Used in melting ulcers - although serum is preferable. Can also be used to break up thick discharge as part of multi-modal KCS management. 

Dose: 

• Melting ulcer: two drops q6-8h (if Stromease is all you have available then you may need to use more than this frequency for acute melts) 

• KCS: one drop q6-8h (will also need KCS treatment alongside)

Topical mydriatic and cycloplegic - used for therapeutic effects in uveitis. Has a longer onset of action (~1 hour), and long duration of action (generally around 3 days, can be up to ~5 days) 

Dose: one drop q12-24h to cause mydriasis, then if a longer lasting effect is needed apply q24-96h.

• Do not use if KCS, glaucoma or lens luxation is present - reduces tear production and increases IOP. May cause salivation due to a bitter taste – you can reduce this by occluding the medial canthal punctum for a minute or so after applying

Carbonic anhydrase inhibitor that reduces aqueous humour production. Has a good effect on IOP but not as profound as prostaglandins. 

Good for dogs, variable effect in cats so less guaranteed to be effective (dorzolamide preferable for these) 

Dose: 

• In emergency setting may need to be given more frequently (q~20-30mins), but always use alongside prostaglandins if appropriate. 

• Longer term: one drop q8-12h. May sting on application.

Carbonic anhydrase inhibitor (Brinzolamide) with beta blocker (Timolol) that reduces aqueous humour production. Has good effect on IOP but not as profound as prostaglandins.

Good for dogs, variable effect in cats so less guaranteed to be effective (dorzolamide preferable for these) 

Care with systemic absorption of timolol - especially in smaller patients or those with cardiorespiratory disease – can cause bradycardia, hypotension, bronchoconstriction. Timolol cannot be used with lens luxation due to the miosis it causes

Dose: one drop q8-12h. May sting on application.

Topical NSAID with analgesic and anti-inflammatory for use in anterior uveitis - has little-no posterior segment penetration.

Can be used if necessary if ulceration is present (but has been associated with melts in humans) 

Not a pain relief for ulceration

Care with hyphema – can worsen due to platelet inhibiting effect

Dose: one drop q6-24h depending on the severity of the problem. 

Best first-line for corneal ulceration. Most commonly used and recommended topical antibiotic, is broad spectrum against many gram positive, negative and anaerobic bacteria

Dose: one drop q4-8h, or ointment: q8-12h

Multiple uses: 

• For keratitis, conjunctivitis and blepharitis caused by a wide range of bacteria

• Immunomodulatory effect for SCCEDs

• Can be used for feline chlamydial conjunctivitis, however oral doxycycline remains the treatment of choice

Dose: 0.5-2cm ointment to affected eye q6h for 5 days

Calcineurin inhibitor (immunomodulatory drug) for surface level immune-mediated disease, eg. KCS, pannus (CSK)

Off license in cats**

Takes 2-4 weeks (up to 12 weeks) to build up to full effect - may need additional support in the early stages

Dose: ~0.5cm ointment to affected eye(s) q12h 

Calcineurin inhibitor (immunomodulatory drug) for surface level immune-mediated disease, eg. KCS, pannus (CSK)

Off license in cats** 

Dose: ~0.5cm ointment to affected eye(s) q12h Takes 2-4 weeks (up to 12 weeks) for full effect - requires lubrication in the interim.

Active against many pathogens – mostly gram negative, some gram positive

Resistance common, use should be reserved for C&S based cases or melting ulcers – not for standard ulceration 

Dose: one drop q6h, or for emergency use: q30-120m (for 1-2 days)

Systemic antibiotic often used for the treatment of Toxoplasma/Neospora

Dose: 25mg/kg PO in one or two doses (q12h or q24h) for ~4 weeks if treating Toxoplasma/Neospora. (30-50mg/kg in cats if CNS involvement)

Broad spectrum systemic antibiotic (active against gram positive, negative and some anaerobes. Pseudomonas is often resistant)

Can penetrate well into the eye when uveitis is present 

Dose: 12.5-25mg/kg q8-12h

Topical mydriatic and cycloplegic. Has a lesser effect on STT than atropine, but can still increase IOP. 

Onset ~30-120mins, duration 24-36h cats, 72h dog

Topical steroid - better for surface disease, eg. pannus, eosinophilic keratitis, allergic conjunctivitis

Do not use in ulceration (risk of melt) 

Dose: one drop q6-12h

Topical steroid - better for surface disease, eg. pannus, eosinophilic keratitis, allergic conjunctivitis 

Do not use in ulceration (risk of melt) 

Dose: one drop q6-12h

Topical steroid - better for surface disease, eg. pannus, eosinophilic keratitis, allergic conjunctivitis, however most surface diseases do not require the antibiosis - consider Maxidex instead. If antibiosis is required consider an antibiotic lower down on the protected list

Do not use in ulceration (risk of melt)

Dose: one drop q6-12h,or ointment q6-24h

Topical steroid - better for surface disease, eg. pannus, eosinophilic keratitis, allergic conjunctivitis, however most surface diseases do not require the antibiosis - consider Maxidex instead. If antibiosis is required consider an antibiotic lower down on the protected list 

Do not use in ulceration (risk of melt) 

Dose: one drop q6-12h,or ointment q6-24h

Carbonic anhydrase inhibitor that reduces aqueous humour production. Has good effect on IOP but not as profound as prostaglandins

Good for feline glaucoma

Dose: 

• In emergency setting may need to be given more frequently (q~20-30mins), but always use alongside prostaglandins if appropriate

• Longer term: one drop q8-12h. May sting on application.

Carbonic anhydrase inhibitor (Dorzolamide) with beta blocker (Timolol) that reduces aqueous humour production. Has good effect on IOP but not as profound as prostaglandins.

Dorzolamide good for feline glaucoma but care with timolol too to avoid systemic effects 

Care with systemic absorption of timolol - especially in smaller patients or those with cardiorespiratory disease – can cause bradycardia, hypotension, bronchoconstriction. Timolol cannot be used with lens luxation due to the miosis it causes

Dose: one drop q8-12h. May sting on application.

Systemic antibiotic. Has good intraocular penetration with an ok spectrum, active against Mycoplasma and Chlamydophila

Supposedly has anti-collagenase activity

Do not give if pregnant, and if given at a very young age can cause tooth discolouration

Dose: 10mg/kg PO with food (for up to 3-4 weeks if treating Chlamydophila)

Anti-collagenase activity, also has some calcium-chelating activity for calcium corneal deposits. 

Recipes vary, but I use Hypromellose (10ml) with 2-3x large animal EDTA tubes or 20x 1ml EDTA tubes (decant 10ml into 10x vials, then these into 10x more EDTA vials). 

Dose: 

• Melt: one drop q1-2h in the acute stages, reducing as necessary. Give alongside other treatment appropriate for the melt. 

• Calcium deposits: one drop q6h.

Systemic antiviral for targeting FHV-1 (not effective against Calicivirus). Cannot eradicate infection, only manage the flare up at hand. 

Dose: dosages vary, but often recommend 90mg/kg q12h PO (reduce if renal disease is present). Come in tablet form or BOVA paste form (palatability can be tricky in some).

Topical steroid that has a weaker strength, can be a good alternative for certain conditions that do not require stronger steroid use – eg. tapering topical steroid use for longer term when topical ciclosporin is not an option

Do not use if ulceration present (risk of melt)

Dose: one drop q6-12h as necessary

Licensed for conjunctivitis only, not ulceration. Active against gram positive bacteria only.

Dose: one drop q12h

Topical antiviral cream for the management of FHV-1 flare ups. Cannot eradicate infection. 

Dose: apply small amount to affected eye q4-6h for max three weeks. Balance against effect of stress with cats that resent treatment.

Good for gram negatives, limited use for gram positives - use should be reserved for C&S based cases or melting ulcers – not for standard ulceration

Dose: one drop q6-8h, or 1cm of ointment q8-12h

Topical NSAID with analgesic and anti-inflammatory for use in anterior uveitis - has little-no posterior segment activity. 

Care with hyphema – can worsen due to platelet inhibiting effect

Can be used if necessary if ulceration is present (been associated with melts in humans). 

Not a pain relief for ulceration 

Dose: one drop q6-24h depending on the severity of the problem

Topical NSAID with analgesic and anti-inflammatory for use in anterior uveitis - little-no posterior segment penetration

Can be used if necessary if ulceration is present (been associated with melts in humans). 

Not a pain relief for ulceration

Care with hyphema – can worsen due to platelet inhibiting effect

Dose: one drop q6-24h depending on the severity of the problem. 

A prostaglandin drop that increases aqueous outflow, used for the acute management of glaucoma (has profound effect on IOP) but only if no lens luxation or uveitis as causes intense miosis and also furthers inflammation 

Can cause conjunctival hyperaemia and may sting on application 

Not useful in cats 

Dose: 

• In emergency setting: can be given q15min+ for a couple of hours to reduce IOP. If pressure not reducing or worsening then re-evaluate. 

• Longer term used q8-12h

• Also used for posterior lens luxation q12h to prevent anterior movement of lens

Hyaluronic acid based drops: best for immune-mediated dry eye. Preservative-free preparations are preferable for longer term use. 

• Dose: one drop to the affected eye(s) as often as necessary – ~q2-6-8h (tailored to clinical response, varies depending on response to other eye drops).

Carbomer based preparations: best for mucin-deficient "qualitative" KCS 

• Dose: one drop to the affected eye(s) q4-6h. 

Paraffin based preparations: best for lipid-deficiency KCS. Vision can be blurred as thicker drop. Useful for dogs that sleep with their eyes open

• Dose: one drop to the affected eye(s) q8-12h.

Active against many gram negative bacteria (Staphs and Pseudomonas) 

Resistance common - use should be reserved for C&S based cases or melting ulcers – not for standard ulceration 

Dose: one drop q6h or for emergency use: q30-120m (for 1-2 days)

Topical mast cell stabiliser. 

Dose: one drop q12h, reducing to q24h with clinical improvement.

Useful in canine neurogenic KCS (or facial nerve paralysis). Used to be used for glaucoma but its use has been superceded by better drops now. 

Dose: 

• Oral: 1 drop/10kg in food q12h. Increase q2-3d until positive effect, or until side effects (GI disturbances, cardiac arrhythmias) are seen and then tone back down again. 

• Eye drop: one drop q8-12h. May sting or cause conjunctival hyperaemia.

Topical steroid - good intraocular corneal penetration for anterior uveitis – has little-no posterior segment penetration. Has some systemic absorption, so care with diabetes mellitus. 

Do not use if ulceration present (risk of melt)

Dose: one drop q4-24h depending on the severity of the problem present

Most commonly used for stabilising melting ulcers. Helpful when corneas are avascular. 

Preparation: collect blood sample, allow to clot for 30 minutes before centrifuging. Decant into 1ml vials - keep one open in the fridge, keep others in the freezer and defrost as and when needed. 

Can use patient's own serum, or that from another dog (even if patient is a cat), but do not give one cat's serum to another cat. 

Dose: one drop q1-2h in the acute stages, reducing as necessary. Give alongside other treatment appropriate for the melt.

Topical mast cell stabiliser. 

Dose: one-two drops q6h.

Calcineurin inhibitor (immunomodulatory drug) for surface level immune-mediated disease, eg. KCS, pannus (CSK). Stronger than ciclosporine, so useful in cases with little-no response to optimmune. 

Takes 2-4 weeks (up to 12 weeks) for full effect - requires lubrication in the interim.

Dose: 

• Drops: one drop q12h. Can sting on application. 

• Ointment (Protopic 0.03% or 0.1%): pea sized amount to the affected eye(s) every 12 hours. Must wash hands if cream comes into contact. 

Beta blocker, has minimal effect on IOP on its own - other drops are far preferable 

Care with systemic absorption - especially in smaller patients or those with cardiorespiratory disease – can cause bradycardia, hypotension, bronchoconstriction 

Causes miosis – not for use in lens luxation or uveitis 

Dose: (note these doses will likely not be appropriate for acute glaucoma - please use alternative drops)

• Dogs: one drop q8-12h

• Cats: one drop q12h

A prostaglandin drop that increases aqueous outflow, used for the acute management of glaucoma (has profound effect on IOP) but only if no lens luxation or uveitis as causes intense miosis and also furthers inflammation 

Can cause conjunctival hyperaemia and may sting on application 

Not useful in cats 

Dose: 

• In emergency setting: can be given q15min+ for a couple of hours to reduce IOP. If pressure not reducing or worsening then re-evaluate. 

• Longer term used q8-12h 

• Also used for posterior lens luxation q12h to prevent anterior movement of lens

Topical mydriatic with some cycloplegic effect. Used for diagnostic purposes. 

Onset of action~20-30m, duration of action 2-12h in dogs, 4-9h in cats 

Avoid in glaucoma