Table 152 Ocular medications commonly used by EPs

Antibiotics Ciprofloxacin (S/O)

Gentamicin (S/O) Sulfacetamide (S/O) Tobramycin (S/O) Cycloplegics Atropine (5-10 days)

(Duration of action) Cyclopentolate (6-24 h)

Homatropine (2-3 days) Tropicamide (6 h) Mydriatic (no cycloplegia) Phenylephrine Topical Anesthetics Proparacaine Tetracaine

Glaucoma Agents ß-blockers (i.e., timolol)

Cholinergic agents (i.e., Pilocarpine) Carbonic Anhydrase Inhibitors (See text below for other treatment)

S: solution; O: ointment

• Antibiotics: Specific agents will be discussed in the following sections. Delivery systems include ointment and solution. Ointments have greater contact time with the eye but can cause blurred vision.

• Topical anesthetics: Use of one or two drops relieves patient discomfort and allows for tonopen measurements and fluoroscein evaluation. These agents should not be prescribed for repetitive use as they retard healing and mask the pain from a worsening ocular condition.

• Cycloplegics: Ciliary muscle spasm causes significant pain in patients with corneal abrasions, iritis and other conditions. Cycloplegics provide pain relief via paralysis of the ciliary muscle. They also cause mydriasis; patients should be warned about this side effect. Duration of action varies between agents.

• Mydriatics: As do cycloplegics, these agents cause pupil dilation. However, mydriatics do not necessarily produce cycloplegia. The main use is to allow for adequate fundoscopic examination. Use in angle closure glaucoma and ruptured globe is contraindicated.

• Glaucoma agents: See discussion below.

• Corticosteroids: Steroids may worsen certain conditions and should be prescribed only in conjunction with a consulting ophthalmologist (with the possible exception of iritis).

• Other: Includes topical antivirals, antifungals, lubricants, decongestants and anti-inflammatories.

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