Drug Group | Drug Examples | Nursing Implications |
β-Adrenergic blocker | timolol | Use nasolacrimal pressure to prevent possible systemic absorption (as with all other topical ophthalmic solutions or ointments); monitor for bradycardia, heart block, and wheezing. |
Osmotic drugs | glycerin, mannitol, urea
| Glycerin should be used with extreme caution; flavor with lemon or lime juice over cracked ice; monitor for signs of cerebral dehydration. |
| | | Mannitol may result in digitalis toxicity when given concurrently; if crystallized, may dissolve in warm water; adequate hydration is important (up to 200 mL/day). |
| | | Urea, if given at a rate 4 mL/min, may result in hemolysis and cerebral vasomotor symptoms; monitor fluid volume status closely; preparation and administration vary; read instructions carefully. |
Mydriatics and cycloplegics | atropine, cyclopentolate
| With atropine, monitor for adverse effects such as irregular pulse, confusion, dry mouth, and fever; causes blurred vision and photosensitivity, so sunglasses should be worn outside until effect is gone. |
| | | With cyclopentolate, use with caution and give as ordered; same nursing management as with atropine. |
Sympathomimetics | epinephrine, hydroxyamphetamine, phenylephrine,
tetrahydrozoline
| Monitor for serious adverse effects that may occur if systemically absorbed, such as tachycardia and elevated BP. |
| | | With corticosteroid agents, report blurred vision or visual disturbances, eye pain, ptosis (lid drooping), or enlarged pupils. |
| | | Prophylactic use is potentially dangerous and is not recommended. This may cause local reactions such as redness, itching, edema, and dermatitis. |
Antimicrobials/
antiinflammatories | | Follow instructions for instillation. |
Antibacterials | chloramphenicol,
erythromycin,
gentamicin,
neomycin,
sulfonamides,
tetracycline,
tobramycin | With chloramphenicol, monitor fever, sore throat, and unusual bleeding, and any drop in complete blood count. |
| | | With erythromycin, make sure to administer as ordered and apply only a thin ointment strip. |
| | | Gentamicin and similar agents should be given as ordered. |
| | | With neomycin combination agents and tetracycline, be sure to follow instructions. |
| | | Cleanse eye with use of sulfonamide agents such as sulfacetamide and sulfisoxazole because they will be inhibited by purulent drainage or exudate; discard any darkened solution; may cause mild pain on instillation. |
Antifungals
Antivirals
| natamycin,
idoxuridine,
trifluridine, vidarabine,
| May cause irritation of the eye. |
| | | Notify physician if the patient complains of blurred vision, eye irritation, visual changes or disturbances, or photosensitivity if not present before therapy; apply as ordered and, if an ointment, apply only a thin strip; always instill drops and ointments into the conjunctival sac. |
Antiseptics | silver nitrate | Used for gonococcal infections and may inactivate bacitracin if used concurrently; leave in contact with sac for at least 3 seconds; irrigation afterward is not recommended. |
Topical anesthetics | proparacaine
tetracaine
| Not recommended for long-term use because they could lead to possible irreversible eye damage; eye should be patched until injury healed; CNS excitation and subsequent depression are potential systemic adverse effects if absorbed. |
Artificial tears | Lacrisert (Lacri-Lube, Duratears, and HypoTears are ointment forms) | Instill as directed. |
Antiallergics | cromolyn sodium | Ocusert forms given daily. |
Enzyme preparations | chymotrypsin | Instill as ordered; therapeutic effects in 4 weeks if given regularly. |
| | | May result in postoperative glaucoma for about 1 week, which can be reversed with parasympathomimetics. |
Hyperosmolar preparations | sodium chloride ointment | Apply as ordered. |
Nonsteroidal antiinflammatories | diclofenac,
flurbiprofen,
ketorolac,
suprofen | Use only as prescribed; solutions preferred for eye infections because ointments often decrease healing. |
Ophthalmic surgery aids | sodium hyaluronate | Used to protect the eye from damage and to be given exactly as ordered. |
Prostaglandin preparations | latanoprost | Instill as ordered; lowers IOP for 20–24 hr with single dose; well tolerated; patients with hazel-colored eyes may experience permanent iris color change to brown, but this is not harmful to the patient. |
