Oral Medications in Eye Care

Ophthalmic Oral Pharmaceuticals

Ocular Oral Medication Overview

Importance of Oral Medications in Optometric Practice

Oral medications play a vital role in managing ocular conditions where topical treatments are inadequate or unsuitable. Systemic therapies offer superior tissue penetration and extensive therapeutic coverage, effectively managing deeper ocular tissues, severe infections, or systemic involvement, thereby significantly enhancing patient outcomes and ocular health.

Frequently Used Oral Medications in Eye Care

Optometrists commonly prescribe systemic medications for complex ocular conditions, including:

  • Antibiotics (e.g., Doxycycline, Azithromycin): Broad-spectrum antibiotics effectively treat bacterial infections involving ocular and periocular tissues, particularly conditions like blepharitis or orbital cellulitis.
  • Antivirals (e.g., Acyclovir, Valacyclovir): Critical for managing severe viral ocular infections such as herpes simplex or herpes zoster ophthalmicus, significantly reducing complications and vision loss risks.
  • Carbonic Anhydrase Inhibitors (e.g., Acetazolamide): Essential adjunctive treatments for glaucoma management, efficiently reducing intraocular pressure, particularly in acute or uncontrolled cases.

Oral Therapy in Glaucoma Management

Oral carbonic anhydrase inhibitors (CAIs) like acetazolamide and methazolamide rapidly reduce intraocular pressure (IOP) in urgent glaucoma situations, including acute angle-closure glaucoma attacks. Their systemic effect complements topical glaucoma medications, although vigilant monitoring is required due to potential systemic adverse effects, such as electrolyte imbalances, paresthesias, and gastrointestinal disturbances. Comprehensive patient education and routine clinical assessment ensure effective and safe glaucoma control.

Clinical Guidelines for Systemic Therapy Selection

Choosing the right oral medication involves carefully evaluating patient-specific factors such as age, systemic health status, potential medication interactions, and side-effect profiles. Special consideration and dosage adjustments may be necessary for patients with chronic conditions like diabetes, hypertension, or kidney impairment, ensuring medication safety, effectiveness, and optimal patient outcomes.

Ophthalmic Oral Medications

Ophthalmic Oral Medications
BrandGenericDosingAmountAgesPregnancyMechanism
Amoxil
GenericPO
amoxicillin500mg po bid-tid x10d250/500/875mg>3 monthsBpenicillin
Augmentin
GenericPO
amoxicillin
clavulanate
250-500mg po bid-tid x10d250/500/875mg>3 monthsBpenicillin
β-lactamase inhibitor
Diamox
GenericPO
acetazolamide500mg po bid125/250mg
500mg ('Sequels')
>12 yearsCcarbonic anhydrase inhibitor
↓ aqueous production
Diclocil
GenericPO
dicloxacillin250mg po qid250/500mg>3 monthsBpenicillin
Famvir
GenericPO
famciclovir250mg po tid x 7d (simplex)
500mg po tid x 7d (zoster)
125/250/500mgNABguanine analogue
Keflex
GenericPO
cephalexin1-4g/d po250/500/750mg>1 yearBcephalosporin
Tylenol #3
GenericPO
acetaminophen 300mg
codeine 30mg
q4-6hsingle tablet>18 yearsCanalgesic
narcotic (Sch.III)
Ultracet
GenericPO
acetaminophen 325mg
tramadol 37.5mg
q4-6h
(max 8 tabs/d)
single tablet>12 yearsCanalgesic
narcotic (Sch.IV)
Ultram
GenericPO
tramadol hydrochlorideq4-6h
(max 400mg/d)
50mg>18 yearsCnarcotic (Sch.IV)
Valtrex
GenericPO
valcyclovir500mg po tid (simplex)
1g po tid x7d (zoster)
500mg/1g>12 yearsBguanine analogue
Vibramycin
GenericPO
doxycycline100mg po bid x7d50/100mg>8 yearsDtetracycline
Vicodin
GenericPO
acetaminophen 300mg
hydrocodone 5mg
q4-6h
(max 12 tabs/d)
single tabletNACnarcotic (Sch.II)
Z-Pak
GenericPO
azithromycinbid po x1d, then qd po x4d250mg x6
250/500/600mg
>6 monthsBmacrolide
Zovirax
GenericPO
acyclovir400mg po 5x/d x7d (simplex)
800mg po 5x/d x7d (zoster)
200/400/800mg>2 yearsBinhibits DNA polymerase