62 – OPHTHALMIC GELS

63 – PILOPINE HS (PILOCARPINE HYDROCHLORIDE) OPHTHALMIC GEL 4%

• It is a sterile topical ophthalmic aqueous gel which contains more than 90% water and employs carbopol 940, a
synthetic high molecular weight cross-linked polymer of acrylic acid, to impart a high viscosity. The active
ingredient, pilocarpine hydrochloride, is a cholinergic agent.

64 -- INDICATIONS AND USAGE FOR PILOCARPINE HS

• Pilocarpine Hydrochloride is a miotic (parasympathomimetic) used to control intraocular pressure. It may be
used in combination with other miotics, beta-blockers, carbonic anhydrase inhibitors, sympathomimetics or
hyperosmotic agents.

65 – OCCULAR INSERTS

66 – LACRISERT
• LACRISERT is indicated in patients with moderate to severe Dry Eye syndromes, including keratoconjunctivitis
sicca. It is indicated especially in patients who remain symptomatic after an adequate trial of therapy with
artificial tear solutions. It is also indicated for patients with exposure keratitis, decreased corneal sensitivity, and
recurrent corneal erosions.

67 – USAGE, SIDE EFFECTS AND STORAGE OF OCCULAR INSERTS

68 – DRUG ADMINISTRATION

69 -- PROPER ADMINISTRATION OF OPHTHALMIC SOLUTIONS AND SUSPENSIONS

70 -- INSTRUCTIONS AND PRECAUTIONS IN USING TOPICAL ADMINISTRATION

71 -- HOW TO USE EYEDROPS

72 - 73 -- PRECAUTIONS WHEN USING EYEDROPS

• Eye drops are meant for the health of our eyes. It should use carefully for best results. Our eyes are so delicate
and need special care. Even a small carelessness can cause a big loss. That is why; you need some
precautions before using eye drops.

99 – NORFLOXACIN
• Chibroxin
• Antibiotic.
• Used to treat bacterial infections of the eyes.
• Can cause the development of crystals on contact lenses. After applying this medication, wait at least 15
minutes before inserting contact lenses, unless otherwise directed by your doctor.
• Do not use if you have a viral or fungal infection in your eye. It is used to treat infections caused by bacteria
only.
• If you are using it to treat a corneal ulcer, you may notice a whitish buildup on the ulcer. This means that the
medication is working; it is not a harmful development.
• May cause blurred vision. If you experience blurred vision, avoid driving, operating machinery, or performing
other hazardous activities.
• Do not use other eye drops or medications during treatment with norfloxacin ophthalmic unless otherwise
directed by your doctor.
• Commonly, some eye burning, stinging, irritation, itching, redness, blurred vision, eyelid itching, eyelid swelling
or crusting, a bad taste in your mouth, tearing, or sensitivity to light may occur.

101 – TOBRADEX
• Treating eye infections and associated symptoms, including redness, irritation, and discomfort.
• Antibiotic (tobramycin) and a corticosteroid (dexamethasone) combination. The antibiotic works by slowing the
growth of, or killing, sensitive bacteria in the eye. The corticosteroid works by reducing inflammatory reactions.
• Do not use if you are allergic to any ingredient in TobraDex Drops
• Do not use if you have tuberculosis, fungal, or viral (e.g., herpes simplex, chickenpox) eye infection
 • Ask first your doctor if it’s OK to use it if you are taking any prescription or nonprescription medicine, herbal
preparation, or dietary supplement
• Ask first your doctor if it’s OK to use it if you have allergies to medicines, foods, or other substances
• Ask first your doctor if it’s OK to use it if you have thinning of the cornea or the white part of the eye
• Ask first your doctor if it’s OK to use it if you have diabetes
• TobraDex Drops are absorbed into the blood; the risk of interacting with another medicine is low.
• Be sure to use TobraDex Drops for the full course of treatment. If you do not, the medicine may not clear up
your infection completely. The bacteria could also become less sensitive to this or other medicines. This could
make the infection harder to treat in the future.

104 – TRAVOPROST
• Reduces pressure in the eye by increasing the amount of fluid that drains from the eye.
• Used to treat certain types of glaucoma and other causes of high pressure inside the eye.
• May cause a gradual change in the color of your eyes or eyelids and lashes, as well as increased growth or
thickness of your eyelashes. These color changes, usually an increase in brown pigment, occur slowly and you
may not notice them for months or years. Color changes may be permanent even after your treatment ends,
and may occur only in the eye being treated. This could result in a cosmetic difference in eye or eyelash color
from one eye to the other.
• If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or
serious damage to the eye.
• Do not use this medication if you are allergic to travoprost.

HARD CONTACT LENSES

• There are very few of the old type of "hard contact lens" wearers today due to improvements in other types of
contact lenses. The old types of hard contact lenses were made of hard plastic material called
Polymethylmethacrylate or "PMMA". These lenses offered excellent durability and vision correction, but had two
major limitations.
• First, they were difficult to get used to wearing as they were not terribly comfortable. Second, they did not allow
oxygen to reach the cornea easily and thus caused it to swell and cloud your vision. Sometimes the swelling
could become serious enough to cause a "scratched cornea" which was very painful and required you to stop
wearing lenses for a while. Fortunately the cornea is very robust and it usually healed within a few days.
• Even when worn successfully, rigid contact lenses caused the cornea to "mold" or change shape making it
difficult if not impossible to wear glasses after removing the hard contact lenses. For that reason rigid contact
lenses were replaced by gas permeable contact lenses, which although still being rigid, allow oxygen to reach
the cornea eliminating the possibility of swelling and usually allowing better vision with eyeglasses when they
are removed. They provide clear vision and last as long as 2-3 years, but because they are still rigid they are
somewhat hard to adjust to. They are harder to insert and take out but correct most vision problems. Even with
the advantages of gas permeable contact lenses over hard contact lenses, they still only account for about 15%
of all of the contact lenses being worn in the United States today.

SOFT CONTACT LENSES

• Enter the contact lens care aisle of most supermarkets and drugstores, and you'll find a confusing array of
products.
• Though daunting, it's essential to understand lens care: Not caring for your contact lenses properly can lead to
a variety of eye infections, including some that cause blindness.
• Actually, contact lens care is easier than ever. One-bottle care systems and disposable contact lenses mean
that proper lens care involves much less time, expense and trouble than it did years ago.
• Before we get started, understand that you should not switch care regimens without asking your eye doctor first.
Some products are not compatible with each other, or with certain contact lenses. Using incompatible products
can ruin your contact lenses or harm your eyes.
• To make sense of all the bottles and boxes, it helps to know what steps are required to care for soft contacts.
• It's particularly important to follow guidelines for safe handling of soft contact lenses in light of recent outbreaks
of serious fungal eye infections associated with a popular (now discontinued) brand of contact lens
cleaning/disinfecting solution.

The Basics of Soft Contact Lens Care: Clean, Rinse and Disinfect
1. Wash your hands so that you don't transfer dirt and germs to your eye. Try to avoid moisturizing soaps, as they
are not good for contact lenses. Dry your hands with a lint-free towel.
 2. Remove one lens and clean it with the recommended solution. Cleaning removes eye-produced buildup,
cosmetics and other debris that impairs lens comfort. The FDA recommends that you rub the lens in the palm of
your hand with a few drops of solution, even if you are using a "no-rub" product.
3. Rinse the lens again to remove the loosened debris, making sure to take as long as the package directs:
Rinsing is an important step.
4. Place the lens in your clean lens case or lens holder and fill with fresh solution; don't "top off" your old solution.
Disinfecting kills microorganisms on the lens. Disinfection time varies from product to product; check the
package for details.
5. Repeat steps two through four for your other lens.

Beyond Clean, Rinse and Disinfect

• Protein. Depending on what kind of contact lenses you wear and how much protein your eyes deposit on your
contacts, your doctor may recommend you use a product for protein removal.
• While cleaning them does remove some protein, it can still build up on your lenses and make them
uncomfortable. That's why the longer you wear lenses before replacing them, the more likely you are to need a
protein remover.
• For example, if you wear disposables, you probably won't need one; but if you wear the kind of lenses that are
replaced only once or twice a year, you definitely will. Products for removing protein include enzymatic cleaner
and daily protein removal liquids.
• Eye dryness and irritation. Use contact lens eye drops to lubricate your eyes and rewet your lenses.
• Eye sensitivity and allergies, A small percentage of lens wearers develop an eye allergy to the chemicals
present in contact lens solutions. If this is the case with you, you don't need an additional product: You just
need to switch products to those marked "preservative-free."

The Products: Cleaning, Rinsing and Disinfecting Solutions

• Saline solution is for rinsing and storing contact lenses, when you're using a heat or UV disinfection system.
You also may need it for use with enzymatic cleaning tablets or cleaning/disinfecting devices. Never use saline
products for cleaning and disinfection.
• Daily cleaner is for cleaning your contact lenses. You place a few drops in the palm of your hand and carefully
rub the lens for as long as directed, usually around 20 seconds, making sure to clean both sides. Use other
products for rinsing and disinfection.
• Multipurpose solution is for cleaning, rinsing, disinfecting and storing your contact lenses. Clean your lenses
as you would with daily cleaner, then rinse (as long as directed) and disinfect, all with the same solution; or
rinse the lenses twice, then place them in the clean lens case with solution to clean and disinfect. When you are
ready to wear the lenses, rinse them again. With multipurpose solutions, no other lens care products are
necessary.
• Hydrogen peroxide solution is for cleaning, disinfecting, rinsing and storing your contact lenses. With this
product, you place your lenses in the provided basket and rinse them, then place the basket in its cup and fill
the cup with solution to clean and disinfect your lenses.
• Hydrogen peroxide systems may help wearers who are sensitive to the preservatives in multipurpose solutions.
• Some lens holders for hydrogen peroxide systems have a built-in neutralizer (to convert the hydrogen peroxide
to water, so it doesn't sting your eyes), but with others you need to add a neutralizing tablet.
• After the disinfection and neutralizing step is completed, you can remove the lenses from the case and put them
on.
• Never rinse your contacts with hydrogen peroxide solution and apply them directly to your eyes without
completing the entire disinfecting and neutralizing step. Doing so can cause a painful chemical injury to the eye.
• Cleaning/disinfecting devices will, as you would expect, both clean and disinfect your contact lenses.
Depending on how the brand is designed, cleaning is accomplished with either ultrasonic waves or subsonic
agitation, whereas disinfection occurs via multipurpose solution or ultraviolet light.
• The instructions for the devices are all a little different. In general, you first rinse the lenses, using either saline
or multipurpose solution as directed. One brand requires rubbing with the saline, but most are no-rub.
• Then, put your contact lenses in the device and fill it with the same type of solution as for the rinse. Place the lid
on the device and plug it in to clean and disinfect your lenses.

The Products: Protein Removers, Eye Drops and Options for Sensitive Eyes
• Enzymatic cleaner is for removing protein from your contact lenses, usually on a weekly basis. You use the
tablets with saline solution or disinfecting solution (multipurpose or hydrogen peroxide), as directed.
• Before using enzymatic cleaner, clean and rinse your contacts using other products. Fill your lens case or vials
(as directed) with solution, then drop an enzymatic tablet in each lens well or vial. Wait for them to dissolve, and
then add your contacts. Leave them in for the required time, usually 15 minutes.
• Afterward, disinfect with another product if necessary. Certain enzymatic cleaners allow you to skip the
disinfection step if you use disinfecting solution rather than saline, but that's not always the case; check the
enzymatic cleaner packaging to find out.
 • Daily protein remover also removes protein from your lenses, but it's in liquid form and you use it daily. You
use it during disinfection with multipurpose solution.
• Before using a daily protein remover, you clean and rinse your contacts using other products. Fill both wells of
your lens case with multipurpose solution, and then add a drop of daily protein remover to each. Disinfect your
lenses as usual.
• Eye drops for contact lenses are for lubricating your eye and rewetting your contacts. Make sure to choose a
brand that is safe for contact lenses. Eye drops that aren't mean for contact lenses can temporarily alter how a
lens fits your eye, or discolor the lens.
• If your eyes feel dry, you may want to re-wet your contact lenses with lubricating drops.
• Products for sensitive eyes help people who have allergic reactions to contact lens solutions. These allergies
can crop up even if you've been using the same products for years without difficulty. Symptoms may include
itching, tearing, foreign body sensation, burning, redness and discharge. It's important to see your eye doctor if
you're experiencing these symptoms, as they can have many causes.
• A preservative called thimerosal was found to cause problems in about 10 percent of patients, so most brands
do not use it nowadays. Thimerosal-free saline is usually marked "for sensitive eyes."
• However, people do have reactions to other preservatives as well and need to switch to preservative-free care
products. Some of these have what's called a "disappearing" preservative that's gone before the solution comes
in contact with your eyes.
• Be sure to pay close attention to the expiration dates on all contact lens solutions, particularly preservative-free
solutions. Non-aerosol preservative-free saline, for example, should be discarded within two weeks after you
open it to reduce the risk of contamination.

What's Most Popular? Ease of Use

• Nowadays, most people don't go for the multi-bottle cleaning conglomerate unless they have to. Instead, they
choose a multipurpose solution for the clean, disinfect and rinse steps.
Multipurpose solutions make caring for your lenses easier than ever. This one is designed to retain moisture on
the contact lens surface so eyes stay moist throughout the day.
• Then, if they experience any discomfort, or are not satisfied with the product, they look into the other options.

Store Brands
• You may have noticed that stores like your pharmacy and grocer sell store-branded contact lens care products,
also known as "private label" products. Often they are considerably cheaper than name-brand products. Should
you use them?
• These products are safe and FDA-approved, or they couldn't be sold. But there are potential problems.
Sometimes private label products are made from older formulations, which don't offer the same advantages as
newer products.
• But here's a bigger problem: As you know, you shouldn't switch products without consulting your doctor to make
sure the new solution is compatible with your lenses. Let's say that you buy a bottle of Store-brand X, bring it to
your doctor, and he gives you the OK. You use the product, and everything is dandy.
• Next time you buy Store-brand X, it may not be the same product. That's because the store doesn't, of course,
make its own solution. They buy it from a supplier. If a better deal comes along, they might switch suppliers —
and even formulations — but still sell the revised product under the "Store-brand X" name. And the revised
formulation may or may not be right for your eyes or your particular contact lenses.

Contact Lens Care Must-Knows

• Once you've decided which product you'd like to try, discuss your plans with your eye doctor. Don't switch
brands until you determine that the new brand is compatible with your other products and with your contact
lenses.
• Regardless of which care regimen or brands you use, remember:
• Never touch solution bottle tips to any surface, including your body: This can cause contamination of the
solution.
• Avoid getting tap water on your contact lenses and accessories, as it can carry a microorganism
called Acanthamoeba that causes serious eye infections.
• Remember to clean your contact lens accessories (lens case, cleaning/disinfecting devices, enzymatic cleaner
vials and so on) as directed.
• Lens cases should be rinsed with hot tap water and dried when not in use. (Because Acanthamoeba cysts may
be present in tap water and can survive for years after drying,* some eye doctors recommend using only
contact lens disinfecting or multipurpose solution for this step.)
• Throw out your contact lens case once a month, or as directed, to reduce your risk of infection.
• Most importantly, clean and disinfect your contact lenses once a day. If you wear extended wear contacts, clean
and disinfect the lenses as soon as you remove them, unless they are designed to be discarded immediately
after use. Not only will your eyes be safer and healthier, but your contact lenses will be more comfortable to
wear, too.

RIDGID GAS PERMEABLE CONTACT LENSES

• Soft contact lenses are most common, but there is another lesser-known category of contact lens materials: gas
permeable (GP) contact lenses, also known as RGPs, rigid gas permeable, or oxygen permeable lenses.
 • GP contact lenses are rigid, but they shouldn't be confused with old-style "hard" contact lenses, which are now
obsolete. Hard contact lenses were made of a material known as PMMA. Before 1971, when soft contact
lenses were introduced, just about all contact lenses were made from PMMA.
• The problem with PMMA lenses is that they are difficult to get used to and somewhat uncomfortable to wear.
Also, PMMA does not allow oxygen to pass through it, and healthy eyes need plenty of oxygen.

What Makes GPs Different?

• GP lenses were first introduced in the late 1970s; they are actually a newer technology than soft lenses. Most
GPs incorporate silicone, which makes them more flexible than PMMA. And silicone is oxygen permeable, so
oxygen can pass through GP lenses, resulting in greater comfort and better eye health.
• In fact, GPs transmit more oxygen to the eye than do traditional soft contact lenses (although some silicone
hydrogel soft lenses are comparable to GPs in oxygen transmission).
• GPs can also provide better vision, durability, and deposit resistance than soft contact lenses. They can be
easier to clean, and since they're long-lasting, they can be less expensive in the long term than soft lenses.
• One big difference between soft lenses and GP lenses is their size: GP lenses generally have a smaller
diameter.

You'll need to Adapt

• So why doesn't everyone wear GPs? Primarily because soft lenses are instantly comfortable to wear, and GPs
require an adaptation period before they can be comfortable.

The Benefits of GPs

• GPs offer some outstanding benefits over soft lenses. For one, because an RGP is made of a stiff material, it
retains its shape well when you blink, which tends to provide crisper vision than would a soft lens.
• GPs are extremely durable. Although you can break them (for instance, if you step on them), you can't tear
them easily, like soft lenses.
• And they're made of materials that don't contain water (as soft contact lenses do), so protein and lipids from
your tears do not adhere to GPs as readily as they do to soft lenses.
• With a little care, they may last for years, as long as you don't require a prescription change.

Niches Where GPs Excel

• GPs are frequently the answer for people who don't obtain acceptable vision with soft lenses.
• GPs are made from permeable materials that allow oxygen to reach your eye.
• Individuals who are very fussy about the quality of their vision.
• Some people with astigmatism for whom soft contacts don't produce the desired visual acuity.
• People with presbyopia, because GPs come in numerous bifocal. Different bifocal designs work well for
different people, so having many choices is a real plus. Also, many people find that the best combination of
near and distance acuity is obtained with GP bifocals.
• People who have a condition called keratoconus, where the cornea is cone-shaped and causes extreme visual
distortion.
• People who need contact lenses after refractive surgery.
• GPs are also used for ortho-k, where specially designed contacts are worn during sleep to reshape the cornea
and improve vision.

The Downside of GP Contact Lenses

• Unlike soft lenses, to achieve maximum comfort with GPs, you need to wear them regularly (though not
necessarily every day).
• If you don't wear your soft lenses for a week, they'll still be comfortable when you put them on a week later. But
if you don't wear your GPs for a week, you'll probably need some time to get comfortable again.
• Also, some people experience "spectacle blur" with GPs: when lenses are removed, vision is blurry, even while
wearing glasses. This effect is temporary, but it can necessitate full-time GP wear. This can make GPs an all-
or-nothing proposition, which some people will find inconvenient.
• Finally, GPs do require care, since they are reused for one year or more.

Best of Both Worlds

• Since comfort is the primary barrier to GP use, one interesting innovation is the SynergEyes lens, which was
FDA-approved in 2005.
• SynergEyes hybrid contact lenses have an RGP center and a soft outer skirt.
• This lens combines a GP center with a soft outer ring; the idea is that this configuration can provide the comfort
of a soft lens and the visual acuity of a GP. Newer versions of the lens are for presbyopia, keratoconus and
post-surgical use.