Clinical Pearls
Hold the bottle straight down and not at an angle
NEVER touch the patient's eye with your bare hand. Always use a tissue
Hold the bottle far away enough so you don't contact their eye or lashes with the tip of the bottle. If you do this, the bottle will have to be thrown out as to not cross- contaminate!!
Pull the bottom lid down, and put a drop in between the eye and the bottom lid
If a patient is flinching, when dropping OD, have the patient look to the left and then place a drop in the temporal corner of OD. This will distract them so they don't see the tip of the bottle coming. Repeat for OS, but have them look to the right!
GTTS: This means drops (plural form of guttae, which is Latin for drops)
QAM: Once in the morning
QHS: Once at night (you would think it would be QPM.........)
QD: Once daily
BID: Twice daily
TID: Three times daily
QID: Four times daily
Q1hr: Once every hour (can be adjusted accordingly; Q2hrs, etc...)
Other Abbreviations:
AT: Artificial tears
PF: Preservative- Free
PFAT: Preservative- Free Artificial Tears
Ung: Ointment
OD / OS/ OU: Right eye / Left eye / Both eyes
RUL / RLL: Right upper lid / right lower lid
LUL / LLL: Left upper lid / left lower lid
BUL / BLL: Bilateral upper lid / bilateral lower lid
This is a combination of Fluorescein (yellow dye) and Benoxinate (an anesthetic, AKA Oxybuprocaine)
We administer this drop so we can check IOP. The dye reacts to the blue light on the slit lamp to illuminate the mires, and the anesthetic allows us to comfortably make contact with the cornea
It is easy to recognize as this is the only drop we have that has a rubber plunger at the top
The fluorescein also makes corneal pathologies, such as abrasions and ulcers, much more visible for our providers
This causes mild stinging, but goes away in about 10 seconds
It will last for about 10 minutes
Note
Fluorescein also comes in strip form and usually preferred by providers in this form
White top
Anything ending in "caine" is an anesthetic!
This is a more powerful anesthetic used for a multitude of procedures (pachymetry, tonopen, lasers)
This will also cause mild stinging for 10 seconds
It last for about 15-20 minutes
Red Top
We dilate the eyes to be able to get a better look at structures behind the Iris, such as the lens, retina, and optic nerve
Dilation is essential for a proper eye exam and makes this very difficult if not dilated. This is especially important if the patient is experiencing vision- threatening symptoms, such as flashes/floaters, or a sudden loss of vision
Dilation makes near vision blurry, but does not affect distance vision. It also makes eyes very sensitive to light. Be sure to explain this to patients when you administer them
Note: These bottles can look very similar to one another! Please read and make sure they are what you thing they are!
Standalone Dilation Drops
Tropicamide (.5% and 1%)
Used if people have more narrow angles (esp .5%)
Lasts about 6 hours
Phenylephrine (2.5% and 10%)
2.5% is favored by ST's team
10% is used for Light Adjustable Lens (LAL) adjustments
Lasts for 3-6 hours
Cyclopentolate 1%
Primarily used in children (seldomly used at HEA)
Dilates the pupil for 24 hours!
Atropine 1%
This will dilate the pupil for 1 week!!!
Combination Drop
1% Tropicamide with 2.5% Phenylephrine
This is our standard dilation drop. It is powerful as it combines two different acting medications
Tropicamide paralyzes the sphincter muscle of the pupil, while Phenylephrine overexcites the dilator muscle of the pupil
Green Top
Pilocarpine 1% is primarily used to constrict the pupil prior to YLPI and SLT procedures
Also used to decrease IOP in acute angle closure glaucoma
Ryzumvi (phentolamine .75%)
Used to shorten/reverse the dilation period
Onset of action is 30-90 minutes
Grey Top
Anything ending in "nac" or "lac"
Prolensa (bromfenac .07%)
Ketorolac (generic)
Nepafenac (generic)
Pink Top
These will have "pred" somewhere in the name, and/or end in "lone"
Lotemax SM (loteprednol .38%)
Pred Forte (Prednisolone Acetate)
Eyesuvis (loteprednol .25%)
Durezol (difluprednate .05%)
Tan Top
These end in floxacin, mycin/micin/myxin
Ofloxacin
Ciprofloxacin
Tobramycin
Erythromycin (ointment)
Gentamicin
Can also be a combination of two drops
Polytrim (polymyxin B & trimethoprim)
Zylet (tobramycin & loteprednol)
Tobradex (tobramycin and dexamethasone)
For people with allergies
Pataday (olopatadine)
Zatidor (ketotifen fumarate)
Immunosuppressants (cyclosporine)
These reduce inflammation that causes dry eyes
Cequa (cyclosporine .09%)
Restasis (cysclosporine .05%)
Vevye (cyclosporine .1%)
LFA-1 Antagonists
Xiidra (lifitegrast 5%)
Reduces inflammation by inhibiting LFA-1 from binding and causing inflammation
Meibo (perfluorohexyloctane)
Creates a protective layer over the tear film surface that reduces tear evaporation
Acoltremon .003%
Just got FDA approved!
The first eyedrop that stimulates corneal nerves to address tear deficiency
Works in 1-2 days
Tyrvaya is a nasal spray for dry eyes!
It is a nicotinic receptor agonist, which increases tear production
Fluorescein
For dry eyes, abrasions, and ulcers
Providers like to use the strips because they can put just a small amount of fluorescein on the cornea which highlights imperfections very well
Using the drops puts too much on the cornea and looks like a pool under the slit lamp, so they can't see small details
Rose Bengal
Used for HSV Keratitis as it highlights the dendritic pattern very well
Lissamine Green
Rarely used, but good for dry eyes and also conjunctival lesions that could be cancerous
What does a bottle with a green top mean?
What does a bottle with a red top mean?
What does bottle with a pink top mean?
What kind of drop is Ofloxacin?
What kind of drop is Loteprednol?
Describe the proper process of administering drops to a patient
How do we abbreviate once at night for drops? Once in the morning? Twice daily? Four times daily?
What does Tropicamide do the sphincter muscle of the Iris? How about Phenylephrine?
A patient with a narrow angle comes in for an exam. What is the safest dilation drop to use to avoid an angle closure glaucoma attack?
You put a fluorescein drop into a patient's eye and you notice that you brushed their eyelashes with the tip of the dropper. What do you do?
You dilated a person's eye and they came back 4 days later with their eye still dilated. What drop was most likely used?