Understanding eye medications and discharging the ... - Love My Pet

Natasha Mitchell MVB DVOphthal MRCVS 

Understanding eye medications and discharging the ophthalmic patient 

Abstract: 

There are a wide range of ophthalmic medications used in dogs and cats, and there can be 

confusion about what each product is used for. It is important to stock a range of medications so 

that the most appropriate one is available when needed. Most ophthalmic preparations are 

human medications, and therefore a prescription can be supplied if a medication is needed 

promptly. The following is a discussion of ophthalmic medication available in Ireland along with 

their uses. Tips are given for discharging the ophthalmic patient after a procedure such as 

surgery. 

Topical antibiotics 

Broadly speaking, topical antibiotics are given for surface eye disease (for example infection of 

the eyelids, conjunctiva or cornea) whereas systemic antibiotics are given for intraocular or 

more serious infections (for example uveitis or a deep corneal ulcer). Antibiotics are over-used 

in veterinary medicine in general, and they should only be given when an infection is suspected 

or would result in harm. 

Gentamycin 0.3% eye and ear drops 

Amdipharm Limited 

Chloramphenicol 0.5% eye drops 

Martindale Pharmaceuticals Ltd 

Chloramphenicol eye ointment 1% 

Martindale Pharmaceuticals Ltd 

Exocin 0.3% eye drops 

Allergan 

Fucithalmic 

Dechra 

Opticlox 

Norbrook 

Mainly Gram negative activity 

Pseudomonas - Melting ulcers? 

Broad spectrum, good corneal penetration 

Good when epithelium intact or deep ulcer 

As above 

Avoid ointment with deep ulcers 

Broad spectrum but more Gram negative 

than positive – melting corneal ulcers 

Licensed for cats, dogs and rabbits 

Mainly Gram positive, carbomer base 

Licensed for cows, horses (food) and 

sheep 

Gram positive

Topical anti-inflammatories 

Topical anti-inflammatories can either be steroids or non-steroidal anti-inflammatory agents 

(NSAIDs). Steroids are contraindicated if there is a corneal ulcer (in other words, if there is 

fluorescein uptake). NSAIDs are preferred if the patient is diabetic because a small amount of the 

drug will be absorbed systemically, particularly if the eye is inflamed or immediately following 

surgery. Steroids can interfere with diabetic control with insulin by altering glucose levels. Systemic 

steroids or NSAIDs are given for more serious conditions such as uveitis. 

Topical steroids: 

Maxidex 0.1% eye drops 

Alcon 

Maxidex 0.1% eye ointment 

Alcon 

Betnesol eye, ear and nasal drops 

RPH Pharmaceuticals AB 

Betnesol 0.1% eye ointment 


Pred forte 1% eye drop suspension 

Allergan 

FML liquifilm 0.1% 

Allergan 

FML forte liquifilm 

Allergan 

Combination steroid / antibiotic drops 

Maxitrol eye drops, Alcon 

Dexamethasone, Neomycin, Polymyxin B 

Superficial ocular inflammation 

Anterior uveitis 

As above 

Longer contact time, less frequent 

application 


As above 

Longer contact time, less frequent 

application 

Pannus 

Uveitis 


Increased strength 

Anterior uveitis / pannus 

Inflammation plus infection

Maxitrol eye ointment, Alcon 

Dexamethasone, Neomycin, Polymyxin B 

Betnesol-N eye eye, ear and nasal drops 


Betnesol-N eye ointment 

UCB Pharma Limited 

FML / Neo liquifilm 1/5 mg/ml 

Allergan 

NSAIDs 

Acular 

Ketorolac, Allergan 

Glaucoma medication 

When topical steroid undesirable e.g. diabetes 

Don’t use with deep or melting ulcer 

Glaucoma is the result of a raised intraocular pressure. It is very painful and leads to 

irreversible blindness. Blindness can occur very rapidly, and it is important that the owners 

know that they must religiously apply the medication as directed by the vet. Ideally the 

pressure-lowering response to the medication should be monitored by tonometry. 

Trusopt (dorzolamide) 

MSD and others 

Azopt (brinzolamide) 

Alcon 

Xalatan 0.005% (latanoprost) 

Pharmacia Ireland Limited and others 

Travatan 0.004% (travoprost) 

Alcon 

Timoptal Β-blocker 

Carbonic anhydrase inhibitor 

Reduced production of aqueous humour 

qid 

Carbonic anhydrase inhibitor 

Reduced production of aqueous humour 

tid 

Prostaglandin analogue, increased 

drainage of aqueous, contraindicated if 

uveitis 

Prostaglandin analogue, increased 

drainage of aqueous, contraindicated if 

uveitis 

Side effects miosis, local irritation,

MSD or Wockhardt UK Ltd bradycardia 

Cosopt (dorzolamide plus timolol) 

Several, including MSD 

Immunosuppressants 

Not commonly used in small animals 

Certain immune-mediated ocular conditions respond very well to topical immunosuppression 

treatment. Examples include dry eye (keratoconjunctivitis sicca), pannus and eosinophilic (or 

proliferative) keratitis in cats. These drugs are powerful and the owner must not get them on 

their own skin. At the start they could wear gloves when applying it to ensure they don’t get any 

on themselves. However, with a little practice, it is usually simple for them to apply. They could 

wash their hands if not wearing gloves. 

Optimmune is a long-term medication, and it is common for an animal to need to continue with 

treatment with life. Sometimes the vet will reduce the dose but may have to increase it again. It 

is normally started twice daily. The tube is inflated with air so they owner might think that they 

have been sold a faulty tube, but this is normal. They should be told not to role up the tube (like 

some people do with tooth-paste) as they go along, as this can crack the tube and result in 

product loss. 

Before applying Optimmune, any ocular discharge that is present should be gently cleansed 

from the eye. If this is not done, the drug is not going to work as effectively. The ointment may 

be applied to the cornea or to the conjunctiva at the back of the eyelids. A small amount is 

sufficient, about the length of a rice grain. If I find owners needing more than one tube a month, 

I usually demonstrate how to apply it to ensure they are not applying too much. Applying an 

excessive quantity does not improve the eye condition, and therefore it is wasteful. If the 

owners complain that they squeeze out too much ointment and cannot retract it, I suggest that 

they store the Optimmune in the fridge. This makes it more difficult to squeeze the tube, and 

therefore there is more control over what comes out of the nozzle. However in normal 

circumstances, it is not necessary to store Optimmune in the fridge. 

The benefits of Optimmune are not immediately apparent. Treatment needs to continue for 4-6 

weeks before it achieves maximal effect. If it is being used to treat keratoconjunctivitis sicca, 

there is no need for the owner to withhold treatment on the morning of a follow-up 

appointment, as it doesn’t have an immediate effect on the Schirmer tear test result. 

Optimmune 0.02% Suppresses T-cells; KCS, pannus,

Merck Animal Health episcleritis 

Protopic 0.03% ointment 

Astellas Pharma Europe BV 

Artificial tears 

Proliferative eosinophilic keratitis in cats 

Off-label use, full effects not known, CARE! 

KCS when Optimmune not effective 

There are several types of artificial tears available. Recently, some have been marketed in 

Ireland for animals. They are usually multi-dose solutions which contain preservatives, but 

single use vials without preservatives are useful if the pet seems irritated by the medication. 

Artifical tears may be drops, gel or ointment. Ointment lasts the longest length of time but tends 

to blur vision, and for this reason is usually used only at bed-time. Gels are very popular, 

especially carbomer gel. Common trade names in this country include Vidisic and Gel Tears. 

Drops are uncommonly used as the effect is so short-lived, although drops containing 

hyaluronic acid do last longer than regular aqueous tear preparations. 

Carbomer 980 Vidisic / Gel Tears 

Gel, good contact time, still qid 

Acetyl cysteine (Ilube) Mucolytic. KCS with much mucous 

Hylo-Tear 0.1% sodium hyaluronate 

URSA Pharm 

Hylo-Forte 0.2% sodium hyaluronate 

URSA Pharm 

Melting ulcers but stop once melt 

improves 

Single use or multi-use vial 

Viscoelastic gel with mucomimetic 

properties 

Lacrilube Longer contact time but blurs vision 

Mydriatics 

At bed-time for KCS 

Mydriatics are drugs that dilate the pupil. They are used in two situations clinically. During the 

ocular examination, the short-acting drug tropicamide is applied. This takes 20 minutes to work 

and lasts on average 6 hours. By dilating the pupil, the vet can examine the lens and fundus

much more thoroughly. The second situation is when there is miosis (a constricted pupil) due to 

uveitis. This may be due to immune-mediated disease or secondary to a corneal ulcer, among 

many other possible causes. By dilating the pupil, several potentially harmful events are 

avoided. It stops the edge of the pupil sticking to the lens (called a posterior synechia). If that 

happens, there might be permanent opacity of the lens capsule as pigment is left behind. The 

peripheral edge of the iris can also swell and stick to the cornea, and this or posterior synechia 

can interrupt the normal circulation of aqueous humour within the eye, and that causes 

glaucoma which leads to irreversible blindness. Another good effect of mydriatics is that they 

paralyse intraocular muscles which spasm when they are inflamed, and thus they improve the 

over-all comfort of the eye. Tropicamine is excellent for short-term dilation and is very useful in 

cats which can resent atropine. Atropine is useful because it lasts much longer and therefore can 

be applied less frequently. However it dries the ocular surface in some circumstances, and so 

shouldn’t be used in animals with dry eye. It can raise the intraocular pressure and so is avoided 

in glaucoma patients. After application, some of the medication runs down the tear duct and into 

the mouth. It has a bitter taste and some dogs (and many cats) will start to salivate profusely 

and seem quite irritated for 1-3 minutes. It is important to warn owners about this so that they 

don’t think that their pet is having a seizure. 

Tropicamide 0.5% or 1% 

Minims vials, Chauvin Pharmaceuticals Ltd 

Atropine 1% 


Topical anaesthetic agents 

Single use vial (discard after 24 hours) 

Short-acting, for diagnosis or treatment 


Long-acting, for treatment only 

Topical anesthetic drugs numb the cornea by acting on the sensory nerve endings of the 

Trigeminal Nerve (Cranial Nerve V). They are available only as Minims vials. Proxymetacaine 

(also called proparacaine in the USA) is a useful preparation as it is potent and works quickly 

(within 30 seconds). It sometimes makes the conjunctiva a little red but otherwise it is well 

tolerated. It must be stored in the fridge. Tetracaine (also called amethocaine in the USA) is also 

potent and works in 30 seconds, and it doesn’t need to be stored in the fridge. However in 

general it causes more ocular irritation and occasionally a mild allergic reaction which 

chemosis. They are used to facilitate diagnostic tests such as tonometry and distinguishing

spastic from anatomical entropion. They are also used to facilitate examination of a painful eye. 

They are epitheliotoxic and therefore will inhibit healing of a corneal ulcer. For this reason, they 

must never be dispensed to an owner to apply as treatment at home. 

Proxymetacaine 1% 


Tetracaine 1% 


Discharging the ophthalmic patient 


Store in fridge 


Keep at room temperature 

Receiving clear instructions on discharge is a vital component of good post-op recovery and a 

good surgical result. If there are complicated instructions, it would be very useful to supply 

them in written form as well as going over them verbally. The vet should have already explained 

to the owner what was wrong with the eye and the surgical procedure. 

They will probably be discharged wearing a buster collar, and it is important that the owner 

understands the importance of leaving this on for the recommended period of time. If the dew 

claws were bandaged, this should be pointed out (there may also be a bandage on the site where 

the catheter was placed) and routine advice given about not getting them wet, watching for toe 

swelling and when to remove them (usually 2-3 days). 

Medications should be individually and clearly labeled. The owner always asks when they 

should give the first dose, and this of course depends on what peri-operative injections were 

given. Owners can find it difficult to apply eye medications and to understand why they are 

required. It is the role of the veterinary nurse to help explain to the owner the importance of 

applying the medication as directed by the vets, and to demonstrate to them how they might 

apply it easily and effectively. The following are a list of instructions that can be explained to or 

printed out for the owner. 

HOW DO I APPLY EYE MEDICATIONS?

It is important to store eye medications correctly. All need to be stored below 25ºC. Some need 

to be kept in the fridge (including Chloramphenicol, Xalatan until opened and Serum). The 

majority need to be discarded 28 days after opening, but some expire sooner. 

Eye medications may be drops, gels or ointments. Where a combination of these formulations 

has been dispensed, first apply the drops, then the gel, then the ointment. 

Gently invert the dropper bottle a couple of times to make the suspension uniform. 

The animals head should be slightly elevated. This is achieved by placing one hand under the 

chin. The other hand holds the dropper bottle, and this hand may rest against the animals 

forehead in order to steady it, and to feel if the animal is going to make a sudden movement. 

The drop or ointment should be applied to the centre of the cornea (the clear window of the 

eye). If the drop misses the eye, another attempt can be made straight away. 

Care should be taken that the nozzle does not come into contact with the cornea. This is to 

prevent trauma to the eye but also in order to keep the nozzle clean. 

One drop is all that is required. A strip the size of a rice grain is all that is required when 

applying ointment. 

The animal should be allowed to blink, and where possible the head should remain slightly 

elevated for a few seconds. 

Where multiple medications are dispensed, allow at least five minutes between each 

application.

It is useful to distract the animal immediately after applying eye medication to stop them from 

rubbing at the eye. Feeding a meal or a treat, or taking them for a walk may provide a good 

distraction. Some animals will have a buster (Elizabethan) collar which prevents them from 

traumatizing the eye. 

A standard 5ml bottle of eye drops contains approximately 100 drops. 

By regularly applying eye drops, you get a chance to check the appearence of the eye. If any 

changes concerns you, please contact your veterinary clinic immediately. 

When drops are to be given several times a day, it is important that the owner is aware that 

these need to as spread out as possible – for example, twice daily application means every 

twelve hours, and four times daily means every 6 hours etc. 

Do point out that the left eye refers to the animal’s left eye (therefore the right eye as the owner 

looks at them) as this can often confuse owners and lead to medication being applied to the 

wrong eye. 

The owners are encouraged to cleanse the eye and eyelids if there is ocular discharge. They 

could use previously boiled water soaked into cotton wool and squeezed out. This should be 

done before applying topical medications. 

Routine advice is given regarding eating, drinking and toileting on return home after the 

anaesthetic. 

A harness is a good idea as it prevents any pressure on the neck. Some harness designs don’t 

have to be fitted over the head, and these are preferable for dogs that have to wear a buster 

collar. 

The owner should be given a time frame for when to expect an improvement. They should be 

given instructions for when to call – for example if the eye is sore and squinting, or if vision is 

suddenly lost. Depending on the surgery carried out, of course a small amount of redness or 

swelling is expected. They should be encouraged to phone if they are in doubt, and a post-op 

appointment should be made. Many stitches used in ocular surgery are dissolvable and 

therefore don’t need to be removed, but wound healing still needs to be checked. 

Further reading:

Veterinary Ophthalmology - a manual for nurses and technicians. Sally Turner. 2005. Elsevier. 

ISBN 0750688416 

Chapter 2: Ocular pharmacology and therapeutics 

BSAVA Manual of Small Animal Ophthalmology. Simon Peterson-Jones and Sheila Crispin 2002. 

BSAVA. ISBN 0 905214 54 4 

Chapter 2: Ophthalmic surgery and anaesthesia 

Chapter 3: Ophthalmic drugs

Understanding eye medications and discharging the ... - Love My Pet

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