected eye.
Adverse Effects/Clinical Implications: Ocular: Ciliary spasm with browache, twitching of eyelids, eye pain with change in eye focus, miosis, diminished vision in poorly illuminated areas, blurred vision, reduced visual acuity, sensitivity, contact allergy, lacrimation, follicular conjunctivitis, conjunctival irritation, cataract, retinal detachment.CNS: Headache, drowsiness, depression, syncope.GI: Abnormal taste, dry mouth. Clinical Implications: Wait 15 min after instillation before inserting soft contact lenses to avoid staining the lenses. Use with MAO inhibitors may have increased risk of hypertensive emergency. May increase the effects of beta blockers and other antihypertensives on blood pressure and heart rate. TCAs may reduce the effects of brimonidine. Brinzolamide is a carbonic anhydrase inhibitor (prototype: acetazolamide) and is a sulfonamide. It should not be used by patients with sulfa allergies. Demecarium bromide is capable of producing cumulative systemic effects. It is essential to adhere precisely to prescribed drug concentration, dosage schedule, and technique of administration. Reconstituted solutions of echothiophate remain stable for 1 mo at room temperature. Expiration date should appear on label. The length of time solutions remain stable under refrigeration varies with manufacturer. Echothiophate therapy is generally discontinued 2–6 wk before surgery. If necessary, alternate miotic therapy is substituted. Medication should be given in the evening. Give at least 5 min apart from other topical ophthalmic drugs. The patient with brown or hazel eyes may require a stronger ophthalmic solution or more frequent instillation of physostigmine for desired effects than the patient with blue eyes.

PROSTAGLANDINS

Prototype for classification: Latanoprost     Use: Open-angle glaucoma and intraocular hypertension

Bimatoprost
Lumigan 		  Adult: Topical 1 drop in affected eye(s) once daily in the evening.
Latanoprost
Xalatan 		  Adult: Topical 1 drop (1.5 mcg) in affected eye(s) once daily in the evening.
Travoprost
Travatan 		  Adult: Topical 1 drop in affected eye(s) once daily in the evening.
Unoprostone isopropyl
Rescula 		  Adult: Topical 1 drop in affected eye(s) b.i.d.
Adverse Effects: Ocular: Conjunctival hyperemia, growth of eyelashes, ocular pruritus, ocular dryness, visual disturbance, ocular burning, foreign body sensation, eye pain, pigmentation of the periocular skin, blepharitis, cataract, superficial punctate keratitis, eyelid erythema, ocular irritation, eyelash darkening, eye discharge, tearing, photophobia, allergic conjunctivitis, increases in iris pigmentation (brown pigment), conjunctival edema. Body as a Whole: Headaches, abnormal liver function tests, asthenia, and hirsutism. Clinical Implications: Should instill in the evening. Wait 15 min after instillation before inserting soft contact lenses to avoid staining the lenses. Give at least 5 min apart from other topical ophthalmic drugs.

MYDRIATIC

Prototype for classification: Homatropine HBr     Use: Mydriatic for ocular examination and as cycloplegic to measure errors of refraction. Also inflammatory conditions of uveal tract, ciliary spasm, as a cycloplegic and mydriatic in preoperative and postoperative conditions, and as an optical aid in select patients with axial lens opacities

Cyclopentolate HCl
AK-Pentolate, Cyclogyl, Pentalair 		  Cycloplegic Refraction:
Adult: Topical 1 drop of 1% solution in eye 40–50 min before procedure, followed by 1 drop in 5 min; may need 2% solution in patients with darkly pigmented eyes.
Child: Topical 1 drop of 0.5–1% solution in eye 40–50 min before procedure, followed by 1 drop in 5 min; may need 2% solution in patients with darkly pigmented eyes.
Dipivefrin HCl
Propine 		  Glaucoma:
Adult: Topical 1 drop in eye q12h.
Epinephryl borate
Epinal, Eppy/N 		  Adult: Topical 1–2 drops as needed.
Homatropine HBr
AK-Homatropine, Homatrine, Isopto Homatropine 		  Cycloplegic Refraction:
Adult: Topical 1–2 drops of 2% or 5% solution in eye repeated in 5–10 min if necessary.
Ocular Inflammation:
Adult: Topical 1–2 drops of 2% or 5% solution in eye up to q3–4h.
Hydroxyamphetamine HBr
Paredrine 		 
Hydroxyamphetamine HBr/Tropicamide
Paremyd 		  Dilation of pupil:
Adult: Topical 1–2 drops in conjunctival sac.
Phenylephrine HCl
AK-Dilate Ophthalmic, Alconefrin, Isopto Frin, Mydfrin, Neo-Synephrine, Prefrin Liquifilm, Vacon 		  Ophthalmoscopy:
Adult: Topical 1 drop of 2.5% or 10% solution before examination.
Child: Topical 1 drop of 2.5% solution before examination.
Vasoconstrictor:
Adult: Topical 2 drops of 0.12–0.15% solution q3–4h as necessary.
Tropicamide
Mydriacyl, Tropicacyl 		  Refraction:
Adult: Topical 1–2 drops of 1% solution in each eye, repeat in 5 min; if patient is not seen within 20–30 min, an additional drop may be instilled.
Examination of Fundus:
Adult: Topical 1–2 drops of 0.5% solution in each eye 15–20 min prior to examination; may repeat q30min if necessary.
Contraindicated in: Primary (narrow-angle) glaucoma or predisposition to glaucoma; children <6 y. Cautious use in: Increased IOP, infants, children, pregnancy (category C), the elderly or debilitated; hypertension; hyperthyroidism; diabetes; cardiac disease. Adverse Effects: Increased IOP, blurred vision, photophobia.Prolonged use: Local irritation, congestion, edema, eczema, follicular conjunctivitis.Excessive dosage/systemic absorption: Symptoms of atropine poisoning (flushing, dry skin, mouth, nose; decreased sweating; fever, rash, rapid/irregular pulse; abdominal and bladder distension; hallucinations, confusion).CNS: Psychotic reaction, behavior disturbances, ataxia, incoherent speech, restlessness, hallucinations, somnolence, disorientation, failure to recognize people, grand mal seizures. Clinical Implications: Carefully monitor cyclopentolate patients with seizure disorders, since systemic absorption may precipitate a seizure. Photophobia associated with mydriasis may require patient to wear dark glasses. Since drug causes blurred vision, supervision of activity may be indicated.

VASOCONSTRICTOR; DECONGESTANT

Prototype for classification: Naphazoline HCl     Use: Ocular vasoconstrictor

Naphazoloine HCl
AK-Con, Albalon, Allerest, Clear Eyes, Comfort, Degest-2, Muro's Opcon, Nafazair, Naphcon, Privine, VasoClear, Vasocon 		  Adult: Topical 1–3 drops of 0.1% solution q3–4h prn or 1–2 drops of a 0.01–0.03% solution q4h prn.
Tetrahydrozoline HCl
Collyrium, Mallazine, Murine Plus, Optigene, Soothe, Tyzine, Visine 		  Adult: Topical 1–2 drops of 0.05% solution in eye b.i.d. or t.i.d.
Contraindicated in: Narrow-angle glaucoma; concomitant use with MAO INHIBITORS or TRICYCLIC ANTIDEPRESSANTS Cautious use in: Hypertension, cardiac irregularities, advanced arteriosclerosis; diabetes; hyperthyroidism; elderly patients. Adverse Effects: Pupillary dilation, increased intraocular pressure, rebound redness of the eye, headache, hypertension, nausea, weakness, sweating. Overdosage: Drowsiness, hypothermia, bradycardia, shocklike hypotension, coma.

CORTICOSTEROID, ANTI-INFLAMMATORY

Prototype for classification: Hydrocortisone     Use: Inflammation     Unlabeled Use: Anterior uveitis

Dexamethasone sodium phosphate
Decadron Phosphate, Maxidex Ophthalmic 		  Adult: Topical 1–2 drops in conjunctival sac up to 4–6 times/d; may instill hourly for severe disease.
Fluorometholone
Fluor-Op, FML Forte, FML Liquifilm 		  Adult and Child >2 y: Topical 1–2 drops of suspension in conjunctival sac q.h. for the first 24–48 h; then b.i.d. to q.i.d.; or a thin strip of ointment q4h for the first 24–48 h; then 1–3 times/d.
Loteprednol etabonate
Alrex, Lotemax 		  Adult: Topical 1–2 drops in conjunctival sac q.i.d. during initial treatment, may increase to q1h if necessary.
Prednisolone sodium phosphate
Inflamase, Inflamase Mild, Pred Mild, Inflamase Forte 		  Adult: Topical 1–2 drops in conjunctival sac q.h. during the day; then q2h at night; may decrease to 1 drop t.i.d. or q.i.d.
Rimexolone
Vexol 		  Postoperative Ocular Inflammation:
Adult: Topical 1–2 drops q.i.d. beginning 24 h after surgery, continue through first 2 wk postoperatively.
Anterior Uveitis:
Adult: Topical 1–2 drops in affected eye every hour while awake for first week, then q2h for second week, then taper frequency until uveitis resolves.
Contraindicated in: Ocular fungal diseases, herpes simplex keratitis, ocular infections, ocular mycobacterial infections, viral disease of cornea or conjunctiva such as vaccina, varicella. Adverse Effects: Ocular: Blurred vision, photophobia, conjunctival edema, corneal edema, erosion, eye discharge, dryness, irritation, pain; prolonged use: glaucoma, ocular hypertension, damage to optic nerve, defects in visual acuity and visual fields, posterior subcapsular cataract formation, secondary ocular infections.Other: Headache, taste perversion. Clinical Implications: Shake all products well before use.

OCULAR ANTIHISTAMINES

Use: Relief of signs and symptoms of allergic conjunctivitis

Azelastine HCl
OPTIVAR 		  Adult and Child >3 y: Topical 1 drop in affected eye(s) b.i.d.
Cromolyn sodium
Crolom, Opticrom 		  Adult: Topical 1–2 drops in each eye 4–6 times/d.
Emedastine difumarate
Emadine 		  Adult and Child >3 y: Topical 1 drop in affected eye(s) up to q.i.d.
Epinastine hydrochloride
Elestat 		  Adult and Child >3 y: Topical 1 drop in affected eye(s) up to b.i.d.
Ketotifen fumarate
Zaditor 		  Adult: Topical 1 drop in affected eye(s) q8–12h.
Levocabastine HCl
Livostin 		  Adult: Topical 1 drop in affected eye(s) q.i.d., shake well before using.
Lodoxamide
Alomide 		  Adult and Child >2 mo: Topical 1–2 drop in affected eye(s) q.i.d. for up to 3 mo.
Nedocromil sodium
Alocril 		  Adult and Child >3 y: Topical 1–2 drops in affected eye(s) b.i.d.
Olopatadine HCl
Patanol 		  Adult and Child >3 y: Topical 1–2 drops in affected eye(s) b.i.d. at least 6–8 h apart.
Pemirolast potassium
Alamast 		  Adult: Topical 1–2 drops in affected eye(s) q.i.d.
Adverse Effects: Ocular: Allergic reactions, burning, stinging, discharge, dry eyes, eye pain, eyelid disorder, itching keratitis, lacrimation disorder, mydriasis, photophobia, rash.CNS: Drowsiness, fatigue, headache.Other: Dry mouth, cold syndrome, pharyngitis, rhinitis, sinusitis, taste perversion. Clinical Implications: Wait 10 min after instilling emedastine before inserting soft contact lenses; do not use levocabastine, olopatadine with soft contact lenses.

OCULAR NON-STEROIDAL ANTI-INFLAMMATORY DRUGS:

Prototype for classification: Ibuprofen     Use: Treatment of ocular pain and inflammation associated with cataract surgery

Bromfenac
Xibrom 		  Adult: Topical 1 drop into affected eye(s) b.i.d. beginning 24 h after cataract surgery and continuing for 14 d.
Nepafenac
Nevanac 		  Adult and Child >10 y: Topical 1 drop into affected eye(s) t.i.d. beginning 24 h after cataract surgery and continuing for 14 d.
Adverse Effects: Ocular: Conjunctival hyperemia, ocular hypertension, foreign body sensation, decreased visual acuity, headache, iritis, ocular inflammation (e.g., edema, erythema), ocular irritation (burning/stinging), ocular pruritus, ocular pain, photophobia, lacrimation, abnormal sensation in the eye, delayed wound healing, keratitis, lid margin crusting, corneal erosion, corneal perforation, corneal thinning, and epithelial breakdown. Continued use can lead to ulceration or perforation. Clinical Implications: Nepafenac suspension must be shaken well prior to use.