I am an intern and made to sit in opd of ophtha for 3 hours without any senior And im clueless Help me with common prescriptions

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I now have solid textbook content. Let me compile this into a comprehensive, practical prescription guide for a first-year intern in Ophthalmology OPD.

Ophthalmology OPD - Common Prescriptions for Interns

You're going to be fine. Here's a practical, condition-by-condition guide for the most common patients you'll see. For anything that looks serious (severe pain, sudden vision loss, trauma, suspected glaucoma attack), refer to a senior immediately.

🚦 FIRST - How to Quickly Sort Your Patient

Ask 4 questions:

Itchy? → Think allergic
Discharge (sticky/mucoid)? → Think bacterial
Watery + recent URTI / contact with someone with red eye? → Think viral
Pain + photophobia + blurred vision? → REFER - don't manage alone

1. BACTERIAL CONJUNCTIVITIS

Presentation: Mucopurulent sticky discharge, both eyes (often), no vision change, no significant pain.

Rx:

Ciprofloxacin 0.3% eye drops - 1 drop in affected eye(s) QID × 5-7 days
  OR
Tobramycin 0.3% eye drops - 1 drop QID × 5-7 days
  OR (cheap & effective)
Chloramphenicol 0.5% eye drops - 1 drop QID × 5 days

Add Chloramphenicol 1% eye ointment at night (lubricates + treats)
Counsel: wash hands, don't share towels, do not rub eyes

From Histology A Text and Atlas: Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments.

2. VIRAL CONJUNCTIVITIS

Presentation: Watery discharge, follicles, unilateral first then bilateral, recent cold/sore throat, very contagious. No pus.

No antibiotic needed. Treatment is supportive.

Rx:

Carboxymethylcellulose (CMC) 0.5% / Hydroxypropyl methylcellulose (HPMC) eye drops
  - 1 drop QID (artificial tears for comfort)

Cold compresses 3-4 times/day

If severe inflammation (membranous EKC):
  Prednisolone 0.5% eye drops QID (only after ruling out herpes - get senior opinion)

Self-limiting: resolves in 2-3 weeks
Strict hygiene: hand wash, no towel sharing, disinfect surfaces
Stop contact lenses until resolved

From Kanski's Clinical Ophthalmology 10th ed.: "Spontaneous resolution of adenoviral infection usually occurs within 2-3 weeks, so specific treatment is typically unnecessary."

3. ALLERGIC CONJUNCTIVITIS

Presentation: Bilateral itching (hallmark), watering, red eyes, seasonal pattern or perennial. No discharge or just mild watery. Associated with sneezing, nasal discharge.

Rx (mild):

Sodium Cromoglicate 2% eye drops - 1 drop QID (mast cell stabilizer)
  OR
Olopatadine 0.1% eye drops - 1 drop BD (dual action - antihistamine + mast cell)
  OR
Ketotifen 0.025% eye drops - 1 drop BD

Artificial tears PRN for lubrication

Cold compresses for symptomatic relief

If moderate-severe:

Olopatadine 0.1% eye drops BD
+
Oral antihistamine:
  Cetirizine 10 mg OD  OR  Loratadine 10 mg OD (non-sedating)
  (Diphenhydramine/Chlorpheniramine if night itching is dominant - sedating)

Avoid topical steroids unless instructed by senior. Mast cell stabilizers take a few days to work - tell the patient this.

From Kanski's Clinical Ophthalmology 10th ed.: Dual action antihistamine and mast cell stabilizers (olopatadine, ketotifen, azelastine) "act rapidly and are often very effective for exacerbations."

4. VERNAL KERATOCONJUNCTIVITIS (VKC)

Presentation: Young boys, severe itching, cobblestone papillae on upper tarsal conjunctiva, shield ulcer possible, seasonal. Common in South Asia.

Rx (initiation - mild case):

Olopatadine 0.1% eye drops BD
+
Sodium Cromoglicate 2% eye drops QID
+
Lubricating drops QID

Moderate/severe VKC (steroids, cyclosporine) - refer senior.

5. DRY EYE / KERATOCONJUNCTIVITIS SICCA

Presentation: Burning, grittiness, foreign body sensation, worse in the evening or in AC/windy environments. Paradoxically may have watering (reflex tearing).

Rx:

Carboxymethylcellulose (CMC) 0.5% eye drops - 1 drop TID-QID PRN
  OR
HPMC 0.3% eye drops QID
  OR (preservative-free preferred for long-term)
Sodium Hyaluronate 0.1-0.2% eye drops - 1 drop TID-QID

Carbomer gel (Viscotears) at night for prolonged lubrication

Counsel: blink exercises, avoid AC/fans blowing directly, screen breaks (20-20-20 rule)
Omega-3 supplements can help long-term

6. BLEPHARITIS (Lid Margin Disease)

Presentation: Crusting at lid margins, morning stickiness, burning, dandruff-like flakes on lashes. Chronic, bilateral.

Rx:

Lid hygiene (MOST IMPORTANT):
  Warm compress to closed eyes × 5-10 min BD
  Lid scrub with diluted baby shampoo or commercial lid wipes BD

Chloramphenicol 1% ointment applied to lid margins at night × 2-4 weeks
  OR
Tobramycin ointment at lid margin at night

If Meibomian gland dysfunction:
  Doxycycline 100 mg OD × 6-12 weeks (adults, anti-inflammatory dose)

7. SUBCONJUNCTIVAL HAEMORRHAGE

Presentation: Bright red patch on white of eye, no pain, no vision change. Alarming to patient but benign.

No treatment needed. Reassure the patient. Resolves in 1-2 weeks.

Artificial tears QID (for comfort if any irritation)

Check BP if spontaneous and recurrent
If associated with trauma or vision change → refer

8. CORNEAL ABRASION

Presentation: History of foreign body / finger poke / contact lens, acute pain, photophobia, excessive tearing. Fluorescein staining positive.

Rx:

Tobramycin 0.3% eye drops - 1 drop QID × 3-5 days
  OR
Chloramphenicol 0.5% eye drops QID × 3-5 days

Homatropine 2% eye drops - 1 drop BD (cycloplegic for ciliary spasm pain)
  OR
Cyclopentolate 1% for larger abrasions

Lubricating drops/ointment at night

Do NOT patch the eye - can mask worsening infection
Do NOT give topical steroids - absolutely contraindicated with epithelial defect
Review in 24-48 hours
If dendritic ulcer seen → Acyclovir 3% ointment 5×/day (herpetic)

From Rosen's Emergency Medicine: "Prophylactic topical antibiotics are not indicated for corneal abrasions, and eye patches are not recommended because they can mask a worsening infection."

9. STYE (External Hordeolum) and CHALAZION

Presentations:

Stye = acute, painful, red swelling at lid margin (infected lash follicle)
Chalazion = chronic, non-tender, firm nodule in lid (blocked Meibomian gland)

Rx for Stye:

Warm compress × 5-10 min, 3-4 times/day (to bring to a head)
Chloramphenicol 1% ointment applied to lid margin TID × 5-7 days
Oral antibiotic only if spreading cellulitis:
  Amoxicillin-Clavulanate 625 mg BD × 5 days

Rx for Chalazion:

Warm compress BD-TID (most resolve spontaneously over weeks-months)
Lid massage after compresses
If persistent > 6 weeks: refer for incision and curettage (I&C)

10. ACUTE ANGLE-CLOSURE GLAUCOMA

Presentation: Sudden severe headache + eye pain, blurred vision with halos, nausea/vomiting, fixed mid-dilated pupil, rock-hard eye, corneal haze.

⛔ THIS IS AN EMERGENCY. CALL SENIOR IMMEDIATELY.

While waiting:

Tab Acetazolamide 500 mg STAT (oral if able to take)
Timolol 0.5% eye drops - 1 drop
Pilocarpine 2% eye drops - 1 drop (after IOP starts to fall)

Do not give any mydriatic (tropicamide, atropine) - will worsen the attack.

QUICK CHEAT SHEET

Condition	Key Feature	First Rx
Bacterial conjunctivitis	Mucopurulent discharge	Ciprofloxacin / Tobramycin drops
Viral conjunctivitis	Watery, follicles, no pus	Artificial tears only
Allergic conjunctivitis	Itching, seasonal	Olopatadine / Cromoglicate drops
Dry eye	Burning, grittiness	CMC / Sodium hyaluronate drops
Blepharitis	Lid crusting, morning stickiness	Warm compress + lid scrub
Corneal abrasion	Fluorescein staining	Tobramycin + cycloplegic, NO patch
Subconj haemorrhage	Bright red, no pain	Reassure + lubricants
Stye	Painful lid lump	Warm compress + chloramphenicol oint
Chalazion	Painless lid lump	Warm compress, refer if persistent
Acute glaucoma	Severe pain + nausea + mid-dilated pupil	EMERGENCY - call senior

GENERAL TIPS FOR WRITING OPHTHA PRESCRIPTIONS

Always write "in affected eye(s)" or "in the right/left eye" - not just "eye drops."
Wash hands before instilling drops - counsel every patient.
Wait 5 minutes between two different drops if prescribing multiple drops.
Suspensions need to be shaken before use (e.g., prednisolone acetate).
Ointments go after drops and are typically prescribed at bedtime.
Never give steroids without senior supervision unless you're confident there's no corneal ulcer / herpes.
Topical NSAIDs (e.g., Ketorolac 0.5%, Diclofenac 0.1%) are useful for pain in corneal abrasion and post-op.

You've got this. For anything with vision loss, severe pain, trauma, or that just doesn't fit the simple patterns above, call your senior without hesitation. That's the right call every time.

Sources: Kanski's Clinical Ophthalmology: A Systematic Approach, 10th ed. | Rosen's Emergency Medicine | Textbook of Family Medicine 9e

Give me this table in photo form

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A clean medical quick reference cheat sheet table titled "Ophthalmology OPD Quick Cheat Sheet" with a white background and professional clinical style. The table has 3 columns: "Condition", "Key Feature", "First Rx". Rows are: 1. Bacterial Conjunctivitis | Mucopurulent discharge | Ciprofloxacin / Tobramycin drops 2. Viral Conjunctivitis | Watery, follicles, no pus | Artificial tears only 3. Allergic Conjunctivitis | Itching, seasonal | Olopatadine / Cromoglicate drops 4. Dry Eye | Burning, grittiness | CMC / Sodium Hyaluronate drops 5. Blepharitis | Lid crusting, morning stickiness | Warm compress + lid scrub 6. Corneal Abrasion | Fluorescein staining positive | Tobramycin + cycloplegic, NO patch 7. Subconjunctival Haemorrhage | Bright red, no pain | Reassure + lubricants 8. Stye (Hordeolum) | Painful lid lump | Warm compress + Chloramphenicol oint 9. Chalazion | Painless lid lump | Warm compress, refer if persistent 10. Acute Angle-Closure Glaucoma | Severe pain + nausea + mid-dilated pupil | EMERGENCY - Call Senior NOW (highlighted in red) The table has alternating light blue and white row colors, bold dark blue header row, clean sans-serif font, and a small red warning note at the bottom: "Never prescribe steroids without senior supervision"

Here you go! Save this to your phone for quick reference during OPD.

Dosages

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A clean medical quick reference cheat sheet table titled "Ophthalmology OPD Quick Cheat Sheet — WITH DOSAGES" with a white background and professional clinical style. The table has 3 columns: "Condition", "Key Feature", "Drug & Dosage". Rows are: 1. Bacterial Conjunctivitis | Mucopurulent discharge | Ciprofloxacin 0.3% drops 1 drop QID x 5-7 days OR Tobramycin 0.3% drops 1 drop QID x 5-7 days OR Chloramphenicol 0.5% drops 1 drop QID x 5 days + Chloramphenicol 1% oint at night 2. Viral Conjunctivitis | Watery, follicles, no pus | CMC 0.5% drops 1 drop QID (artificial tears only). Self-limiting 2-3 weeks 3. Allergic Conjunctivitis | Itching, bilateral, seasonal | Olopatadine 0.1% 1 drop BD OR Ketotifen 0.025% 1 drop BD OR Sodium Cromoglicate 2% 1 drop QID + Cetirizine 10mg OD if severe 4. Dry Eye | Burning, grittiness, worse in AC | CMC 0.5% or Sodium Hyaluronate 0.1% 1 drop TID-QID + Carbomer gel at night 5. Blepharitis | Lid crusting, morning stickiness | Warm compress 5-10 min BD + Lid scrub BD + Chloramphenicol 1% oint to lid margin at night x 2-4 weeks 6. Corneal Abrasion | Fluorescein staining positive | Tobramycin 0.3% 1 drop QID x 3-5 days + Homatropine 2% 1 drop BD. NO patch. NO steroids 7. Subconjunctival Haemorrhage | Bright red patch, no pain, no vision change | Reassure. CMC drops QID for comfort. Resolves in 1-2 weeks 8. Stye (Hordeolum) | Painful red lid margin lump | Warm compress 3-4x/day + Chloramphenicol 1% oint TID x 5-7 days. Oral Amox-Clav 625mg BD only if cellulitis 9. Chalazion | Painless firm lid nodule | Warm compress BD-TID + lid massage. Refer for I&C if >6 weeks 10. Acute Angle-Closure Glaucoma | Severe pain, nausea, mid-dilated pupil, hard eye | EMERGENCY: Tab Acetazolamide 500mg STAT + Timolol 0.5% 1 drop + CALL SENIOR NOW (this row highlighted in red/orange) The table has alternating light blue and white row colors, bold dark blue header row, clean readable sans-serif font, slightly larger text for dosages, and a red warning at the bottom: "⚠ Never prescribe steroids without senior supervision | Wait 5 min between different drops"

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Dosages of these medicines

Here are the dosages for all the medicines mentioned, organized by condition:

💊 DOSAGES - Ophthalmology OPD Drugs

🔵 BACTERIAL CONJUNCTIVITIS

Drug	Concentration	Dose	Duration
Ciprofloxacin eye drops	0.3%	1 drop QID	5-7 days
Tobramycin eye drops	0.3%	1 drop QID	5-7 days
Chloramphenicol eye drops	0.5%	1 drop QID	5 days
Chloramphenicol eye oint	1%	Apply at night	5 days

🟡 VIRAL CONJUNCTIVITIS

Drug	Concentration	Dose	Notes
CMC (Carboxymethylcellulose) drops	0.5%	1 drop QID	Comfort only
Prednisolone drops (only if severe EKC)	0.5%	1 drop QID	Only under senior supervision

🟢 ALLERGIC CONJUNCTIVITIS

Drug	Concentration	Dose	Notes
Olopatadine drops	0.1%	1 drop BD	Dual action - works fast
Ketotifen drops	0.025%	1 drop BD	Dual action
Sodium Cromoglicate drops	2%	1 drop QID	Takes 2-3 days to work
Azelastine drops	0.05%	1 drop BD	Dual action
Cetirizine (oral)	10 mg	1 tab OD	For severe cases
Loratadine (oral)	10 mg	1 tab OD	Non-sedating
Chlorpheniramine (oral)	4 mg	1 tab TID	Sedating - for nighttime itch

🔵 DRY EYE

Drug	Concentration	Dose	Notes
CMC drops	0.5%	1 drop TID-QID	Standard lubricant
Sodium Hyaluronate drops	0.1-0.2%	1 drop TID-QID	More viscous, longer action
HPMC drops	0.3%	1 drop QID	Alternative lubricant
Carbomer gel (Viscotears)	0.2%	Apply at night	Longer lasting

🟠 BLEPHARITIS

Drug	Dose	Duration
Warm compress	5-10 min BD	Ongoing
Chloramphenicol 1% oint	Apply to lid margin at night	2-4 weeks
Tobramycin oint	Apply to lid margin at night	2-4 weeks
Doxycycline (oral)	100 mg OD	6-12 weeks (anti-inflammatory)

🟣 CORNEAL ABRASION

Drug	Concentration	Dose	Notes
Tobramycin eye drops	0.3%	1 drop QID	3-5 days
Chloramphenicol eye drops	0.5%	1 drop QID	3-5 days
Homatropine (cycloplegic)	2%	1 drop BD	Relieves ciliary spasm pain
Cyclopentolate (cycloplegic)	1%	1 drop BD	For larger abrasions
Acyclovir oint (if herpetic/dendritic)	3%	5× per day	10 days

⛔ NO steroids. NO patching.

🟤 STYE / HORDEOLUM

Drug	Dose	Duration
Warm compress	5-10 min, 3-4×/day	Till resolves
Chloramphenicol 1% oint	Apply to lid margin TID	5-7 days
Amoxicillin-Clavulanate 625 mg (oral)	BD	5 days - ONLY if cellulitis spreading

⚫ SUBCONJUNCTIVAL HAEMORRHAGE

Drug	Dose
CMC 0.5% drops	1 drop QID (optional, for comfort)
No other treatment needed	Reassure - resolves in 1-2 weeks

🔴 ACUTE ANGLE-CLOSURE GLAUCOMA (EMERGENCY)

Drug	Dose	Route
Acetazolamide	500 mg STAT	Oral / IV
Timolol	0.5%, 1 drop	Topical
Pilocarpine	2%, 1 drop	Topical (after IOP starts to fall)
Mannitol 20%	1-2 g/kg over 30 min	IV (if available)

🚨 Call senior immediately. Do NOT give tropicamide or atropine.

⚠️ Key Rules to Remember

1 drop at a time - the eye holds only 1 drop; more just spills out
Wait 5 minutes between two different drops
Ointments always last - apply after all drops
Shake suspensions before use (prednisolone acetate)
Never prescribe steroids without senior confirmation - can cause corneal melt in herpes, can raise IOP in steroid responders
Cycloplegics (homatropine, cyclopentolate) will blur vision and dilate pupils - warn the patient not to drive

In one table

Condition	Drug	Concentration	Dose	Duration	Notes
Bacterial Conjunctivitis	Ciprofloxacin drops	0.3%	1 drop QID	5-7 days
	Tobramycin drops	0.3%	1 drop QID	5-7 days	Alternative
	Chloramphenicol drops	0.5%	1 drop QID	5 days	Cheap option
	Chloramphenicol oint	1%	Apply at night	5 days	Add to drops
Viral Conjunctivitis	CMC drops	0.5%	1 drop QID	Till resolved	Comfort only
	Prednisolone drops	0.5%	1 drop QID	Short course	Senior supervision only
Allergic Conjunctivitis	Olopatadine drops	0.1%	1 drop BD	Ongoing	Dual action, works fast
	Ketotifen drops	0.025%	1 drop BD	Ongoing	Dual action
	Sodium Cromoglicate drops	2%	1 drop QID	Ongoing	Takes 2-3 days to work
	Cetirizine (oral)	10 mg	1 tab OD	As needed	Severe cases
	Loratadine (oral)	10 mg	1 tab OD	As needed	Non-sedating
Dry Eye	CMC drops	0.5%	1 drop TID-QID	Ongoing
	Sodium Hyaluronate drops	0.1-0.2%	1 drop TID-QID	Ongoing	Longer action
	Carbomer gel	0.2%	Apply at night	Ongoing	Nighttime lubrication
Blepharitis	Warm compress	-	5-10 min BD	Ongoing	Do first
	Chloramphenicol oint	1%	Lid margin at night	2-4 weeks
	Doxycycline (oral)	100 mg	1 tab OD	6-12 weeks	Anti-inflammatory dose
Corneal Abrasion	Tobramycin drops	0.3%	1 drop QID	3-5 days	NO steroids, NO patch
	Homatropine drops	2%	1 drop BD	2-3 days	Cycloplegic - relieves pain
	Cyclopentolate drops	1%	1 drop BD	2-3 days	Alternative cycloplegic
	Acyclovir oint	3%	5x per day	10 days	Only if herpetic/dendritic ulcer
Subconj. Haemorrhage	CMC drops	0.5%	1 drop QID	1-2 weeks	Optional comfort only
Stye / Hordeolum	Warm compress	-	5-10 min, 4x/day	Till resolved
	Chloramphenicol oint	1%	Lid margin TID	5-7 days
	Amox-Clavulanate (oral)	625 mg	BD	5 days	Only if cellulitis
Acute Angle-Closure Glaucoma	Acetazolamide (oral/IV)	500 mg	STAT	Once	🚨 CALL SENIOR
	Timolol drops	0.5%	1 drop	Once	🚨 CALL SENIOR
	Pilocarpine drops	2%	1 drop	Once	After IOP starts to fall
	Mannitol 20% (IV)	1-2 g/kg	Over 30 min	Once	If available

⚠️ Never give steroids without senior confirmation. Never give tropicamide/atropine in glaucoma. Wait 5 min between different drops. Ointments always go last.

What eye drops to pt for near vision

Near vision problems (presbyopia/hyperopia) are corrected with glasses, not eye drops — that's the standard of care.

However, there is one relatively new eye drop approved for presbyopia:

Pilocarpine 1.25% (Brand: Vuity - USA)


Drug	Pilocarpine HCl 1.25%
Dose	1 drop in each eye OD (once daily)
Onset	~15 minutes
Duration	~6 hours
Mechanism	Miosis (pupil constriction) → increases depth of focus
Approved for	Presbyopia (age-related near vision loss)

Drawbacks:

Works best in patients aged 40-55
Less effective in dim light (small pupil = less light in)
Can cause headache, brow ache, dim vision at night
Not available widely in India - Vuity is a US FDA-approved product (2021)
Expensive, temporary fix - not a cure

What you should actually prescribe in OPD:

For a patient complaining of difficulty reading/near work:

Refraction first - check if glasses are needed (almost always yes in >40 yrs)
Prescribe reading glasses based on refraction
Lubricating drops (CMC/Sodium Hyaluronate) if there's associated eye strain + dry eye

Bottom line: If a patient in your OPD says "I can't see near," send them for refraction and prescribe reading glasses. Eye drops for near vision are not part of routine Indian ophthalmology OPD practice yet.

Aerofort eye drop uses

Searching the Web

Aerofort eye drops composition uses India

"Aerofort" doesn't appear to exist as an eye drop - you may be thinking of "Aurofort" (by Aurolab), which is a common Indian brand. Here's the info:

Aurofort Eye Drops


Generic name	Prednisolone Acetate
Concentration	1% ophthalmic suspension
Class	Topical corticosteroid (steroid)
Manufacturer	Aurolab (India)
MRP	~₹37

Uses

Post-operative inflammation (after cataract surgery, squint surgery)
Uveitis (anterior)
Allergic conjunctivitis (severe)
Episcleritis / scleritis
Any inflammatory condition of the eye where steroid is indicated

Dosage

Typical: 1-2 drops every 4-6 hours (QID)
Post-op: Often tapered - 4×/day → 3×/day → 2×/day → 1×/day over weeks

Important Points

⚠️ Shake the bottle well before use - it is a suspension, not a solution

⛔ Never prescribe without senior guidance - steroids can:

Raise IOP → steroid-induced glaucoma

Cause posterior subcapsular cataract on long-term use

Cause corneal melt if there is a herpetic/fungal ulcer

Did you mean "Aurofort"? If you saw a different name on the bottle, let me know and I'll look it up specifically.

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