When is a topical steroid preferred over an NSAID, and vice versa?

Steroids are preferred for clinically meaningful inflammation but require IOP and healing monitoring. NSAIDs are used for peri-operative pain and CME without raising IOP, but prolonged use can cause surface toxicity or delayed epithelial healing.

What systemic factors matter most when prescribing glaucoma drops?

Key issues include pulmonary and cardiac disease with beta blockers, CNS risk in young children with alpha-agonists, and renal concerns with carbonic anhydrase inhibitors. Systemic history should guide selection, with punctal occlusion counseling when appropriate.

How should topical medications be managed in contact lens wearers?

Most preserved drops should not be used over soft lenses. Remove lenses before dosing, wait at least 15 minutes before reinsertion unless labeled for in-lens use, and consider preservative-limited strategies or temporary lens discontinuation for frequent dosing.

What is a safe default approach when the diagnosis is uncertain?

If the diagnosis is uncertain, rule out infection first and avoid topical steroids until herpetic, fungal, and other infectious causes are reasonably excluded. Use appropriate antimicrobials and short-interval follow-up, escalating as the diagnosis clarifies.

Ophthalmic Medications: Dosing Tables & Prescribing Guide

Drug-class tables with dosing, strengths, and mechanisms

Ophthalmic Medications: A Practical Prescribing Framework

Red eye: decide what you are treating first

A red, painful, or photophobic eye requires an early decision about whether infection is plausible or whether the picture is primarily sterile inflammation. Many conditions overlap in appearance, but the treatment priorities differ. Use the Antibiotics and Antivirals pages when infection is on the differential, and the Steroids page when inflammation control is the primary goal. When both concerns are present, the Antibiotic and Steroid Combinations guide reviews when combination therapy fits and what to monitor during follow-up.

Chronic care: keep regimens tolerable and easy to follow

Long-term outcomes depend on stable regimens that match the patient's systemic history, ocular surface status, and adherence realities. This section is organized around common stepwise management paths.

Glaucoma and ocular hypertension: The Glaucoma Medications guide summarizes drug classes, typical dosing patterns, common adverse effects, and systemic precautions when escalating therapy.
Dry eye and ocular allergy: The Dry Eye and Allergy pages cover anti-inflammatory options, dual-action antihistamine and mast cell stabilizers, and adjunctive strategies used for long-term surface stability.

Diagnostics and procedures: use short courses with clear counseling

Prescribing in optometric practice also includes diagnostic drops, peri-procedural agents, and treatment for adnexal or deeper tissue disease. The Cycloplegics and Pain Management pages focus on common in-office patterns and safety counseling. When systemic therapy is needed, the Oral Medications section summarizes commonly used systemic antibiotics, antivirals, and analgesics with attention to major contraindications and monitoring.

How to use ODReference medication tables

Each category page groups drugs by class and route, with tables that highlight typical adult dosing ranges, formulation strengths, and high-impact cautions such as systemic contraindications, pediatric restrictions, and intraocular pressure considerations. This is a chairside reference and does not replace full prescribing information, package inserts, local guidelines, or pharmacist review. Confirm dosing and safety for the individual patient, especially in pregnancy, breastfeeding, renal or hepatic disease, significant cardiopulmonary history, and when interacting medications are present.

Pharmacology and Prescribing FAQs

When is a topical steroid preferred over an NSAID, and vice versa?: Topical steroids provide broad anti-inflammatory control and are typically chosen for significant anterior uveitis, immune or stromal keratitis, marked post-operative inflammation, and severe ocular surface inflammation when benefits outweigh risks. Key risks include intraocular pressure elevation, delayed epithelial healing, and cataract formation, so planned follow-up and taper strategy matter. Topical NSAIDs are most commonly used for peri-operative pain control, cystoid macular edema prevention or treatment, and short-term analgesia. They do not raise intraocular pressure, but prolonged use can increase surface toxicity and may delay epithelial healing in susceptible eyes. See the Steroids and NSAIDs pages for common pitfalls and practical selection.
What systemic factors matter most when prescribing glaucoma drops?: Systemic absorption of topical glaucoma medications can be clinically relevant. Beta blockers such as timolol require caution in asthma or COPD, symptomatic bradycardia, heart block, or decompensated heart failure. Alpha-agonists such as brimonidine are avoided in young children due to CNS depression risk and require caution with monoamine oxidase inhibitors. Carbonic anhydrase inhibitors require extra care in significant renal disease, and oral forms raise more systemic concerns. Review cardiovascular, respiratory, and medication history before selecting therapy, and teach punctal occlusion when appropriate to reduce systemic exposure.
How should topical medications be managed in contact lens wearers?: Most preserved ophthalmic medications are not intended for use directly over soft contact lenses. Preservatives and active drugs can bind to the lens matrix, increasing exposure time and the risk of toxicity. As a general rule, remove lenses before instillation and wait at least 15 minutes before reinsertion unless the product is explicitly labeled for in-lens use. For frequent dosing or prolonged courses, consider preservative-limited strategies when feasible, daily disposable lenses, or temporarily stopping lens wear until the acute issue is controlled.
What is a safe default approach when the diagnosis is uncertain?: When the diagnosis is unclear, prioritize ruling out vision-threatening infection and avoid treatments that can worsen occult disease. In particular, avoid starting topical steroids on an undifferentiated red eye until herpetic and fungal keratitis and other infectious causes have been reasonably excluded. If infection is plausible, start appropriate antimicrobial therapy, arrange short-interval follow-up, and escalate only as the clinical picture becomes clearer or as consultation and culture results guide the plan.