Eye Drops 👁️
Reference guide for commonly prescribed eye drops in Ireland. Lubricants, chloramphenicol, azithromycin (Azyter), allergy and glaucoma drops, with HSE AMRIC conjunctivitis dosing and Irish SmPC links.
💡 Ward approach
- Most inpatient prescriptions are lubricants, continuing a patient’s usual glaucoma drops, or chloramphenicol for true bacterial conjunctivitis.
- Per HSE AMRIC: most acute bacterial conjunctivitis is self-limiting. Consider a delayed antibiotic prescription for 3 days. About 80% of adult cases are viral. Bacterial cases typically have yellow-white mucopurulent discharge without itch. Blurring that clears with blinking is tear-film only; blurring that persists needs same-day review.
- If a topical antibiotic is needed: chloramphenicol 0.5% drops (or 1% ointment, unlicensed, from 2 years) first-line. Second-line is azithromycin 15 mg/g (Azyter) or fusidic acid. Avoid prolonged or repeated topical antibiotics.
- Per HSE CCS: a lubricant up to four times daily may ease viral (or bacterial) conjunctivitis symptoms. A preservative-free lubricant is preferable if use will last more than a month. Also consider if preserved drops sting.
- Itch is the most consistent feature of allergic conjunctivitis. Use a mast-cell or antihistamine drop, and an oral non-sedating antihistamine if there is also hay fever. See Antihistamines.
- If using more than one topical eye medicine, leave a gap between them (Opatanol/Maxidex SmPC: 5 minutes; Cosopt: 10 minutes; Celluvisc/Azyter: 15 minutes, and use Azyter last). Ointment last. After glaucoma drops, close the eye and press the inner canthus for 2 minutes (Cosopt/timolol SmPC) to cut systemic absorption. Do not let the dropper touch the eye. Many preserved bottles: discard 28 days after opening; Hylo-Forte is a 6-month device bottle. Check the product.
- Children with conjunctivitis can attend school or childcare if otherwise well. Inform the school.
🚨 Red flags: do not treat as simple conjunctivitis
- Reduced or blurred vision that does not clear with blinking, moderate–severe pain, severe photophobia, irregular pupil, ciliary flush, or a white corneal opacity: same-day ED or emergency eye service.
- Contact-lens wearer with a red eye: stop lenses for 2 weeks or until symptoms resolve, and discard any disposable lens used in that eye. Per HSE AMRIC this may warrant urgent ophthalmology (risk of microbial keratitis). Do not treat as simple conjunctivitis with chloramphenicol and discharge.
- Vesicles on the forehead, eyelid, or nose tip (Hutchinson sign): herpes zoster ophthalmicus. Dendritic fluorescein stain: herpes simplex keratitis. See Shingles. No steroid drops.
- Hyperacute copious purulent discharge (onset 12–24 h): consider gonococcal conjunctivitis. Conjunctivitis in the first week of life: consider gonorrhoea. Red sticky eye in the first month of life: consider chlamydia. Urgent senior/ophthalmology review, not topical chloramphenicol alone.
- Do not start steroid drops (Maxidex, Pred Forte) for undiagnosed red eye. They can worsen herpes keratitis.
- Never give topical anaesthetic drops to take home. They hide pain and delay recognition of a worsening cornea.
📌 Safety-net and when to refer
- If an antibiotic is started: seek review if no improvement after 2 days, or if pain, photophobia, or vision change develops.
- Per HSE AMRIC: refer to ophthalmology if symptoms persist beyond 7–10 days, if corneal infection is possible (especially contact-lens wearers), or if infection is chronic beyond 1 month.
- Consider a swab if infection is chronic, recurrent, or fails first-line treatment. Adenoviral conjunctivitis can last 2–3 weeks.
- Teenagers and adults with chronic low-grade mucous discharge not responding to topical therapy: consider chlamydia and refer. Do not treat suspected STI eye disease with chloramphenicol alone.
📋 Continuing glaucoma drops
- Continue the patient’s usual drops in hospital, including the morning of surgery, unless ophthalmology or anaesthetics advise otherwise.
- Do not start a new glaucoma agent overnight. New therapy belongs to ophthalmology.
- Timolol and Cosopt are topical beta-blockers: caution in asthma, COPD, heart block, and bradycardia. Discuss with ophthalmology before stopping rather than omitting silently.
- Latanoprost is the prostaglandin analogue most often continued on Irish wards (Xalatan or preservative-free Monopost), one drop at night.
Eye drops
Common Irish hospital and community products
| Drug | Dose | Frequency | Type | Notes |
|---|---|---|---|---|
| Lubricants (artificial tears) | ||||
| Hypromellose (Artelac) | 1 drop | 3–5 times daily or as required | Lubricant | Artelac SmPC. Viral conjunctivitis comfort / dry eye. HSE: consider PF if use >1 month. |
| Carbomer 0.2% (Viscotears) | 1 drop | 3–4 times daily or as required | Gel lubricant | Viscotears SmPC. Thicker gel; lasts longer than watery drops. Blur for a few minutes after instillation. |
| Carmellose 1% (Celluvisc) | 1–2 drops | As needed | Unit-dose PF | Celluvisc SmPC: 1–2 drops as needed. Discard each vial after use. Separate from other eye medicines by 15 minutes. |
| Sodium hyaluronate 0.2% (Hylo-Forte) | 1 drop | Per device IFU | PF bottle | Medical device, not a licensed medicine. Common Irish hospital stock. Typically used several times daily; 6-month bottle once opened (manufacturer IFU). |
| Paraffin ointment (Lacri-Lube / Xailin Night) | Small amount | Nocte | Ointment | For lids stuck in the morning or severe dry eye at night. Apply last, after any drops. Blurs vision. |
| Antibiotics (bacterial conjunctivitis) | ||||
| Chloramphenicol 0.5% (Chloromycetin) | 1–2 drops | Every 6 h while awake | 1st choice | Follow HSE AMRIC: 1–2 drops every 6 h while awake. Irish Chloromycetin SmPC is 2 drops every 3 h (or more often if required). Continue 48 h after resolution, max 1 week. Avoid in pregnancy/breastfeeding. Caution <2 years (boron in Chloromycetin Redidrops). Consider delayed script for 3 days. |
| Chloramphenicol 1% ointment | Apply to eye | Every 6–8 h while awake | 1st choice | Unlicensed. HSE AMRIC: adults and children from 2 years. Useful if drop frequency is hard to manage. Blurs vision in the day. Same duration as drops (48 h after resolution, max 1 week). |
| Azithromycin 15 mg/g (Azyter) | 1 drop | Every 12 h for 3 days only | 2nd choice | HSE AMRIC and Azyter SmPC: morning and evening for 3 days only. Do not extend even if signs remain. Unit-dose vials; discard each vial after use. |
| Fusidic acid 1% (Fucithalmic) | 1 drop | Every 12 h | 2nd choice | If chloramphenicol unsuitable. Continue 48 h after resolution, max 1 week. Little Gram-negative cover (caution in contact-lens wearers). |
| Allergy | ||||
| Sodium cromoglicate 2% (Vividrin / Opticrom) | 1–2 drops | QDS | Mast-cell stabilizer | CCS: use regularly through allergen exposure. Vividrin/typical SmPC: 1–2 drops QDS. Full effect 5–14 days (CCS). |
| Olopatadine 1 mg/ml (Opatanol) | 1 drop | BD (8-hourly) | Antihistamine + MCS | Opatanol SmPC: 1 drop twice daily; may continue up to 4 months. Licensed from 3 years. CCS: review if no improvement by 2 weeks. |
| Ketotifen 0.25 mg/ml (Zaditen) | 1 drop | BD | Antihistamine + MCS | Zaditen SmPC: 1 drop twice daily from 3 years. CCS: review if no improvement by 2 weeks. |
| Glaucoma (continue usual drops; do not start overnight) | ||||
| Latanoprost 50 mcg/ml (Xalatan / Monopost) | 1 drop | Nocte | Prostaglandin | Xalatan SmPC: 1 drop once daily in the evening. Iris darkening and longer lashes with long-term use. Monopost is preservative-free latanoprost. Continue usual drop; do not start overnight. |
| Timolol 0.25–0.5% (Timoptol) | 1 drop | BD | Beta-blocker | Timoptol SmPC: 1 drop twice daily. Systemic absorption can worsen asthma, heart block, or bradycardia. Nasolacrimal occlusion or closed lids for 2 minutes after the drop. |
| Dorzolamide/timolol (Cosopt) | 1 drop | BD | CAI + beta-blocker | Cosopt SmPC: 1 drop twice daily. Same beta-blocker cautions as timolol. Separate from other drops by 10 minutes. Sulphonamide-related CAI: caution if sulpha allergy. Discard 28 days after opening. |
| Steroids (ophthalmology-directed only) | ||||
| Dexamethasone 0.1% (Maxidex) | Per ophthalmology | Per ophthalmology | Steroid | Maxidex SmPC: severe every 30–60 min until response, then reduce (often towards 4-hourly). Do not start on the ward for undiagnosed red eye. Can worsen herpes keratitis and raise IOP. |
| ED / diagnostic | ||||
| Tropicamide 1% (Minims) | 1 drop | Then a second after 5 min | Mydriatic | Minims SmPC: 1 drop, then a second after 5 minutes; a further drop after 30 minutes if needed. Short-acting dilation for fundoscopy. Blur and photophobia for a few hours. Avoid if acute angle-closure suspected. |
| Fluorescein 1–2% (Minims) | 1 drop | Once | Stain | Look for abrasion or a dendritic HSV pattern. Same-day ophthalmology if dendritic stain. Never start steroids if HSV is possible. |
| Proxymetacaine 0.5% (Minims) | 1 drop | Once, in ED only | Anaesthetic | For exam or fluorescein if the eye cannot be opened. Never supply to take home. |
Lubricants (artificial tears)
Hypromellose (Artelac)
LubricantDose:1 drop
Frequency:3–5 times daily or as required
Notes: Artelac SmPC. Viral conjunctivitis comfort / dry eye. HSE: consider PF if use >1 month.
Carbomer 0.2% (Viscotears)
Gel lubricantDose:1 drop
Frequency:3–4 times daily or as required
Notes: Viscotears SmPC. Thicker gel; lasts longer than watery drops. Blur for a few minutes after instillation.
Carmellose 1% (Celluvisc)
Unit-dose PFDose:1–2 drops
Frequency:As needed
Notes: Celluvisc SmPC: 1–2 drops as needed. Discard each vial after use. Separate from other eye medicines by 15 minutes.
Sodium hyaluronate 0.2% (Hylo-Forte)
PF bottleDose:1 drop
Frequency:Per device IFU
Notes: Medical device, not a licensed medicine. Common Irish hospital stock. Typically used several times daily; 6-month bottle once opened (manufacturer IFU).
Paraffin ointment (Lacri-Lube / Xailin Night)
OintmentDose:Small amount
Frequency:Nocte
Notes: For lids stuck in the morning or severe dry eye at night. Apply last, after any drops. Blurs vision.
Antibiotics (bacterial conjunctivitis)
Chloramphenicol 0.5% (Chloromycetin)
1st choiceDose:1–2 drops
Frequency:Every 6 h while awake
Notes: Follow HSE AMRIC: 1–2 drops every 6 h while awake. Irish Chloromycetin SmPC is 2 drops every 3 h (or more often if required). Continue 48 h after resolution, max 1 week. Avoid in pregnancy/breastfeeding. Caution <2 years (boron in Chloromycetin Redidrops). Consider delayed script for 3 days.
Chloramphenicol 1% ointment
1st choiceDose:Apply to eye
Frequency:Every 6–8 h while awake
Notes: Unlicensed. HSE AMRIC: adults and children from 2 years. Useful if drop frequency is hard to manage. Blurs vision in the day. Same duration as drops (48 h after resolution, max 1 week).
Azithromycin 15 mg/g (Azyter)
2nd choiceDose:1 drop
Frequency:Every 12 h for 3 days only
Notes: HSE AMRIC and Azyter SmPC: morning and evening for 3 days only. Do not extend even if signs remain. Unit-dose vials; discard each vial after use.
Fusidic acid 1% (Fucithalmic)
2nd choiceDose:1 drop
Frequency:Every 12 h
Notes: If chloramphenicol unsuitable. Continue 48 h after resolution, max 1 week. Little Gram-negative cover (caution in contact-lens wearers).
Allergy
Sodium cromoglicate 2% (Vividrin / Opticrom)
Mast-cell stabilizerDose:1–2 drops
Frequency:QDS
Notes: CCS: use regularly through allergen exposure. Vividrin/typical SmPC: 1–2 drops QDS. Full effect 5–14 days (CCS).
Olopatadine 1 mg/ml (Opatanol)
Antihistamine + MCSDose:1 drop
Frequency:BD (8-hourly)
Notes: Opatanol SmPC: 1 drop twice daily; may continue up to 4 months. Licensed from 3 years. CCS: review if no improvement by 2 weeks.
Ketotifen 0.25 mg/ml (Zaditen)
Antihistamine + MCSDose:1 drop
Frequency:BD
Notes: Zaditen SmPC: 1 drop twice daily from 3 years. CCS: review if no improvement by 2 weeks.
Glaucoma (continue usual drops; do not start overnight)
Latanoprost 50 mcg/ml (Xalatan / Monopost)
ProstaglandinDose:1 drop
Frequency:Nocte
Notes: Xalatan SmPC: 1 drop once daily in the evening. Iris darkening and longer lashes with long-term use. Monopost is preservative-free latanoprost. Continue usual drop; do not start overnight.
Timolol 0.25–0.5% (Timoptol)
Beta-blockerDose:1 drop
Frequency:BD
Notes: Timoptol SmPC: 1 drop twice daily. Systemic absorption can worsen asthma, heart block, or bradycardia. Nasolacrimal occlusion or closed lids for 2 minutes after the drop.
Dorzolamide/timolol (Cosopt)
CAI + beta-blockerDose:1 drop
Frequency:BD
Notes: Cosopt SmPC: 1 drop twice daily. Same beta-blocker cautions as timolol. Separate from other drops by 10 minutes. Sulphonamide-related CAI: caution if sulpha allergy. Discard 28 days after opening.
Steroids (ophthalmology-directed only)
Dexamethasone 0.1% (Maxidex)
SteroidDose:Per ophthalmology
Frequency:Per ophthalmology
Notes: Maxidex SmPC: severe every 30–60 min until response, then reduce (often towards 4-hourly). Do not start on the ward for undiagnosed red eye. Can worsen herpes keratitis and raise IOP.
ED / diagnostic
Tropicamide 1% (Minims)
MydriaticDose:1 drop
Frequency:Then a second after 5 min
Notes: Minims SmPC: 1 drop, then a second after 5 minutes; a further drop after 30 minutes if needed. Short-acting dilation for fundoscopy. Blur and photophobia for a few hours. Avoid if acute angle-closure suspected.
Fluorescein 1–2% (Minims)
StainDose:1 drop
Frequency:Once
Notes: Look for abrasion or a dendritic HSV pattern. Same-day ophthalmology if dendritic stain. Never start steroids if HSV is possible.
Proxymetacaine 0.5% (Minims)
AnaestheticDose:1 drop
Frequency:Once, in ED only
Notes: For exam or fluorescein if the eye cannot be opened. Never supply to take home.
SmPCs (medicines.ie / HPRA)
Hypromellose (Artelac)Carmellose (Celluvisc 1%)Viscotears (emc UK)Chloramphenicol (Chloromycetin 0.5%)Azithromycin (Azyter 15 mg/g): SmPC (HPRA PDF)Fusidic acid (Fucithalmic)Sodium cromoglicate (Vividrin)Olopatadine (Opatanol)Ketotifen (Zaditen, emc UK)Latanoprost (Xalatan)Timolol (Timoptol 0.5%)Dorzolamide/timolol (Cosopt)Dexamethasone (Maxidex)Tropicamide 1% (Minims)Fluorescein 1% (Minims)Proxymetacaine 0.5% (Minims)
Based on
Related NICE guidance
NICENICE NG81 — Glaucoma: diagnosis and management (updated Jan 2022)
Full guidance on nice.org.uk. BetterCall is not endorsed by NICE.
External resources
Note Template
Ready-to-use clinical note structure
🕒 16 / 10 / 2026 — 16:19 ATRP re: red eye / eye drops Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [glaucoma, previous keratitis, contact lenses, atopy] Allergies: [drops / preservatives / chloramphenicol / macrolides] 🧾 Hx: • Onset and which eye: [R / L / both] • Pain, photophobia, reduced vision, discharge (watery vs mucopurulent), itch • Contact lenses: [no / yes — removed] • Current eye drops: [none / list, including glaucoma drops] • Trauma, welding, recent eye surgery, rash around eye/nose 🩺 Exam: • Visual acuity (with glasses if used): R __ L __ • Pupils: [equal/reactive / irregular] • Discharge: [none / watery / mucopurulent] • Pattern of redness: [diffuse conjunctiva / ciliary flush / sectoral] • Lids / vesicles / Hutchinson sign: [none / describe] • Fluorescein (if done): [no stain / dendritic / abrasion / not done] 📋 Impression: [viral conjunctivitis / bacterial conjunctivitis / allergic / dry eye / other — red flags present/absent] 💊 Plan: • Drops prescribed: [lubricant / chloramphenicol every 6 h while awake (HSE) / Azyter 3 days / fusidic acid / olopatadine / continue glaucoma drops / none] • Contact lenses: [off 2 weeks / until reviewed / N/A] • Ophthalmology / ED: [not required / same day — reason] • Safety-net: [worse pain, vision change, no improvement 48 h; ophthalmology if still not settling 7–10 days] 👤 [Your Name], [Role] IMC: _______
Educational reference only. Medical disclaimer