Eye Drops 👁️

• 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.

• 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.

• 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.

• 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.

Based on