GPs guide to some topical eye medications

Key points and background Eye medications: Antiviral Eye medications: Antibacterial Eye medications: Corticosteroid drops & ointments Eye medications: Non-steroidal antiinflammatory drops Eye medications: Intraocular pressure reduction with topical eye treatments References Issue 10 Contents

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Key Points

• Specialist prescribing restrictions have been removed from some topical eye treatments
• Although general practitioners can now initiate some topical eye treatments, it does not mean they should
• Significant corneal disease, intraocular inflammation and glaucoma still require specialist diagnosis and management
• Primary care will still be involved in the ongoing support and education of people with these conditions and the continuation of the medications used to treat them

Eye medications are often used in High risk situations requiring specialist skills

Some eye medications are used when there is high risk of visual loss and their misuse can increase this risk. Initiation and monitoring often require specialist expertise as well as the availability and ability to use specialist equipment. For example:

• Slit-lamp examination is needed for accurate diagnosis and monitoring of intraocular inflammation, such as iritis and keratitis and ulceration of the cornea.
• Accurate diagnosis and monitoring for adequacy of treatment of glaucoma requires accurate detailed assessment of intraocular pressure, the optic disk and visual fields.
• Accurate distinction between infective and non-infective inflammatory conditions is essential because medications, such as steroid drops, used for some conditions, will make others much worse.
• Use of steroid drops for more than ten days requires, monitoring for steroid-induced glaucoma.

Primary care role still important

Although primary care is not equipped to initiate and monitor treatment for these conditions, it still plays a valuable role. People will still look to primary care for support, education and continuation of treatment. Clinicians, particularly prescribers, need to understand the actions of these medications and how to avoid and identify possible adverse effects. For example:

• Some topical preparations, e.g. beta blockers, if sufficiently absorbed, may cause systemic effects.
• Unless medically indicated, soft contact lenses should not be used for the duration of treatment with eye drops and ointments.¹
• However, it is safe to replace contact lenses 15 minutes after use of some drops.
• Application of gentle pressure to the tear duct after instilling drops increases exposure of the anterior eye tissues to the treatment and reduces systemic absorption. This is especially advisable in children.²

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