top of page

FORMULARY

Unsure of which medication to dispense? This condensed formulary* provides all the need-to-know information about each ophthalmic drug.

*reproduced with permission from BSAVA

​

Listed in alphabetical order.

Category:

Glaucoma

Dry Eye

Allergies

Anti-virals

Anti-collagenases

Mydriatics

​​

**off-license and needs written consent

Italicised font is my own anecdotal addition

Antibiotics

  • Chloramphenicol**

    • Best first-line for corneal ulceration

    • Most commonly used and recommended antibiotic, broad spectrum against many gram positive, negative and anaerobic bacteria

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

  • Chlortetracycline hydrochloride (Ophtocycline)

    • 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 

  • Ciprofloxacin (ciloxan)**

    • 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)

  • Fusidic acid (Isathal)

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

    • Dose: one drop q12h

  • Gentamicin (Tiacil)

    • 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

  • Ofloxacin (Exocin)**

    • 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

SYSTEMIC

  • Co-Amoxiclav 

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

    • Penetrates well into the eye when uveitis is present

    • Dose: 12.5-25mg/kg q8-12h 

  • Doxycycline 

    • Good intraocular penetration with an ok spectrum, active against Mycoplasma and Chlamydophila

    • Supposedly has anti-collagenase activity

    • Do not give if pregnant, if very young can cause tooth discolouration

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

  • Clindamycin 

    • Often used for the treatment of Toxoplasma/Neospora

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

Anti-inflammatories

  • Bromfenac (Yellox)** 

    • 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

    • Dose: one drop q6-24h depending on the severity of the problem. Care with hyphema – can worsen due to platelet inhibiting effect  

  • Ciclosporine (Optimmune) 

    • 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 - may need additional support in the early stages

  • Dexamethasone (Maxidex)** 

    • 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

  • Dexamethasone/neomycin/polymyxin B (Maxitrol)** 

    • 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 

  • Fluromethalone (FML)** 

    • 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 

  • Ketorolac (Acular)** 

    • 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

    • Dose: one drop q6-24h depending on the severity of the problem. Care with hyphema – can worsen due to platelet inhibiting effect  

  • Prednisolone acetate (Pred Forte)** 

    • Topical steroid - good 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 

Glaucoma

  • Brinzolamide (Azopt)** 

    • 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. Can sting on application, especially in dogs.  

  • Brinzolamide and Timolol (Azarga)** 

    • 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. Can sting on application, especially in dogs

  • Dorzolamide (Trusopt)** 

    • 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. Can sting on application, especially in dogs.  

  • Dorzolamide + Timolol (Cosopt)** 

    • 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. Can sting on application, especially in dogs

  • Latanoprost (Xalatan)** 

    • 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

  • Travoprost (Travatan)** 

    • 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

  • Timolol** 

    • 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:

      • Dogs: one drop q8-12h

      • Cats: one drop q12h  

Dry Eye

  • Ciclosporine (Optimmune) 

    • 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. 

  • Lubricants**

    • 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. Blur the vision as are a thicker preparation.  

  • Pilocarpine** 

    • 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:

        • Often given orally: 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 again. 

        • Can be given as eye drop q8-12h, but may sting or cause conjunctival hyperaemia

  • Tacrolimus** 

    • 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. 

      • ​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.  

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

Anti-virals

  • Famciclovir** 

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

      • 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). 

  • Ganciclovir (Virgan 0.15%)** 

    • 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 

Allergic Conjunctivitis

  • Dexamethasone (Maxidex)** 

    • 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

  • Dexamethasone/neomycin/polymyxin B (Maxitrol)** 

    • 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 

  • Ketorolac (Acular)** 

    • Topical NSAID with analgesic and anti-inflammatory for use in anterior uveitis. Used in humans for management of allergic conjunctivitis. 

    • 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. Care with hyphema – can worsen due to platelet inhibiting effect  

  • Olopatadine hydrochloride (Opatanol)** 

  • Topical mast cell stabiliser.

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

  • Sodium cromoglycate (Opticrom, Allercrom, Optrex Allergy)**

  • Topical mast cell stabiliser.

    • Dose: one-two drops q6h.  

Mydriatics

  • Atropine** 

    • Topical mydriatic and cycloplegic - used for therapeutic effects in uveitis. Longer onset of action (~1 hour), 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  

  • Cyclopentolate** 

    • 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

  • Tropicamide** 

    • 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 

Anti-collagenases

  • Acetylcysteine (Stromease) 

    • 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)

  • Serum** 

    • 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. 

  • EDTA drops** 

    • 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. 

bottom of page