Guide to Ophtho Medications

Typical Dose Range: BID (prophylaxis) - TID * Narrow spectrum antibiotic - Gram negative * Can be used for prophylaxis but since most infections are Gram positive, may not be best choice for empirical/prophylactic use * There is some concern for gentamicin inhibiting wound healing in cell culture - do not dose excessively * More appropriate for use if rods are noted on cytology or as indicated by culture. * Can be used in combination with a compounded topical beta-lactam (e.g. cephalosporin) for possible synergistic effect - do not combine together, give separately.

• Narrow spectrum antibiotic - Gram negative
• Can be used for prophylaxis but since most infections are Gram positive, may not be best choice for empirical/prophylactic use
• There is some concern for gentamicin inhibiting wound healing in cell culture - do not dose excessively
• More appropriate for use if rods are noted on cytology or as indicated by culture.
• Can be used in combination with a compounded topical beta-lactam (e.g. cephalosporin) for possible synergistic effect - do not combine together, give separately.

Typical Dose Range: BID (prophylaxis) - TID * Narrow spectrum antibiotic - Gram negative * Can be used for prophylaxis but since most infections are Gram positive, may not be best choice for empirical/prophylactic use * There is conflicting evidence of tobramycin inhibiting wound healing in cell culture (like its cousin Gentamicin) - do not dose excessively * More appropriate for use if rods are noted on cytology or as indicated by culture. * Can be used in combination with a compounded topical beta-lactam (e.g. cephalosporin) for possible synergistic effect - do not combine together, give separately.

• Narrow spectrum antibiotic - Gram negative
• Can be used for prophylaxis but since most infections are Gram positive, may not be best choice for empirical/prophylactic use
• There is conflicting evidence of tobramycin inhibiting wound healing in cell culture (like its cousin Gentamicin) - do not dose excessively
• More appropriate for use if rods are noted on cytology or as indicated by culture.
• Can be used in combination with a compounded topical beta-lactam (e.g. cephalosporin) for possible synergistic effect - do not combine together, give separately.

Typical Dose Range: BID (prophylaxis) * Broad spectrum combination (Neo: G-, Poly: G-, Gram: G+) * The author's preferred prophylactic topical since resistance is less likely with combination of drugs * Poor penetration through intact epithelium (so not a big deal in superficial ulcers but problematic if trying to treat a corneal abscess)

• Broad spectrum combination (Neo: G-, Poly: G-, Gram: G+)
• The author's preferred prophylactic topical since resistance is less likely with combination of drugs
• Poor penetration through intact epithelium (so not a big deal in superficial ulcers but problematic if trying to treat a corneal abscess)

Typical Dose Range: BID (prophylaxis) * Broad spectrum combination (Neo: G-, Poly: G-, Bac: G+) * The author's preferred prophylactic topical since resistance is less likely with combination of drugs * Poor penetration through intact epithelium (so not a big deal in superficial ulcers but problematic if trying to treat a corneal abscess)

• Broad spectrum combination (Neo: G-, Poly: G-, Bac: G+)
• The author's preferred prophylactic topical since resistance is less likely with combination of drugs
• Poor penetration through intact epithelium (so not a big deal in superficial ulcers but problematic if trying to treat a corneal abscess)

Typical Dose Range: BID (mild-moderate) - QID (severe) * Antibiotic-steroid combination * Can be used for immune-mediated conditions (e.g. pannus, nodular granulomatous episcleritis) when steroid-alone drops are expensive or unavailable * Handy where a secondary bacterial infection is also present as well as keratoconjunctivitis such as in chronic dry eye * Can be used for moderate-severe cases of conjunctivitis

• Antibiotic-steroid combination
• Can be used for immune-mediated conditions (e.g. pannus, nodular granulomatous episcleritis) when steroid-alone drops are expensive or unavailable
• Handy where a secondary bacterial infection is also present as well as keratoconjunctivitis such as in chronic dry eye
• Can be used for moderate-severe cases of conjunctivitis

Typical Dose Range: BID * Antibiotic-steroid combination * Hydrocortisone is a very weak steroid so its efficacy in treating immune-mediate disease is slim to none * Useful for mild conjunctivitis but has limited efficacy otherwise, you're probably better off with NeoPolyDex

• Antibiotic-steroid combination
• Hydrocortisone is a very weak steroid so its efficacy in treating immune-mediate disease is slim to none
• Useful for mild conjunctivitis but has limited efficacy otherwise, you're probably better off with NeoPolyDex

Typical Dose Range: BID-QID * Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms * 2nd generation fluoroquinolone * Has relatively good penetration into the cornea/eye but ofloxacin may be marginally better

• Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms
• 2nd generation fluoroquinolone
• Has relatively good penetration into the cornea/eye but ofloxacin may be marginally better

Typical Dose Range: BID-QID * Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms * 2nd generation fluoroquinolone * Good corneal and intraocular penetration (probably up-to but not past the anterior chamber) * Usually well-tolerated

• Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms
• 2nd generation fluoroquinolone
• Good corneal and intraocular penetration (probably up-to but not past the anterior chamber)
• Usually well-tolerated

Typical Dose Range: BID-QID * Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms * 2nd generation fluoroquinolone * Good corneal and intraocular penetration (probably up-to but not past the anterior chamber)

• Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms
• 2nd generation fluoroquinolone
• Good corneal and intraocular penetration (probably up-to but not past the anterior chamber)

Typical Dose Range: BID-QID * Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms * 4th generation fluoroquinolone * Good corneal and intraocular penetration (probably up-to but not past the anterior chamber)

• Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms
• 4th generation fluoroquinolone
• Good corneal and intraocular penetration (probably up-to but not past the anterior chamber)

Typical Dose Range: BID-QID * Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms * 4th generation fluoroquinolone * Good corneal and intraocular penetration (probably up-to but not past the anterior chamber)

• Broad spectrum antibiotic - relatively good efficacy against Gram positive and negative organisms
• 4th generation fluoroquinolone
• Good corneal and intraocular penetration (probably up-to but not past the anterior chamber)

Typical Dose Range: BID * Primarily for Gram positive but most often used against intracellular organisms - namely Chlamydia and Mycoplasma in cats * Bacteriostatic drug so is not first line therapy in cases with active infections unless indicated by culture and sensitivity

• Primarily for Gram positive but most often used against intracellular organisms - namely Chlamydia and Mycoplasma in cats
• Bacteriostatic drug so is not first line therapy in cases with active infections unless indicated by culture and sensitivity

Typical Dose Range: BID-TID * Broad spectrum antibiotic but use is typically limited to intracellular infections (Chlamydia & Mycoplasma in cats) * Has been reported to be efficacious in healing of indolent ulcers (dogs) in conjunction with debridement (TID dosing frequency)

• Broad spectrum antibiotic but use is typically limited to intracellular infections (Chlamydia & Mycoplasma in cats)
• Has been reported to be efficacious in healing of indolent ulcers (dogs) in conjunction with debridement (TID dosing frequency)

Typical Dose Range: BID-TID * Has to be ordered from a compounding pharmacy (1% concentration) * Typically only used when indicated by a culture and sensitivity (i.e. resistance is noted to everything else except chloramphenicol) * It is broad spectrum and has been shown to be efficacious against most Gram positive and negative bacteria, as well as intracellular bacteria (Chlamydia, Mycoplasma, Rickettsial organisms) * Importantly, however, resistance has been noted in Pseudomonas (a rarer infection than Staph or Strep, but terrible when present) * Also used for treatment of corneal abscesses due to good penetration

• Has to be ordered from a compounding pharmacy (1% concentration)
• Typically only used when indicated by a culture and sensitivity (i.e. resistance is noted to everything else except chloramphenicol)
• It is broad spectrum and has been shown to be efficacious against most Gram positive and negative bacteria, as well as intracellular bacteria (Chlamydia, Mycoplasma, Rickettsial organisms)
• Importantly, however, resistance has been noted in Pseudomonas (a rarer infection than Staph or Strep, but terrible when present)
• Also used for treatment of corneal abscesses due to good penetration

Typical Dose Range: BID * Has to be ordered from a compounding pharmacy (usually at a 0.5% concentration) * Long intracellular half-life reduces the frequency of dosing in contrast to other topical anti-virals

• Has to be ordered from a compounding pharmacy (usually at a 0.5% concentration)
• Long intracellular half-life reduces the frequency of dosing in contrast to other topical anti-virals

Typical Dose Range: q4-6h * Has to be ordered from a compounding pharmacy (0.5-1%) solution or ophthalmic ointment * Anecdotally well tolerated by cats but needs to be given frequently

• Has to be ordered from a compounding pharmacy (0.5-1%) solution or ophthalmic ointment
• Anecdotally well tolerated by cats but needs to be given frequently

Typical Dose Range: q4-6h * Commercially available but expensive * Has to be given frequently - 4-6 times per day

• Commercially available but expensive
• Has to be given frequently - 4-6 times per day

Typical Dose Range: 90 mg/kg PO TID * For an average size 10 lb cat - works out to be about a 500 mg tablet orally three times daily * This is a very large tablet to try to give a cat, so generally the author will start with a 250 mg tablet (or half a 500) and if signs do not improve over a 2-4 week course, go to a higher dose or consider co-administration with cidofovir * Probably the most actively studied antiviral in cats

• For an average size 10 lb cat - works out to be about a 500 mg tablet orally three times daily
• This is a very large tablet to try to give a cat, so generally the author will start with a 250 mg tablet (or half a 500) and if signs do not improve over a 2-4 week course, go to a higher dose or consider co-administration with cidofovir
• Probably the most actively studied antiviral in cats

Typical Dose Range: q2h-BID * Only anti-fungal labeled for ocular use (5% ophthalmic suspension) * Good for filamentous fungi * Limited corneal penetration so efficacy in fungal corneal abscesses may be limited

• Only anti-fungal labeled for ocular use (5% ophthalmic suspension)
• Good for filamentous fungi
• Limited corneal penetration so efficacy in fungal corneal abscesses may be limited

Typical Dose Range: q2h-6h topically, q48h x 3 doses (subconj) * Broad spectrum anti-fungal but no specific topical formulation * Good against yeast and filamentous fungi * Can reconstitute (use sterile water not saline) solution into a 0.15% form (can do higher concentrations but can be irritating) for topical use * If you do create this form, protect from light and keep it in the fridge and it will be good for at least 7 days * Can be used topically (usually through an SPL) or injected subconjunctivally or with proper expertise, injected intrastromally * Is thick and viscous so may accumulate in deeper ulcers prolonging contact time;

• Broad spectrum anti-fungal but no specific topical formulation
• Good against yeast and filamentous fungi
• Can reconstitute (use sterile water not saline) solution into a 0.15% form (can do higher concentrations but can be irritating) for topical use
• If you do create this form, protect from light and keep it in the fridge and it will be good for at least 7 days
• Can be used topically (usually through an SPL) or injected subconjunctivally or with proper expertise, injected intrastromally
• Is thick and viscous so may accumulate in deeper ulcers prolonging contact time;

Typical Dose Range: q2h-BID * Can either be compounded into a 1% ophthalmic solution or can utilize (obviously off-label) 2% vaginal cream * Variable efficacy reported in the literature for Aspergillus and Fusarium in vitro

• Can either be compounded into a 1% ophthalmic solution or can utilize (obviously off-label) 2% vaginal cream
• Variable efficacy reported in the literature for Aspergillus and Fusarium in vitro

Typical Dose Range: q2h (in beginning)-BID * Technically broad spectrum against bacteria and fungi usually used for skin application but is safe for cornea and conjunctival use as well * Recent study showed good efficacy in vitro against fungal isolates seen in horses * Clearly states on the packaging "NOT FOR OPHTHALMIC USE" so definitely off-label; recommend obtaining consent for use and potentially avoiding in cases where lawyers could be involved * Main benefit is cost; could be beneficial in early cases of keratitis or infection

• Technically broad spectrum against bacteria and fungi usually used for skin application but is safe for cornea and conjunctival use as well
• Recent study showed good efficacy in vitro against fungal isolates seen in horses
• Clearly states on the packaging "NOT FOR OPHTHALMIC USE" so definitely off-label; recommend obtaining consent for use and potentially avoiding in cases where lawyers could be involved
• Main benefit is cost; could be beneficial in early cases of keratitis or infection

Typical Dose Range: q2-4h * No commercial eye product, usually reconstituted from the IV form - 19 mL of sterile water in 200 mg vial to create 1% solution, refrigerate and discard after 1 month * Oral use has good bioavailability however dosing in horses is usually cost prohibitive * In vitro study found to be more effective in southern and midwestern US than some other antifungals

• No commercial eye product, usually reconstituted from the IV form - 19 mL of sterile water in 200 mg vial to create 1% solution, refrigerate and discard after 1 month
• Oral use has good bioavailability however dosing in horses is usually cost prohibitive
• In vitro study found to be more effective in southern and midwestern US than some other antifungals

Typical Dose Range: q6-24h * The active ingredient in optimmune which is a 0.2% concentration of it * Commonly compounded into 1-2% formulations which are handy for more severe cases * Used primarily for treatment of KCS (immune-mediated lacrimal adenitis) but is also used for immune-mediated keratitis (sometimes as a monotherapy, sometimes in conjunction with topical steroids) * Dosing for KCS is usually BID-TID initially, for immune mediated disease may be more frequent depending on severity

• The active ingredient in optimmune which is a 0.2% concentration of it
• Commonly compounded into 1-2% formulations which are handy for more severe cases
• Used primarily for treatment of KCS (immune-mediated lacrimal adenitis) but is also used for immune-mediated keratitis (sometimes as a monotherapy, sometimes in conjunction with topical steroids)
• Dosing for KCS is usually BID-TID initially, for immune mediated disease may be more frequent depending on severity

Typical Dose Range: q6-24h * Similar to cyclosporine in the indications for use * No commercial product so has to be compounded in a 0.01-0.03% solution (lesser concentration compared to Cyclosporine is due to increased potency) * Used primarily for treatment of KCS (immune-mediated lacrimal adenitis) but is also used for immune-mediated keratitis (sometimes as a monotherapy, sometimes in conjunction with topical steroids) * Dosing for KCS is usually BID-TID initially, for immune mediated disease may be more frequent depending on severity

• Similar to cyclosporine in the indications for use
• No commercial product so has to be compounded in a 0.01-0.03% solution (lesser concentration compared to Cyclosporine is due to increased potency)
• Used primarily for treatment of KCS (immune-mediated lacrimal adenitis) but is also used for immune-mediated keratitis (sometimes as a monotherapy, sometimes in conjunction with topical steroids)
• Dosing for KCS is usually BID-TID initially, for immune mediated disease may be more frequent depending on severity

Typical Dose Range: q6-24h * Pronounced "pee-mek-rowe-li-mus" * Similar to cyclosporine/tacro in the indications for use * No commercial product so has to be compounded in a 1% solution * Used primarily for treatment of KCS (immune-mediated lacrimal adenitis) but also has evidence of effective in cases of pannus as well * Dosing is usually BID * Isn't broadly used because it's newer and not many compounding pharmacies carry it but could be an option if cyclosporine/tacrolimus not well tolerated

• Pronounced "pee-mek-rowe-li-mus"
• Similar to cyclosporine/tacro in the indications for use
• No commercial product so has to be compounded in a 1% solution
• Used primarily for treatment of KCS (immune-mediated lacrimal adenitis) but also has evidence of effective in cases of pannus as well
• Dosing is usually BID
• Isn't broadly used because it's newer and not many compounding pharmacies carry it but could be an option if cyclosporine/tacrolimus not well tolerated

Typical Dose Range: q2-12h * Serum or plasma is used for its anti-collagenase components (macrogloblins) * The main indication is to reduce or stop enzymatic degradation of the cornea (melting or stromal loss) from endogenous or exogenous matrix metalloproteinases (MMPs) * Frequency depends on severity of melting or stromal loss - if aggressive do q1-2 hours acutely and then taper as condition stabilizes * Can be made from an animal's own blood (draw, spin down, place in syringes) or can used "banked" serum from other animals or banked commercial plasma; can also use serum from another species - e.g. horse serum on dogs * Freeze for storage and then thaw and place in fridge with active use

• Serum or plasma is used for its anti-collagenase components (macrogloblins)
• The main indication is to reduce or stop enzymatic degradation of the cornea (melting or stromal loss) from endogenous or exogenous matrix metalloproteinases (MMPs)
• Frequency depends on severity of melting or stromal loss - if aggressive do q1-2 hours acutely and then taper as condition stabilizes
• Can be made from an animal's own blood (draw, spin down, place in syringes) or can used "banked" serum from other animals or banked commercial plasma; can also use serum from another species - e.g. horse serum on dogs
• Freeze for storage and then thaw and place in fridge with active use

Typical Dose Range: q6-24h * No commercial eye product so has to be compounded into a 0.2-2% solution or ointment * Mostly used for calcific keratopathy or degeneration and potentially for melting ulcers

• No commercial eye product so has to be compounded into a 0.2-2% solution or ointment
• Mostly used for calcific keratopathy or degeneration and potentially for melting ulcers

Typical Dose Range: q6-24h * Indicated for control of mild-moderate uveitis but has been show in off-label studies in people to be beneficial for allergic conjunctivitis at a QID dosing (this is in people but can try for dogs) * Indicated for control of mild-moderate uveitis * Few direct comparisons of topical NSAIDs in the veterinary world have been performed (gluts of research in people in contrast); varying methods and concentrations make direct comparisons difficult * To the author's knowledge, little to no studies on clinical efficacy in veterinary patients for the topical form of ketorolac

• Indicated for control of mild-moderate uveitis but has been show in off-label studies in people to be beneficial for allergic conjunctivitis at a QID dosing (this is in people but can try for dogs)
• Indicated for control of mild-moderate uveitis
• Few direct comparisons of topical NSAIDs in the veterinary world have been performed (gluts of research in people in contrast); varying methods and concentrations make direct comparisons difficult
• To the author's knowledge, little to no studies on clinical efficacy in veterinary patients for the topical form of ketorolac

Typical Dose Range: q6-24h * Indicated for control of mild-moderate uveitis * Few direct comparisons of topical NSAIDs in the veterinary world have been performed (gluts of research in people in contrast); varying methods and concentrations make direct comparisons difficult * In cats, one study suggested diclofenac was the better NSAID compared to flurbiprofen * In dogs, there have been a number of studies from the late 1990s that have shown efficacy for controlling uveitis but how these compare to newer NSAIDs is less clear

• Indicated for control of mild-moderate uveitis
• Few direct comparisons of topical NSAIDs in the veterinary world have been performed (gluts of research in people in contrast); varying methods and concentrations make direct comparisons difficult
• In cats, one study suggested diclofenac was the better NSAID compared to flurbiprofen
• In dogs, there have been a number of studies from the late 1990s that have shown efficacy for controlling uveitis but how these compare to newer NSAIDs is less clear

Typical Dose Range: q6-24h * Indicated for control of mild-moderate uveitis * Few direct comparisons of topical NSAIDs in the veterinary world have been performed (gluts of research in people in contrast); varying methods and concentrations make direct comparisons difficult * In cats, one study suggested diclofenac was the better NSAID compared to flurbiprofen * In dogs, a similar findings were noted in 1 study but the difference was small and a 1% solution was used (commercially a 0.3% solution is available).

• Indicated for control of mild-moderate uveitis
• Few direct comparisons of topical NSAIDs in the veterinary world have been performed (gluts of research in people in contrast); varying methods and concentrations make direct comparisons difficult
• In cats, one study suggested diclofenac was the better NSAID compared to flurbiprofen
• In dogs, a similar findings were noted in 1 study but the difference was small and a 1% solution was used (commercially a 0.3% solution is available).

Typical Dose Range: q6-24h * Indicated for control of mild-moderate uveitis * Few direct comparisons of topical NSAIDs in the veterinary world have been performed (gluts of research in people in contrast); varying methods and concentrations make direct comparisons difficult * Has been studied in dogs in the context of post-cataract surgery pressures and inflammation which showed potential risk of increased IOP post-phaco; anti-inflammatory effects comparable with prednisolone acetate 1 week+ post-operatively (immediately after seemed to have less control of post-op uveitis)

• Indicated for control of mild-moderate uveitis
• Few direct comparisons of topical NSAIDs in the veterinary world have been performed (gluts of research in people in contrast); varying methods and concentrations make direct comparisons difficult
• Has been studied in dogs in the context of post-cataract surgery pressures and inflammation which showed potential risk of increased IOP post-phaco; anti-inflammatory effects comparable with prednisolone acetate 1 week+ post-operatively (immediately after seemed to have less control of post-op uveitis)

Typical Dose Range: q8h * Indicated for control of mild-moderate uveitis * No studies on efficacy in veterinary patients

• Indicated for control of mild-moderate uveitis
• No studies on efficacy in veterinary patients

Typical Dose Range: q6-24h * A commonly used topical corticosteroid for inflammatory diseases of the eye * Penetration with the acetate formulation is superior compared to other corticosteroids; particularly useful for anterior uveitis * Has a relative strength of 4 compared to hydrocortisone (1) and dexamethasone (25) * Dosing is typically based on severity of disease with regular monitoring to assess response

• A commonly used topical corticosteroid for inflammatory diseases of the eye
• Penetration with the acetate formulation is superior compared to other corticosteroids; particularly useful for anterior uveitis
• Has a relative strength of 4 compared to hydrocortisone (1) and dexamethasone (25)
• Dosing is typically based on severity of disease with regular monitoring to assess response

Typical Dose Range: q6-24h * A commonly used topical corticosteroid for inflammatory diseases of the eye * While more potent compared to prednisolone acetate, penetrance into the eye is less (especially for the phosphate formulations); can still be used for anterior uveitis however if response is incomplete or partial consider switching to prednisolone acetate * Has a relative strength of 25 compared to hydrocortisone (1) and prednisolone acetate (4) * Dosing is typically based on severity of disease with regular monitoring to assess response * Can be packaged up with Tobramycin (Tobradex) or Neomycin/Polymixin; stand-alone use is recommended in animals with sensitivity to topical antibiotics (e.g. cats)

• A commonly used topical corticosteroid for inflammatory diseases of the eye
• While more potent compared to prednisolone acetate, penetrance into the eye is less (especially for the phosphate formulations); can still be used for anterior uveitis however if response is incomplete or partial consider switching to prednisolone acetate
• Has a relative strength of 25 compared to hydrocortisone (1) and prednisolone acetate (4)
• Dosing is typically based on severity of disease with regular monitoring to assess response
• Can be packaged up with Tobramycin (Tobradex) or Neomycin/Polymixin; stand-alone use is recommended in animals with sensitivity to topical antibiotics (e.g. cats)

Typical Dose Range: TID * Safe for use in both primary and secondary glaucomas * Trade name is "Trusopt" * Can be used alone or bundled up with Timolol as one drug (Cosopt) in which case dosing is BID (vs TID)

• Safe for use in both primary and secondary glaucomas
• Trade name is "Trusopt"
• Can be used alone or bundled up with Timolol as one drug (Cosopt) in which case dosing is BID (vs TID)

Typical Dose Range: TID * Safe for use in both primary and secondary glaucomas * Trade name is "Azopt" * Is potentially better tolerated than Dorzolamide because it's less acidic * But poorly studied in veterinary medicine so comparative effect vs dorzolamide is unknown * Very expensive

• Safe for use in both primary and secondary glaucomas
• Trade name is "Azopt"
• Is potentially better tolerated than Dorzolamide because it's less acidic
• But poorly studied in veterinary medicine so comparative effect vs dorzolamide is unknown
• Very expensive

Typical Dose Range: BID * Comes in a 0.25% solution but has minimal IOP lowering effect in animals, so use 0.5% solution which has a small effect on IOP but can be used for mild cases of ocular hypertension * Non-selective beta-blocker so use caution in cases of asthma or in patients with cardiac disease * Combination form with Dorzolamide is also commonly used; trade-named "Cosopt" which is easier to say (generics are widely used but it's usually easier to say "Ko-sopt" rather than the full name

• Comes in a 0.25% solution but has minimal IOP lowering effect in animals, so use 0.5% solution which has a small effect on IOP but can be used for mild cases of ocular hypertension
• Non-selective beta-blocker so use caution in cases of asthma or in patients with cardiac disease
• Combination form with Dorzolamide is also commonly used; trade-named "Cosopt" which is easier to say (generics are widely used but it's usually easier to say "Ko-sopt" rather than the full name

Typical Dose Range: BID * Most valuable for treatment of primary glaucoma (less so for secondary) * Can also be used specifically as a miotic agent for posterior lens luxations * Can be used in an "acute" glaucoma spikes in place of mannitol; multiple doses can be given with reasonable time period (30-60 min) while monitoring IOP; usually works within 1-2 hours post-administration (again confirm that case is a primary glaucoma)

• Most valuable for treatment of primary glaucoma (less so for secondary)
• Can also be used specifically as a miotic agent for posterior lens luxations
• Can be used in an "acute" glaucoma spikes in place of mannitol; multiple doses can be given with reasonable time period (30-60 min) while monitoring IOP; usually works within 1-2 hours post-administration (again confirm that case is a primary glaucoma)

Typical Dose Range: BID * Essentially equivalent to latanoprost but more expensive * Most valuable for treatment of primary glaucoma (less so for secondary) * Can also be used specifically as a miotic agent for posterior lens luxations * Can be used in an "acute" glaucoma spikes in place of mannitol; multiple doses can be given with reasonable time period (30-60 min) while monitoring IOP; usually works within 1-2 hours post-administration (again confirm that case is a primary glaucoma)

• Essentially equivalent to latanoprost but more expensive
• Most valuable for treatment of primary glaucoma (less so for secondary)
• Can also be used specifically as a miotic agent for posterior lens luxations
• Can be used in an "acute" glaucoma spikes in place of mannitol; multiple doses can be given with reasonable time period (30-60 min) while monitoring IOP; usually works within 1-2 hours post-administration (again confirm that case is a primary glaucoma)

Typical Dose Range: BID * Used by ophthalmologist as an anecdotal "rescue" drug when maximum glaucoma therapy is not sufficient to keep IOP controlled (see MOA for differences in biochemistry) * Most valuable for treatment of primary glaucoma (less so for secondary) * Can also be used specifically as a miotic agent for posterior lens luxations * Can be used in an "acute" glaucoma spikes in place of mannitol; multiple doses can be given with reasonable time period (30-60 min) while monitoring IOP; usually works within 1-2 hours post-administration (again confirm that case is a primary glaucoma)

• Used by ophthalmologist as an anecdotal "rescue" drug when maximum glaucoma therapy is not sufficient to keep IOP controlled (see MOA for differences in biochemistry)
• Most valuable for treatment of primary glaucoma (less so for secondary)
• Can also be used specifically as a miotic agent for posterior lens luxations
• Can be used in an "acute" glaucoma spikes in place of mannitol; multiple doses can be given with reasonable time period (30-60 min) while monitoring IOP; usually works within 1-2 hours post-administration (again confirm that case is a primary glaucoma)

Typical Dose Range: BID-TID * Combination of two glaucoma medications into one drop * Safe for use in both primary and secondary glaucomas * Commonly referred to by its trade name "Cosopt" (pronounced KO-sopt) * When given together, dosing of the Dorzolamide (usually TID) can be reduced to a BID dosing schedule * Comes out as a very viscous and thick eyedrop * Can sometimes be topically irritating (especially if there's an ulcer present)

• Combination of two glaucoma medications into one drop
• Safe for use in both primary and secondary glaucomas
• Commonly referred to by its trade name "Cosopt" (pronounced KO-sopt)
• When given together, dosing of the Dorzolamide (usually TID) can be reduced to a BID dosing schedule
• Comes out as a very viscous and thick eyedrop
• Can sometimes be topically irritating (especially if there's an ulcer present)

Typical Dose Range: q6-24h * Essentially concentrated saline ointment * Used for treatment of bullous keratopathy and endothelial degeneration/dystrophy * Can also be used in some cases of persistent ulcers where bulla formation is a concern

• Essentially concentrated saline ointment
• Used for treatment of bullous keratopathy and endothelial degeneration/dystrophy
• Can also be used in some cases of persistent ulcers where bulla formation is a concern

Typical Dose Range: q12-48h * Cycloplegic for pain from ciliary body spasm that can occur from uveitis or ulcerative keratitis * Mydriasis is handy for use in uveitis as prevention of miosis is useful to prevent secondary glaucoma from posterior synechiae and helps improve vision if miosis is otherwise severe (especially in horses) * In an uninflamed eye, effect can last for 5-6 days in dogs and cats and potentially weeks in horses * The author will usually dose SID, BID, to EOD depending on degree of uveitis, pain

• Cycloplegic for pain from ciliary body spasm that can occur from uveitis or ulcerative keratitis
• Mydriasis is handy for use in uveitis as prevention of miosis is useful to prevent secondary glaucoma from posterior synechiae and helps improve vision if miosis is otherwise severe (especially in horses)
• In an uninflamed eye, effect can last for 5-6 days in dogs and cats and potentially weeks in horses
• The author will usually dose SID, BID, to EOD depending on degree of uveitis, pain

Typical Dose Range: once, q6-12h * A "weaker" mydriatic which is most often used for dilated fundic exam but can also be used more frequently for dilation and to keep the pupil moving with uveitis * Mydriasis usually occurs within 15-30 min and effects last for a few hours post-dilation

• A "weaker" mydriatic which is most often used for dilated fundic exam but can also be used more frequently for dilation and to keep the pupil moving with uveitis
• Mydriasis usually occurs within 15-30 min and effects last for a few hours post-dilation

Typical Dose Range: once * Primarily used as a diagnostic agent to confirm Horner's syndrome * To assess for denervation hypersensitivity - place a drop in both eyes and observe for improvement in clinical signs (ptosis, enophthalmia) within 15-60 minutes * More detailed guidelines with regards to concentration and timeframe to expected response that correlate with first, second, third order lesions exist but are beyond the scope of this site * Expect blanching of conjunctiva with use

• Primarily used as a diagnostic agent to confirm Horner's syndrome
• To assess for denervation hypersensitivity - place a drop in both eyes and observe for improvement in clinical signs (ptosis, enophthalmia) within 15-60 minutes
• More detailed guidelines with regards to concentration and timeframe to expected response that correlate with first, second, third order lesions exist but are beyond the scope of this site
• Expect blanching of conjunctiva with use

Typical Dose Range: once * Ubiquitous use for diagnosis of a corneal ulcer * Also used to test for tear film quality: __tear film break up time [TBUT]__ * Also used to test for nasolacrimal abnormalities: __Jones Test__, positive if stain noted at nostril * Also used to test for aqueous leakage: __Seidel Test__; strip of stain is painted over area, if green rivulet is noted, positive Seidel, consistent with aqueous leakage/perforation

• Ubiquitous use for diagnosis of a corneal ulcer
• Also used to test for tear film quality: tear film break up time [TBUT]
• Also used to test for nasolacrimal abnormalities: Jones Test, positive if stain noted at nostril
• Also used to test for aqueous leakage: Seidel Test; strip of stain is painted over area, if green rivulet is noted, positive Seidel, consistent with aqueous leakage/perforation

Typical Dose Range: once * Used as rapid-acting topical anesthetic to the cornea/conjunctiva * One drop is sufficient to obtain local analgesia for 10-15 minutes; a 2005 study showed greater effect and longer duration (30min) with 2 drops given 1 minute apart * Recommend to be stored refrigerated as efficacy wanes over time after 2 weeks of storage at room temperature * In cats, reported maximal effect is quite short at 5 minutes compared to other species

• Used as rapid-acting topical anesthetic to the cornea/conjunctiva
• One drop is sufficient to obtain local analgesia for 10-15 minutes; a 2005 study showed greater effect and longer duration (30min) with 2 drops given 1 minute apart
• Recommend to be stored refrigerated as efficacy wanes over time after 2 weeks of storage at room temperature
• In cats, reported maximal effect is quite short at 5 minutes compared to other species