Q8 12H up to 72 hours Directions Burning stinging Rarely pupil dilation caution

Q8-12H, up to 72 hours Directions •Burning, stinging •Rarely-pupil dilation, caution narrow angle glaucoma Safety Considerations OPHTHALMIC DECONGESTANTS • Tetrahydrozoline, phenylephrine, oxymetazoline, naphazoline • Mechanism of action • Act on alpha-adrenergic receptors to cause vasoconstriction which reduces eye redness Tetrahydrozoline Naphazoline Oxymetazoline Phenylephrine OPHTHALMIC DECONGESTANTS • 1-2 drops, generally up to QID • Duration of 72 hours • Rebound congestion Directions •Possible pupil dilation •Caution in pregnancy •Systemic effects minimal, but warnings for: •Heart disease, HTN, difficult urination, diabetes, hyperthyroid, narrow angle glaucoma Safety considerations

11/24/14 11 OPHTHALMIC ANTIHISTAMINES • Pheniramine • MOA • H 1 -receptor antagonists • Only combined with decongestants Pheniramine/naphazoline OPHTHALMIC ANTIHISTAMINES •1-2 drops, TID to QID, up to 72 hours Directions •Burning, stinging •Rarely-pupil dilation, caution narrow angle glaucoma Safety Considerations PRODUCT SELECTION • Ketotifen • Safest and most effective • Convenient BID dosing • Naphazoline, tetrahydrozoline • Less rebound congestion • Complementary therapies • Similasan Eye Drops #2

11/24/14 12 OTHER TYPES OF CONJUNCTIVITIS “PINK EYE” Viral •Highly contagious • Colds, sore throat, exposure to virus •Clinical Presentation •Typically unilateral •Pink eye • Watery discharge •Conjuctival swelling •Fever Bacterial •Highly contagious • Exposure to bacteria •Clinical Presentation •Typically unilateral •Pink eye • Purulent discharge •Conjuctival swelling •Fever TREATMENT OF VIRAL CONJUNCTIVITIS Nonpharmacologic therapy Cold compresses Good hygiene Avoid contact lenses, replace after infection clears Pharmacologic therapy Artificial tears Ophthalmic decongestants CORNEAL EDEMA • Pathophysiology • Ov erwear of contacts • Surgical damage • Corneal dystrophies • Clinical Presentation • Fluid accumulation distorts the optical properties resulting in halos or starbursts around lights • Diagnosed by an eye care provider • Treatment • Topical ophthalmic hyperosmotic agents • Solution or ointment

11/24/14 13 CORNEAL EDEMA OPHTHALMIC HYPEROSMOTIC AGENTS • NaCl hypertonicity solution or ointment • Mechanism of action • Increase the tonicity of the tear film promoting movement of the fluid from the cornea to the more highly osmotic tear film OPHTHALMIC HYPEROSMOTIC AGENTS •1-2 drops every 3-4 hours •Ointment typically QHS Directions •Contraindicated in corneal edema with damaged endothelium Safety considerations

11/24/14 14 MINOR EYE IRRITATION • Pathophysiology • Foreign substance, contact lens wear, or exposure to irritants • Clinical Presentation • Immediate watering/tearing • Redness of eye • Pain or feeling of “sand in the eyes ” • Treatment • Artificial tears • Ophthalmic ointment • Ophthalmic irrigants OPHTHALMIC IRRIGANTS • Mechanism of action •