Chapter 58: Adult Eye and Ear Medications

For ophthalmic medications, proper instillation technique involves placing drops or ointments in the lower conjunctival sac while avoiding direct corneal contact, and applying nasolacrimal duct pressure to minimize systemic absorption. When multiple eye medications are prescribed, drops should precede ointments and separate instillations by five to ten minutes to optimize therapeutic effect. Ophthalmic drug classes address various conditions through distinct mechanisms: mydriatic and cycloplegic agents dilate pupils and relax ciliary muscles but carry significant contraindications in glaucoma due to increased intraocular pressure risk; antiinfective and antiinflammatory agents treat infections and inflammatory conditions while requiring awareness of adverse effects like cataract formation; topical anesthetics necessitate corneal reflex protection through eye patching; and glaucoma medications including miotics, beta-adrenergic blockers, and carbonic anhydrase inhibitors work through different pathways to lower intraocular pressure. Osmotic agents provide emergency glaucoma management, while newer therapies address macular degeneration through targeted mechanisms. For otic medications, administration technique varies by age, with pinna positioning differing between adults and young children. Otic irrigation requires careful temperature control and directional technique to prevent eardrum perforation and associated complications like vertigo. Ceruminolytic agents dissolve earwax and often require post-treatment irrigation, while antihistamines and decongestants address eustachian tube obstruction. Critical nursing considerations include monitoring for medication toxicity, recognizing contraindications based on patient medical history, ensuring proper hand hygiene and individual medication bottles to prevent cross-contamination, and educating patients about medication continuation despite symptom resolution, particularly for chronic conditions like glaucoma that require lifelong management rather than cure.