Other Medications in Eye Care

Not every ocular problem fits neatly into antibiotic, steroid, glaucoma, or dry eye categories. Specialized medications fill important gaps, addressing edema, fungal pathogens, cosmetic concerns, and procedural comfort. Knowing when to employ these agents, how they work, and what risks they carry allows optometrists to solve uncommon but clinically significant problems without delay. Incorporating them thoughtfully improves patient comfort, visual quality, and overall satisfaction with care.

Prostaglandin analog based products such as bimatoprost can enhance eyelash length, thickness, and darkness, but they can also darken the iris, increase periocular pigmentation, and cause conjunctival hyperemia. Counsel patients about these potential cosmetic changes, stress correct application to the lash margin only, and discontinue if irritation or unwanted pigmentation spreads. Depigmenting agents or skin lighteners used around the lids require careful monitoring to avoid surface toxicity and allergic reactions.

Sodium chloride 2% drops and 5% ointments draw fluid out of the corneal stroma, improving vision in cases of endothelial compromise, Fuchs dystrophy flares, or postoperative edema. Frequent dosing and nighttime ointment can reduce morning blur but may sting on instillation. Combine hyperosmotics with lubricants to offset surface irritation and reassess regularly to decide when more definitive interventions such as endothelial keratoplasty are warranted.

Natamycin 5% remains the primary FDA approved topical antifungal for filamentous keratitis, while compounded voriconazole or amphotericin may be required for yeasts or resistant organisms. Fungal ulcers progress slowly but respond slowly as well, demanding prolonged therapy and close follow up. Culture guidance, collaboration with corneal or infectious disease specialists, and strict monitoring of infiltrate size, depth, and epithelial status are essential to preserve vision.

In office topical anesthetics such as proparacaine and tetracaine enable procedures and facilitate tonometry, but dispensing them for home use risks epithelial toxicity and delayed healing. OTC redness relievers that use vasoconstrictors can cause rebound hyperemia and mask underlying disease if overused. Miscellaneous categories also include miotics for pharmacologic testing, dyes like fluorescein and lissamine green for diagnostic staining, and collagenase inhibitors or antimetabolites used in specific postoperative or surface disease scenarios.

Review contraindications such as epithelial defects before using anesthetics at home, allergy history with antifungals, and cosmetic expectations for lash enhancers. Educate patients about proper application, duration limits, and warning signs like increased pain, vision loss, or persistent redness. Document the exact product, concentration, frequency, and treatment goal so follow up decisions are clear. Maintain updated dosing tables and cost comparisons since many of these products are compounded or have limited generic options.