Ophthalmic anti-inflammatories and anti-infectives: Nursing pharmacology

Commonly used ophthalmic medications can be broadly divided into two categories: anti-inflammatories and anti-infectives. Ophthalmic anti-inflammatories are a group of medications that are used to treat inflammatory eye conditions, such as allergic conjunctivitis, non-infectious uveitis, and to treat eye inflammation after an ophthalmic procedure.

In contrast, ophthalmic anti-infectives are used to treat infectious eye conditions caused by bacteria, fungi, or viruses. These conditions include infectious conjunctivitis, uveitis, blepharitis, keratitis, and endophthalmitis.

A hordeolum or stye, which is a common bacterial infection of the sebaceous glands of the eyelids, is also treated with ophthalmic anti-infectives. Finally, ophthalmic anti-infectives can also be used in clients with corneal ulceration to prevent infection.

Okay, starting with ophthalmic anti-inflammatories, they can be broadly classified into five groups: NSAIDs, which include diclofenac, flurbiprofen, ketorolac, and nepafenac; as well as corticosteroids, which include dexamethasone and prednisolone; antihistamines, such as emedastine and epinastine; and mast cell stabilizers, including cromolyn and nedocromil.

Finally, a combination of antihistamines and mast cell stabilizers can be used, such as azelastine, epinastine, ketotifen, and olopatadine.

These medications are applied topically in the form of eye drops or ointments. Once applied, they control the eye inflammation by decreasing the number of inflammatory cells, and inhibiting the production and effects of inflammatory mediator molecules, such as histamines or prostaglandins.

Unfortunately, ophthalmic anti-inflammatories can cause side effects, such as headaches, increased intraocular pressure, thinning of the cornea, and a delay in corneal healing. In addition, clients may experience a stinging or burning sensation when the medication is applied.

Finally, prolonged use of these medications has also been associated with the development of cataracts. Luckily, there are no known contraindications for the use of ophthalmic anti-inflammatory medications.

Next are ophthalmic anti-infectives, which can be broken down into three categories: antibiotics, which include ciprofloxacin, erythromycin, gentamicin, levofloxacin, sulfacetamide, tobramycin, and tetracycline; as well as antifungals, such as natamycin; and antivirals, like trifluridine.

These medications are also applied topically in the form of eye drops, or ointments, and they act by respectively killing or stopping the growth of bacteria, fungi, or viruses.

Now, side effects of ophthalmic anti-inflammatories include local skin or eye irritation, which can cause blurred vision or a stinging or burning sensation. Also, ophthalmic anti-inflammatories can increase the risk of non-infectious conjunctivitis or even a superinfection by organisms resistant to these medications. Once again, there are no significant contraindications for ophthalmic anti-infective medications.

Alright, when your client is prescribed an ophthalmic anti-inflammatory or anti-infective, first assess for any ophthalmic symptoms, including redness, discomfort, or decreased visual acuity. Then, be sure to review the results of the most recent ophthalmic exam and intraocular pressure test.