Chapter 54: Eye and Ear Medications

Ophthalmic medication administration requires precise technique including nasolacrimal occlusion to minimize systemic absorption and proper spacing between multiple medications to ensure efficacy. Mydriatics and cycloplegics such as atropine and cyclopentolate dilate the pupil and relax accommodation but carry serious contraindications in glaucoma patients and risks of systemic toxicity requiring careful patient screening. Antiinfective agents address bacterial and viral eye infections while antiinflammatory medications including corticosteroids and nonsteroidal agents reduce inflammation, though they can mask underlying infectious processes. Topical anesthetics provide temporary corneal numbness but require cautious use to prevent corneal damage. Lubricating agents support corneal health in dry eye conditions. Glaucoma management employs multiple drug classes targeting intraocular pressure reduction through different mechanisms: miotics constrict the pupil to improve aqueous humor drainage, beta-blockers decrease aqueous humor production but contraindicate in asthma and cause cardiovascular effects, prostaglandin analogs increase uveoscleral outflow often causing iris pigmentation changes, carbonic anhydrase inhibitors reduce aqueous humor production with photosensitivity concerns, and alpha-adrenergic agonists provide dual mechanisms with potential for ocular dryness. The Ocusert system delivers pilocarpine through time-release technology requiring proper placement education. Osmotic agents provide emergency intraocular pressure reduction. Age-related macular degeneration treatment involves intravitreal injections with endophthalmitis risks. Otic medication administration employs directional techniques varying by age, and ear irrigation necessitates careful warm solution application and eardrum protection. Ototoxic medications including aminoglycosides, loop diuretics, and salicylates require vigilant monitoring for hearing loss and tinnitus. Otitis media and externa treatments include topical antibiotics, cerumenolytics for wax impaction, and systemic decongestants with awareness of potential systemic effects and superinfection development.