BNF for Children 2011-2012

BNFC 2011–2012 51711 Eye11.1 Administration of drugs to theeye 51711.2 Control of microbial contamination51811.3 Anti-infective eye preparations 51811.3.1 Antibacterials 51811.3.2 Antifungals 52011.3.3 Antivirals 52111.4 Corticosteroids and other antiinflammatorypreparations 52111.4.1 Corticosteroids 52111.4.2 Other anti-inflammatory preparations52211.5 Mydriatics and cycloplegics 52411.6 Treatment of glaucoma 52511.7 Local anaesthetics 52911.8 Miscellaneous ophthalmicpreparations 52911.8.1 Tear deficiency, ocular lubricants,and astringents 52911.8.2 Ocular diagnostic and perioperativepreparations 53211.9 Contact lenses 53311.1 Administration of drugsto the eyeDrugs are most commonly administered to the eye bytopical application as eye drops or eye ointments. Whena higher drug concentration is required within the eye, alocal injection may be necessary.Eye-drop dispenser devices are available to aid theinstillation of eye drops from plastic bottles; they areparticularly useful for children in whom normal applicationis difficult, for the visually impaired, or otherwisephysically limited patients.Eye drops and eye ointments Eye drops are generallyinstilled into the pocket formed by gently pullingdown the lower eyelid and keeping the eye closed for aslong as possible after application; in neonates andinfants it may be more appropriate to administer thedrop in the inner angle of the open eye. One drop is allthat is needed; instillation of more than one drop at atime should be discouraged because it may increasesystemic side-effects. A small amount of eye ointment isapplied similarly; the ointment melts rapidly and blinkinghelps to spread it.When two different eye-drop preparations are used atthe same time of day, dilution and overflow may occurwhen one immediately follows the other. The carer orchild should therefore leave an interval of at least 5minutes between the two. Eye ointment should beapplied after drops. Both drops and ointment maycause transient blurred vision; children should bewarned, where appropriate, not to perform skilledtasks (e.g. cycling or driving) until vision is clear.Systemic effects may arise from absorption of drugs intothe general circulation from conjunctival vessels or fromthe nasal mucosa after the excess preparation hasdrained down through the tear ducts. The extent ofsystemic absorption following ocular administration ishighly variable; nasal drainage of drugs is associatedwith eye drops much more often than with eye ointments.Pressure on the lacrimal punctum for at least aminute after applying eye drops reduces nasolacrimaldrainage and therefore decreases systemic absorptionfrom the nasal mucosa.For warnings relating to eye drops and contact lenses,see section 11.9.11 EyeEye lotions These are solutions for the irrigation of theconjunctival sac. They act mechanically to flush outirritants or foreign bodies as a first-aid treatment. Sterilesodium chloride 0.9% solution (section 11.8.1) is usuallyused. Clean water will suffice in an emergency.Other preparations Subconjunctival injection may beused to administer anti-infective drugs, mydriatics, or