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Eye Condition

Eye Care Terminology

The glossary below can help you and your patients understand eye care terminology regarding treatment, medication, tests, and more!

0-9 | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z


0-9
20/20 vision – Normal visual acuity; upper number is the standard distance between the tested eye and the eye chart, and the lower number is the distance at which the tested eye can see the same standard-sized letters as a normal eye at 20 feet

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A
Abduction – Eye rotation away from the midline

Aberration – Blurred or distorted image quality resulting from the physical properties of an optical device (ie, lens)

Accommodation – The eye’s increase in optical power in order to maintain image clarity as objects are moved closer

Adduction – Eye rotation toward the midline

Adherence – Refers to the extent to which a patient follows a doctor’s treatment regimen without close supervision

Adjunctive therapy – Additive treatment or medication that enhances the benefit of another treatment or medication

Age-related macular degeneration – Group of conditions that include deterioration of the macula, resulting in a loss of sharp central vision; the most common cause of decreased vision after 50

Alacrima – Lack of tear production

Albinism – Lack of pigment in the eyes, hair, and skin, which is usually associated with decreased visual acuity

Allergen – An antigen that creates an allergic or hypersensitivity response

Allergic conjunctivitis – Inflammation of the conjunctiva from hypersensitivity to allergens

ALT surgery – Argon laser trabeculoplasty; surgical procedure that uses a laser to create small burns in the trabecular meshwork to lower intraocular pressure

Amblyopia – “Lazy eye”; decreased vision in one or both eyes without anatomical defects detected in the retina or visual pathway

Amblyoscope – Instrument used in evaluation and treatment of strabismus and other binocularity problems

Angle-closure glaucoma – Rise in intraocular pressure due to aqueous fluid behind the iris being unable to pass through the pupil; patients with anatomically narrow angles are predisposed to this condition

Anopsia – Loss of vision, particularly to part of the visual field

Anterior chamber – Space between the iris and innermost corneal surface that is filled with fluid

Aphakia – Absence of the eye’s crystalline lens, such as after cataract extraction

Applanation tonometer – Instrument that flattens the cornea to measure intraocular pressure

Aqueous humor – Clear fluid that fills the space in the eye between the cornea and the lens; maintains intraocular pressure and provides nourishment to the cornea, iris, and lens

Aqueous outflow – Passage of aqueous fluid through the anterior chamber angle structures

Artificial tears – Eyedrops with similar consistency to natural tears to alleviate Dry Eye symptoms

Astigmatism – Refractive error that prevents the eye from focusing sharply, usually resulting from an abnormally shaped corneal surface; correctable by eyeglasses, contact lenses, or refractive surgery

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B
Bacterial conjunctivitis – Inflammation of the conjunctiva caused by a bacterial infection; usually contagious

Basal lamina – Innermost layer of the choroid, directly under the retina; damage to the basal lamina is responsible for many bleeding disorders of the macula area

Bell’s palsy – Condition in which muscles of the brows, eyelids, and mouth are paralyzed by damage to the 7th cranial nerve; may cause affected eyelids to remain open, resulting in corneal drying

BID – Twice daily

Bifocals – Eyeglasses that incorporate lenses of 2 different powers; allows for both near and far distance sight without changing eyewear

Binocular – Referring to or affecting both eyes

Bleb – Flap of tissue created to cover a sclero-corneal drainage channel during glaucoma surgery; enhances fluid outflow from the eye

Blepharitis – Inflammation of the eyelids; may be caused by infection or allergy

Blepharoconjunctivitis – Inflammation of the conjunctiva

Blepharoplasty – Any plastic surgery of the eyelids; often cosmetic

Blepharospasm – Sudden, involuntary spasm causing uncontrolled blinking and squeezing of the eyelid

Blind spot – Nonseeing area within every visual field; caused by absence of photoreceptors where the optic nerve enters the eye

Blindness – Inability to see

Blink reflex – Periodic contraction of the eye muscles approximately every 5 seconds, causing the eyelid to close over the eye, spreading tears over the eye and limiting light entering the eye

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C
Capsulotomy – Incision to remove part of the lens capsule

Cat dander – The result of the normal shedding of cat hair or coat that can cause an allergic response in certain people

Cataracts – Opacity and cloudiness of the lens, preventing a clear image from being formed on the retina; removal may be necessary if vision is affected significantly; caused by age, trauma, or disease

Central retinal artery – First branch of the ophthalmic artery; provides nutrients to the inner two-thirds of the retina

Central retinal vein – Collects retinal venous blood drainage and exits through the optic nerve

Chalazion – Inflamed bump in the eyelid’s meibomian gland

Chemosis – Swelling of the conjunctiva

Choroid – Vascular layer of the eye between the retina and sclera, providing nutrients to the outer layers of the retina

Choroiditis – Inflammation of the choroid

Chronic Dry Eye – Corneal/conjunctival dryness due to deficient tear production; keratoconjunctivitis sicca, Dry Eye syndrome

Ciliary body – Tissue in the eye that is involved in lens accommodation, intraocular pressure control, and producing the aqueous humor

Color blindness – Reduced ability to differentiate between colors, especially reds and greens; usually hereditary

Compliance – Refers to a patient following a doctor’s treatment regimen

Cone – Light-sensitive cell of the retina that allows for sharp visual acuity and color detection

Congenital glaucoma – High intraocular pressure, hazy corneas, and large eyes in children from newborn to 6 months old; developmental abnormalities prevent normal fluid drainage from the eye; requires surgical intervention

Conjunctiva – Mucous membrane covering the outer surface of the eyeball (except the cornea) and inside surface of the eyelids

Conjunctival hyperemia – Redness of the conjunctiva; associated with all types of conjunctivitis

Conjunctival sac – Pocket of conjunctiva between the upper eyelid and eyeball and lower eyelid and eyeball that permits the eyeball to rotate freely

Conjunctivitis – Inflammation of the conjunctiva; usually viral and can be contagious

Contact lens – Small disc worn on the cornea or sclera, providing visual correction of refractive errors

Convergence – Moving both eyes toward each other to maintain single binocular vision of an approaching object

Corectopia – Displacement of the pupil from its normal position

Cornea – Transparent front of the eye covering the iris, pupil, and anterior chamber; provides the bulk of the eye’s optical power

Corneal abrasion – Scraped area of the cornea accompanied by superficial tissue loss

Corneal apex – Central 3-5 mm where the cornea has the greatest curvature

Corneal edema – Hazy and swollen cornea

Corneal erosion – Loss of the outer layer of the cornea because it fails to adhere to the Bowman’s membrane

Corneal staining – Use of dye such as fluorescein to reveal corneal epithelial defects

Corneal transplant – Replacement of damaged or diseased cornea with donor corneal tissue

Corticosteroid – Steroid used to treat inflammatory and allergic diseases

Cup – Optic cup; depression in the center of the optic disc that normally occupies less than one-third of the disc diameter

Cup-to-disc ratio – Evaluates the progression of glaucoma by indicating the percentage of the disc occupied by the optic cup

Cupped disc – Abnormal enlargement of the optic cup, usually due to a long-term increase in intraocular pressure

Cylinder correction – Use of a lens that produces different refractive power in each meridian; used to correct astigmatism

Cystoid macular edema – Retinal swelling and cyst formation in the macular area, can result in temporary or permanent decrease in vision

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D
Dacryocystitis – Inflammation of the tear sac, often associated with poor tear drainage

Depth perception – Awareness of relative spatial location of objects; perception of nearness and farness

Diabetic macular edema – The leaking of retinal blood vessels into the macula in patients with diabetes, causing the macula to swell, which can temporarily or permanently decrease central vision

Diabetic retinopathy – Progressive retinal changes that accompany diabetes mellitus; this can progress from background retinopathy to proliferative retinopathy, which includes abnormal new blood vessels and fibrous tissue development

Dilation – Widening of the pupil

Diopter – Unit of measurement of the refractive power of a lens

Diplopia – Perception of two images from one object; double vision

Disc – Optic disc; ocular end of the optic nerve

Dry Eye – Corneal/conjunctival dryness due to deficient tear production

Dyscoria – Distorted shape of pupil

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E
Epicanthal fold – Vertical skin fold at each side of the nose; hides the caruncle; present in infants before nose bridge is developed

Epiphora – Overflow of tears down the face caused by poor tear drainage, excessive tearing, or outward turning of the lower eyelid

Erythema – Abnormal skin redness caused by capillary congestion under the skin

Esotropia – Eye misalignment in which one eye turns inward while the other stays fixed straight ahead

Evisceration – Procedure that removes the contents of the eyeball, leaving behind the sclera shell and, sometimes, the cornea; usually for reducing pain in a blind eye

Exotropia – Eye misalignment in which one eye turns outward while the other stays fixed straight ahead

Exposure keratitis – Corneal irritation or inflammation caused by corneal drying due to incomplete closure of the eyelid

External diseases – Diseases that affect the cornea, sclera, conjunctiva, or eyelids

Eye – Sense organ for sight

Eyelash – One of the stiff hairs at the margin on the eyelid

Eyelid – Structure covering the front of the eye that protects it, limits the light entering in, and distributes the tear film over the corneal surface

Eyewall – The sclera and the cornea

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F
Farsightedness – Refractive error that allows the eye to see clearly at a distance, but close-up images are blurred; hyperopia

Femtosecond laser – Short-pulse laser that is used to create corneal flaps in refractive surgery

Floaters – Particles that float in the vitreous, casting shadows on the retina and appearing as spots

Fluorescein – Colored dye that illuminates; used on the cornea to identify damage

Focal point – Position on the principal axis of a lens system where parallel light rays are brought to a point of focus

Follicles – Tiny elevations on the undersurface of the eyelids; associated with viral conjunctival inflammation

Foreign body sensation – The feeling of something in the eye; can be caused by an actual foreign body in the eye or by various damage or conditions

Fovea – The central part of the macula that produces the sharpest vision

Fundus – Interior posterior surface of the eyeball which includes the retina, optic disc, macula, and posterior pole

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G
Generic drug – A drug that has gone off patent and is produced by any number of manufacturers; according to the FDA, generic drugs are copies of brand-name drugs and are the same dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use

Gerontoxon – Degenerative change that produces a white ring-shaped deposit of fat near the peripheral edge of the cornea; typically in patients over 60

Glare test – Clinical test that determines the extent to which a bright light shined in the eye changes visual acuity; evaluates the degree of visual impairment caused by a cataract

Glaucoma – Group of ocular diseases characterized by increased intraocular pressure that results in optic nerve damage, affecting visual field; common cause of preventable vision loss

Globe – The eyeball; a sensory organ that uses light to transmit visual information to the brain; 3 major layers in the globe include corneo-sclero, uvea, and retina

Goblet cell – Large mucous glands in the conjunctiva that secrete mucin, a component of precorneal tear film; can be damaged in Dry Eye syndrome

Gonioscopy – Test that examines the anterior chamber angle structures through a special lens with a slit lamp

Goniotomy – Surgical procedure that is often used to treat congenital glaucoma; it consists of an incision in the trabecular meshwork

Graves disease – Symptoms of the eye that may result with excessive thyroid-related concentration, including eyelid retraction, eyelid lag, corneal drying, and optic nerve inflammation

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H
Halo – Hazy ring seen around lights; can be a sign of a refractive error or optical defect such as cataract

Herpes keratitis – Eye infection caused by the herpes simplex virus. Results in inflammation and ulcers

Heterochromia of the iris – Having a different color iris in each eye

Histamine – Chemical that creates an allergic or inflammatory response

Hordeolum – Acute infection of oil glands of the eyelid; externally, also known as a stye; internally (in the meibomian glands), also known as a chalazion, if chronic

Hyperemia – Clinical sign; increased blood flow; usually refers to eye redness due to increased blood flow to the conjunctival blood vessels

Hyperopia – Refractive error in which an underpowered eye is too short for its optical power; farsightedness

Hypertropia – Functional defect in which one eye deviates upward while the other remains straight and fixates normally

Hyphema – Clinical sign; blood in the anterior chamber, often following blunt trauma to the eyeball

Hypotropia – Functional defect in which one eye deviates downward while the other remains straight and fixates normally

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I
Intraocular lens – Lens that may be surgically implanted to replace the eye’s natural lens

Intraocular pressure (IOP) – The pressure of fluid within the eye; elevated IOP is a treatable risk factor for glaucoma

Iridectomy – Removal of a portion of iris tissue

Iris – Pigmented tissue behind the cornea that gives the eye its color and allows light to enter the eye by controlling the size of the pupillary opening; part of the uveal (middle) layer of the eye

Iritis – Inflammation of the iris, causing pain, tearing, blurring, small pupil, and red congested eye

Isopia – Equal vision in both eyes

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J

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K
Keratectomy – Surgical removal of corneal tissue

Keratitis – Corneal inflammation; can be caused by a variety of infections, injuries, and unknown causes

Keratoconjunctivitis sicca – Corneal and conjunctival dryness due to deficient tear production; Dry Eye syndrome

Keratolysis – Corneal melt; superficial corneal layers that "melt" away; often associated with severe inflammation, Dry Eye, or rheumatoid arthritis

Keratoplasty – Surgical procedure on the cornea that usually refers to a corneal graft (replacing damaged corneal tissue with donor tissue)

Keratotomy – Any incision into the cornea (surgical procedure)

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L
Lacrimal gland – Almond-shaped gland located above the eyeball in the upper outer region that produces tears

Lacrimation – Tear production; crying

Laser – Acronym for Light Amplification by Stimulated Emission of Radiation; a high-energy light source that can cut, burn, or dissolve tissues for clinical procedures; used in many eye care procedures such as refractive surgery, treatment of diabetic retinopathy and macular degeneration, and removal of trabecular meshwork in glaucoma patients

LASIKLAser in Sltu Keratomileusis; refractive surgery in which the cornea is reshaped to change its optical power; corrects myopia, hyperopia, and astigmatism

Legal blindness – Visual acuity of 20/200 or less, or visual field reduction to 20 degrees or less (in the better eye)

Lens – Any transparent material (often glass) that can bend light rays predictably

Lensectomy – Removal of the eye’s natural lens

Limbus – Area where the cornea joins the sclera and the bulbar conjunctiva attaches to the eyeball

Low-tension glaucoma – Normal-tension glaucoma; type of open-angle glaucoma in which a patient exhibits signs such as progressive disc cupping and visual field loss, but with normal intraocular pressure

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M
Macropsia – Distorted vision in which objects appear larger than normal

Macula – Central area of the retina; provides central vision used for reading and seeing fine detail

Macular degeneration – Group of conditions that include degeneration of the macula; results in loss of sharp central vision

Macular edema – Retinal swelling and cyst formation in the macula; can temporarily or permanently decrease vision

Maculopathy – Abnormality of the macula

Madarosis – Loss of eyelashes often caused by chronic blepharitis

Magnification – Increased image size created through the use of optical devices

Meibomian gland – Oil gland in the eyelid tissue that secretes the outer portion of the tear film; prevents rapid tear evaporation and tear overflow

Microbial keratitis – Corneal infection from overuse of contact lenses; caused by microorganisms

mm Hg – Millimeters of mercury; units used to measure intraocular pressure

Moll glands – Sweat glands near the eyelash follicles; infection can cause a stye

Monocular – Referring to one eye

Myopia – Refractive error caused by an overpowered eye, which has too much optical power for its length; nearsightedness

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N
Narrow-angle glaucoma – Rise in intraocular pressure caused by narrow anterior chamber angles that prevent aqueous drainage

Nasolacrimal duct – Tear drainage channel from the lacrimal sac to the mucous membrane of the nose

NDC number – US National Drug Code; a standard code used to identify FDA-approved drugs and biologicals

Nearsightedness – Refractive error that allows the eye to see close-up objects clearly, but distance vision is blurred; myopia

Neurotrophic keratitis – Corneal inflammation resulting from trauma or damage to corneal nerves; leads to cornea anesthesia

Night blindness – Poor visual adaptation to the dark, resulting in reduced vision in low light; usually indicates defect in retinal rods

Normal-tension glaucoma – See low-tension glaucoma

Nystagmus – A functional defect in which the patient displays involuntary oscillating eye movements that are faster in one direction than the other

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O
Ocular biometry – Test that measures distance between various ocular structures (usually with A-scan or B-scan ultrasound instruments)

Ocular hypertension – Elevated IOP, but with no evidence of optic disc or visual field changes; potential (but not definite) glaucoma suspect

Ocular Surface Disease Index© (OSDI©) – A valid and reliable instrument of 12 questions for measuring Dry Eye Disease and its effect on vision-related function

OD – Right eye

Open-angle glaucoma – The most common type of glaucoma caused by the slowing of normal aqueous outflow from the eye; can result in gradual, irreversible vision loss

Ophthalmic medical assistant – Certified allied health professional in ophthalmology; three levels are certified by JCAHPO®: COA®, COT®, and COMT®

Ophthalmologist – Doctor of medicine (MD) or doctor of osteopathic medicine (DO) specializing in diagnosis and treatment of eye diseases and disorders.

Ophthalmology – Medical specialty dealing with function and diseases of the eye

Ophthalmoscopy – Use of an ophthalmoscope to examine the internal structures of the eye

Optic nerve – The second cranial nerve that is the largest sensory nerve of the eye; carries sight information from the retina to the brain for processing

Optic neuropathy – Abnormality or degeneration of the optic nerve, not due to inflammation

Optician – Vision care professional who makes and adjusts optical aids such as eyeglasses

Optometrist – Doctor of optometry (OD) who specializes in vision problems and treatments

Optometry – Vision care specialty that deals with the detection and management of ocular disease

Orbit – Socket; cranial cavity of the skull that contains the eyeball

OS – Left eye

Outflow (aqueous) – Passage of aqueous fluid out of the eye through the anterior chamber angles

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P
Pachymetry – Test to measure corneal thickness

Palpebral fascia – Fibrous membrane that forms a protective layer between the eyelid and the bony orbit (socket)

Perennial allergies – Also known as year-round allergies, these are usually due to indoor allergies such as dust mites or mold

Periocular – Area surrounding the eyeball

Peripheral vision – Side vision, created by stimuli falling on retinal areas that are far from the macula

Phacoemulsification – Surgical procedure that uses ultrasound vibration to break up a cataract, making it easy to suction out of the eye

Phakic – Refers to an eye that has its natural lens

Photophobia – Abnormal sensitivity to light; associated with discomfort and excessive tearing; often due to iritis or keratitis

Photopsia – Sensation of light or flashes from mechanical or electrical irritation of the retina (not from a light stimulus)

Photorefractive keratectomy (PRK) – Refractive surgery that reshapes the corneal curvature with a laser after the surface of the cornea has been removed

Pink eye – Conjunctivitis; inflammation of the conjunctiva that is usually viral in origin; symptoms include discharge, grittiness, redness, and swelling

Pollen – Microspores of seed plants that can induce allergic or hypersensitivity reactions in some people

Posterior capsular opacification – After cataract surgery, the rear lens capsule can cloud over; needs removal to improve vision

Posterior chamber – Space between the back of the iris and the front of the vitreous

Presbyopia – Loss of power of accommodation due to the decline in elasticity of the crystalline lens or ciliary muscle function (occurs with aging)

Primary open-angle glaucoma – The most common type of glaucoma caused by the slowing of normal aqueous outflow from the eye; can result in gradual vision loss

PRN – As needed (as medication dosing)

Pruritus – Itching

Pseudoexfoliation – Unknown deposits appearing on the lens surfaces and other ocular structures; often associated with high intraocular pressure

Ptosis – Sagging upper eyelid

Puff tonometer – Device that measures intraocular pressure by blowing a puff of air against the cornea to flatten it

Punctal plug – Plastic plug inserted into the punctum to prevent tear drainage, preserving tears to keep the eye moist

Punctate keratitis – Corneal disease characterized by small corneal lesions of unknown origin

Pupil – Black circular opening in the center of the iris that varies in size to regulate the amount of light that enters the eye

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Q
QD – Once daily

QID – Four times daily

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R
Refraction – Bending of light as it travels from a medium of one density to another medium of another density

Refractive error – Optical defect in an unaccommodating eye; correctible with surgery, eyeglasses, or contact lenses

Retina – Light-sensitive tissue in the eye that converts images into electrical impulses that are sent to the brain via the optic nerve to interpret as vision

Retinal detachment – Separation of the retina from the underlying pigment epithelium; usually caused by a retinal tear that leaks fluid from the vitreous and separates the retina

Retinal vein occlusion – Blockage of blood flow through the central retinal vein, causing a decrease in vision

Retinitis – Inflammation of the retina

Retinoblastoma – Malignant tumor that develops from retinal visual cells

Retinopathy – Any noninflammatory degenerative disease of the retina

Retinoscopy – Test that measures the eye’s refractive error

Rod – Specialized retina cell that is a light-sensitive receptor in low-light levels

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S
Schirmer test – Measures tear production with filter paper strips

Schlemm’s canal – Channel in the corneo-scleral junction that carries aqueous fluid from the anterior chamber to the bloodstream

Sclera – Opaque protective outer layer of the eye (“the white”) that connects to the cornea and the sheath of the optic nerve

Scleritis – Inflammation of the sclera, often painful

Seasonal allergies – Allergies, such as hay fever, that are seasonal in nature (eg, springtime or fall)

Sjögren syndrome – Chronic autoimmune disease often characterized by dry eyes, dry mouth, and arthritis

Slit lamp – Microscope used to examine the eye; shows the cornea, lens, and clear fluids and membranes in layered detail

SLT surgery – Surgical procedure in which a laser is used on the trabecular meshwork to increase aqueous outflow, reducing intraocular pressure

Snellen chart – Lettered chart for measuring visual acuity; usually tested at 20 feet (hence, 20/20 vision)

Somnolence – Sleepiness

Strabismus – Eye misalignment caused by extraocular muscle imbalance

Stye – Acute pustular infection of oil glands located in an eyelash follicle

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T
Tachyphylaxis – Rapid decrease in response to a given dose of a drug after repetitive administration

Tarsal gland – Oil gland within the eyelid tissue; secretes the outer portion of the tear film to prevent tear evaporation and overflow

Tear breakup time – Tests the time between a blink and the development of a dry spot on the ocular surface; less than 10 seconds is abnormal

Tear duct – Tear drainage channel from the lacrimal sac to the mucous membrane of the nose

Tears – Fluid secreted by the lacrimal glands to keep the conjunctiva and cornea moist

Temporal pallor – Loss of pinkish tone in the optic disc; usually indicates optic nerve damage

TID – Three times daily

Tonometer – Instrument that measures intraocular pressure; each type of tonometer measures pressure through slightly different means

Toric lens – An optical device with a cylindrical component to correct astigmatism

Trabecular meshwork – Structure inside the eye at the iris-scleral junction of the anterior chamber angle that filters aqueous fluid and controls its exit from the eye through Schlemm’s canal

Trabeculectomy – Surgical procedure to remove part of the trabecular meshwork to increase the outflow of aqueous fluid to treat elevated intraocular pressure

Trabeculoplasty – Surgical procedure that uses a laser to burn part of the trabecular meshwork to increase outflow of aqueous fluid to treat elevated intraocular pressure

Trachoma – Severe, chronic, and contagious infection of the eyelid and cornea caused by a virus; the leading cause of blindness in the world

Trifocal – Optical device that incorporates lenses of 3 different powers

Triplopia – Ocular defect that causes images to appear in triplicate; often caused by an early cataract

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U
Ultraviolet light – Light with wavelengths between 250 and 400 nanometers; invisible to the naked eye

Uvea – Pigmented vascular layers of the eye (iris, ciliary body, and choroid) that contain most of the eye’s blood vessels

Uveitis – Inflammation of any of the structures of the uvea (iris, ciliary body, or choroid)

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V
Vision – Ability of the eye to receive and transmit light images to the brain, where they are interpreted; the ability to see

Visual acuity – Measurement that assesses the eye’s ability to distinguish details and shape

Visual field – The full area visible to the eye when fixated straight ahead; measured in degrees

Vitrectomy – Surgical removal of the vitreous

Vitreous – Transparent gelatinous mass that fills the back two-thirds of the eyeball between the lens and retina

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W

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X

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Y
Year-round allergies – Also known as perennial allergies, these are usually due to indoor allergies such as dust mites or mold

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Z

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Important Safety Information

Click the links to go to each product's Indication and Important Safety Information.


 

ACUVAIL® (ketorolac tromethamine ophthalmic solution) 0.45% Important Information

INDICATION
ACUVAIL® ophthalmic solution is a nonsteroidal anti-inflammatory indicated for the treatment of pain and inflammation following cataract surgery.

Important Safety Information

CONTRAINDICATIONS
ACUVAIL® solution is contraindicated in patients with previously demonstrated hypersensitivity to any of the ingredients in the formulation.

WARNINGS AND PRECAUTIONS
Delayed Healing
Topical nonsteroidal anti-inflammatory drugs (NSAIDs) may slow or delay healing. Topical corticosteroids are also known to slow or delay healing. Concomitant use of topical NSAIDs and topical steroids may increase the potential for healing problems.

Potential for Cross-Sensitivity
There is the potential for cross-sensitivity to acetylsalicylic acid, phenylacetic acid derivatives, and other NSAIDs.

Increased Bleeding Time
With some NSAIDs, there exists the potential for increased bleeding time due to interference with thrombocyte aggregation. There have been reports that ocularly applied nonsteroidal anti-inflammatory drugs may cause increased bleeding of ocular tissues (including hyphemas) in conjunction with ocular surgery.

Corneal Effects
Use of topical NSAIDs may result in keratitis. In some susceptible patients, continued use of topical NSAIDs may result in epithelial breakdown, corneal thinning, corneal erosion, corneal ulceration, or corneal perforation. These events may be sight threatening.

Postmarketing experience with topical NSAIDs suggests that patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (eg, dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time may be at increased risk for corneal adverse events, which may become sight threatening.

Postmarketing experience with topical NSAIDs also suggests that use more than 1 day prior to surgery or use beyond 14 days postsurgery may increase patient risk for the occurrence and severity of corneal adverse events.

ACUVAIL® should not be administered while wearing contact lenses.

Adverse Reactions
The most common adverse events were reported in 1% to 6% of patients and included increased intraocular pressure, conjunctival hyperemia and/or hemorrhage, corneal edema, ocular pain, headache, tearing, and vision blurred. Some of these events may be the consequence of the cataract surgical procedure.

Please click here for full Prescribing Information.



ALPHAGAN® P (brimonidine tartrate ophthalmic solution) 0.1% and 0.15% Important Information

INDICATIONS AND USAGE

ALPHAGAN® P (brimonidine tartrate ophthalmic solution) 0.1% or 0.15% is an alpha-adrenergic receptor agonist indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

Neonates and Infants (under the age of 2 years): ALPHAGAN® P is contraindicated in neonates and infants (under the age of 2 years).

Hypersensitivity Reactions: ALPHAGAN® P is contraindicated in patients who have exhibited a hypersensitivity reaction to any component of this medication in the past.

WARNINGS AND PRECAUTIONS

Potentiation of Vascular Insufficiency: ALPHAGAN® P may potentiate syndromes associated with vascular insufficiency. ALPHAGAN® P should be used with caution in patients with depression, cerebral or coronary insufficiency, Raynaud's phenomenon, orthostatic hypotension, or thromboangiitis obliterans.

Severe Cardiovascular Disease: Although brimonidine tartrate ophthalmic solution had minimal effect on the blood pressure of patients in clinical studies, caution should be exercised in treating patients with severe cardiovascular disease.

Contamination of Topical Ophthalmic Products After Use: There have been reports of bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products. These containers had been inadvertently contaminated by patients who, in most cases, had a concurrent corneal disease or a disruption of the ocular epithelial surface.

DRUG INTERACTIONS

Antihypertensives/Cardiac Glycosides: Because ALPHAGAN® P may reduce blood pressure, caution in using drugs such as antihypertensives and/or cardiac glycosides with ALPHAGAN® P is advised.

CNS Depressants: Although specific drug interaction studies have not been conducted with ALPHAGAN® P, the possibility of an additive or potentiating effect with CNS depressants (alcohol, barbiturates, opiates, sedatives, or anesthetics) should be considered.

Tricyclic Antidepressants: Tricyclic antidepressants have been reported to blunt the hypotensive effect of systemic clonidine. It is not known whether the concurrent use of these agents with ALPHAGAN® P in humans can lead to resulting interference with the IOP-lowering effect. Caution is advised in patients taking tricyclic antidepressants, which can affect the metabolism and uptake of circulating amines.

Monoamine Oxidase Inhibitors: Monoamine oxidase (MAO) inhibitors may theoretically interfere with the metabolism of brimonidine and potentially result in an increased systemic side effect such as hypotension. Caution is advised in patients taking MAO inhibitors, which can affect the metabolism and uptake of circulating amines.

ADVERSE REACTIONS
Adverse reactions occurring in approximately 10% to 20% of the subjects receiving brimonidine ophthalmic solution (0.1% to 0.2%) included: allergic conjunctivitis, conjunctival hyperemia, and eye pruritus. Adverse reactions occurring in approximately 5% to 9% included: burning sensation, conjunctival folliculosis, hypertension, ocular allergic reaction, oral dryness, and visual disturbance.

Please click here for full Prescribing Information.



COMBIGAN® (brimonidine tartrate/timolol maleate ophthalmic solution) 0.2%/0.5% Important Information

INDICATIONS AND USAGE

COMBIGAN® (brimonidine tartrate/timolol maleate ophthalmic solution) 0.2%/0.5% is an alpha-adrenergic receptor agonist with a beta‐adrenergic receptor inhibitor indicated for the reduction of elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP; the IOP‐lowering of COMBIGAN® dosed twice a day was slightly less than that seen with the concomitant administration of 0.5% timolol maleate ophthalmic solution dosed twice a day and 0.2% brimonidine tartrate ophthalmic solution dosed three times per day.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

COMBIGAN® is contraindicated in patients with reactive airway disease including bronchial asthma; a history of bronchial asthma; severe chronic obstructive pulmonary disease; in patients with sinus bradycardia; second or third degree atrioventricular block; overt cardiac failure; cardiogenic shock; in neonates and infants (aged 2 years and younger); in patients with a hypersensitivity reaction to any component of COMBIGAN® in the past.

WARNINGS AND PRECAUTIONS

COMBIGAN® contains timolol maleate. COMBIGAN® is administered topically, but can be absorbed systemically. The adverse reactions with systemic administration of beta‐adrenergic blocking agents may occur with topical use (eg, severe respiratory reactions and cardiac reactions, including death due to bronchospasm in patients with asthma, and rarely death in association with cardiac failure, have been reported with systemic or ophthalmic administration of timolol maleate). Ophthalmic beta-blockers may impair compensatory tachycardia and increase risk of hypotension.

Sympathetic stimulation may be essential to support the circulation in patients with diminished myocardial contractility, and its inhibition by beta‐adrenergic receptor blockade may precipitate more severe failure. In patients with no history of cardiac failure, continued depression of the myocardium with beta-blocking agents over time can lead to cardiac failure. Discontinue COMBIGAN® at the first sign or symptom of cardiac failure.

Patients with chronic obstructive pulmonary disease (eg, chronic bronchitis, emphysema) of mild or moderate severity, bronchospastic disease, or a history of bronchospastic disease should not receive beta‐blocking agents, including COMBIGAN®.

COMBIGAN® may potentiate syndromes associated with vascular insufficiency. Use caution in patients with depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, or thromboangiitis obliterans.

Patients taking beta-blockers with a history of atopy or severe anaphylactic reactions to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge with such allergens. Such patients may be unresponsive to the usual doses of epinephrine used to treat anaphylactic reactions.

Beta‐adrenergic blockade can potentiate muscle weakness with myasthenic symptoms (eg, diplopia, ptosis, and generalized weakness). Although rare, timolol can increase muscle weakness in some patients with myasthenia gravis or myasthenic symptoms.

Beta‐adrenergic receptor blocking agents may mask the signs and symptoms of acute hypoglycemia and clinical signs (eg, tachycardia) of hyperthyroidism. Use caution in patients subject to spontaneous hypoglycemia or in diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents. Carefully manage patients who may develop thyrotoxicosis to avoid abrupt withdrawal of beta‐adrenergic blocking agents that might precipitate a thyroid storm.

Ocular hypersensitivity has occurred with brimonidine tartrate ophthalmic solutions 0.2% (eg, increase in IOP).

Some authorities recommend gradual withdrawal of beta‐adrenergic receptor blocking agents due to impairment of beta-adrenergically mediated reflexes during surgery. If necessary during surgery, the effects of beta‐adrenergic blocking agents may be reversed by sufficient doses of adrenergic agonists.

ADVERSE REACTIONS

The most frequent reactions with COMBIGAN® in about 5% to 15% of patients included: allergic conjunctivitis, conjunctival folliculosis, conjunctival hyperemia, eye pruritus, ocular burning, and stinging.

DRUG INTERACTIONS

COMBIGAN® may reduce blood pressure. Use caution in patients on antihypertensives and/or cardiac glycosides.

Observe patients receiving a beta‐adrenergic blocking agent either orally or intravenously and COMBIGAN® for additive effects of beta‐blockade, both systemic and on intraocular pressure. Concomitant use of two topical beta‐adrenergic blocking agents is not recommended.

Use caution in the co‐administration of beta‐adrenergic blocking agents (eg, COMBIGAN®) and oral or intravenous calcium antagonists due to possible atrioventricular conduction disturbances, left ventricular failure, and hypotension. Avoid co-administration in patients with impaired cardiac function.

Observe patients closely when a beta‐blocker is administered to patients receiving catecholamine‐depleting drugs (eg, reserpine) due to possible additive effects and the production of hypotension and/or marked bradycardia, which may result in vertigo, syncope, or postural hypotension.

Specific drug interaction studies have not been conducted with COMBIGAN®, but consider the possibility of an additive or potentiating effect with CNS depressants (alcohol, barbiturates, opiates, sedatives, or anesthetics).

Concomitant use of beta‐adrenergic blocking agents with digitalis and calcium antagonists may have additive effects in prolonging atrioventricular conduction time.

Potentiated systemic beta‐blockade (eg, decreased heart rate, depression) has been reported with combined use of CYP2D6 inhibitors (eg, quinidine, SSRIs) and timolol.

Tricyclic antidepressants (TCAs) can blunt the hypotensive effect of systemic clonidine. It is not known whether the concurrent use of TCAs with COMBIGAN® in humans can interfere with the IOP‐lowering effect. Caution is advised in patients taking TCAs, which can affect the metabolism and uptake of circulating amines.

Monoamine oxidase (MAO) inhibitors may theoretically interfere with the metabolism of brimonidine and potentially increase systemic side effects such as hypotension. Use caution in patients taking MAO inhibitors, which can affect the metabolism and uptake of circulating amines.

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DURYSTA™ (bimatoprost implant) 10 mcg Important Information

INDICATIONS AND USAGE
DURYSTA (bimatoprost implant) is indicated for the reduction of intraocular pressure (IOP) in patients with open angle glaucoma (OAG) or ocular hypertension (OHT).

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS
DURYSTA is contraindicated in patients with: active or suspected ocular or periocular infections; corneal endothelial cell dystrophy (e.g., Fuchs’ Dystrophy); prior corneal transplantation or endothelial cell transplants (e.g., Descemet’s Stripping Automated Endothelial Keratoplasty [DSAEK]); absent or ruptured posterior lens capsule, due to the risk of implant migration into the posterior segment; hypersensitivity to bimatoprost or to any other components of the product.

WARNINGS AND PRECAUTIONS
The presence of DURYSTA implants has been associated with corneal adverse reactions and increased risk of corneal endothelial cell loss. Administration of DURYSTA should be limited to a single implant per eye without retreatment. Caution should be used when prescribing DURYSTA in patients with limited corneal endothelial cell reserve.

DURYSTA should be used with caution in patients with narrow iridocorneal angles (Shaffer grade ˂ 3) or anatomical obstruction (e.g., scarring) that may prohibit settling in the inferior angle.

Macular edema, including cystoid macular edema, has been reported during treatment with ophthalmic bimatoprost, including DURYSTA intracameral implant. DURYSTA should be used with caution in aphakic patients, in pseudophakic patients with a torn posterior lens capsule, or in patients with known risk factors for macular edema.

Prostaglandin analogs, including DURYSTA, have been reported to cause intraocular inflammation. DURYSTA should be used with caution in patients with active intraocular inflammation (e.g., uveitis) because the inflammation may be exacerbated.

Ophthalmic bimatoprost, including DURYSTA intracameral implant, has been reported to cause changes to pigmented tissues, such as increased pigmentation of the iris. Pigmentation of the iris is likely to be permanent. Patients who receive treatment should be informed of the possibility of increased pigmentation. While treatment with DURYSTA can be continued in patients who develop noticeably increased iris pigmentation, these patients should be examined regularly.

Intraocular surgical procedures and injections have been associated with endophthalmitis. Proper aseptic technique must always be used with administering DURYSTA, and patients should be monitored following the administration.

ADVERSE REACTIONS
In controlled studies, the most common ocular adverse reaction reported by 27% of patients was conjunctival hyperemia. Other common adverse reactions reported in 5% 10% of patients were foreign body sensation, eye pain, photophobia, conjunctival hemorrhage, dry eye, eye irritation, intraocular pressure increased, corneal endothelial cell loss, vision blurred, iritis, and headache.

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LASTACAFT® (alcaftadine ophthalmic solution) 0.25% Important Information

INDICATIONS AND USAGE
LASTACAFT® (alcaftadine ophthalmic solution) 0.25% is an H1 histamine receptor antagonist indicated for the prevention of itching associated with allergic conjunctivitis.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS
LASTACAFT® is contraindicated in patients with hypersensitivity to any component in the product.

WARNINGS AND PRECAUTIONS
To minimize eye injury and contaminating the dropper tip and solution, care should be taken not to touch the eyelids or surrounding areas with the dropper tip of the bottle. Keep bottle tightly closed when not in use.

Patients should be advised not to wear a contact lens if their eye is red.

LASTACAFT® should not be used to treat contact lens-related irritation.

Remove contact lenses prior to instillation of LASTACAFT®. The preservative in LASTACAFT®, benzalkonium chloride, may be absorbed by soft contact lenses. Lenses may be reinserted after 10 minutes following administration of LASTACAFT®.

ADVERSE REACTIONS
The most frequent ocular adverse reactions, occurring in < 4% of LASTACAFT® treated eyes, were eye irritation, burning and/or stinging upon instillation, eye redness, and eye pruritus.

The most frequent non-ocular adverse reactions, occurring in < 3% of subjects with LASTACAFT® treated eyes, were nasopharyngitis and headache. Some of these events were similar to the underlying disease being studied.

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LUMIGAN® (bimatoprost ophthalmic solution) 0.01% Important Information

INDICATION
LUMIGAN® 0.01% (bimatoprost ophthalmic solution) is indicated for the reduction of elevated intraocular pressure in patients with open angle glaucoma or ocular hypertension.

IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
LUMIGAN® 0.01% is contraindicated in patients with hypersensitivity to bimatoprost or to any of the ingredients.

WARNINGS AND PRECAUTIONS
Pigmentation
Bimatoprost ophthalmic solution has been reported to cause changes to pigmented tissues. The most frequently reported changes have been increased pigmentation of the iris, periorbital tissue (eyelid) and eyelashes. Pigmentation is expected to increase as long as bimatoprost is administered. After discontinuation of bimatoprost, pigmentation of the iris is likely to be permanent, while pigmentation of the periorbital tissue and eyelash changes have been reported to be reversible in some patients. Patients who receive treatment should be informed of the possibility of increased pigmentation. The long term effects of increased pigmentation are not known. Iris color change may not be noticeable for several months to years. While treatment with LUMIGAN® 0.01% can be continued in patients who develop noticeably increased iris pigmentation, these patients should be examined regularly.

Eyelash Changes
LUMIGAN® 0.01% may gradually change eyelashes and vellus hair in the treated eye. These changes include increased length, thickness, and number of lashes. Eyelash changes are usually reversible upon discontinuation of treatment.

Intraocular Inflammation
Prostaglandin analogs, including bimatoprost, have been reported to cause intraocular inflammation. In addition, because these products may exacerbate inflammation, caution should be used in patients with active intraocular inflammation (e.g., uveitis).

Macular Edema
Macular edema, including cystoid macular edema, has been reported during treatment with bimatoprost ophthalmic solution. LUMIGAN® 0.01% should be used with caution in aphakic patients, in pseudophakic patients with a torn posterior lens capsule, or in patients with known risk factors for macular edema.

Use with Contact Lenses
LUMIGAN® 0.01% contains benzalkonium chloride, which may be absorbed by and cause discoloration of soft contact lenses. Contact lenses should be removed prior to instillation of LUMIGAN® 0.01% and may be reinserted 15 minutes following its administration.

ADVERSE REACTIONS
In a 12-month clinical study with bimatoprost ophthalmic solutions 0.01%, the most common adverse reaction was conjunctival hyperemia (31%). Approximately 1.6% of patients discontinued therapy due to conjunctival hyperemia. Other adverse drug reactions (reported in 1 to 4% of patients) with LUMIGAN® 0.01% in this study included conjunctival edema, conjunctival hemorrhage, eye irritation, eye pain, eye pruritus, erythema of eyelid, eyelids pruritus, growth of eyelashes, hypertrichosis, instillation site irritation, punctate keratitis, skin hyperpigmentation, vision blurred, and visual acuity reduced.

USE IN SPECIFIC POPULATIONS
Pediatric Use
Use in pediatric patients below the age of 16 years is not recommended because of potential safety concerns related to increased pigmentation following long-term chronic use.

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OZURDEX® (dexamethasone intravitreal implant) 0.7 mg Important Information

Indications and Usage
Diabetic Macular Edema
OZURDEX® (dexamethasone intravitreal implant) is a corticosteroid indicated for the treatment of diabetic macular edema.

Retinal Vein Occlusion
OZURDEX® is a corticosteroid indicated for the treatment of macular edema following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).

Posterior Segment Uveitis
OZURDEX® is indicated for the treatment of noninfectious uveitis affecting the posterior segment of the eye.

Dosage and Administration
FOR OPHTHALMIC INTRAVITREAL INJECTION. The intravitreal injection procedure should be carried out under controlled aseptic conditions. Following the intravitreal injection, patients should be monitored for elevation in intraocular pressure and for endophthalmitis. Patients should be instructed to report any symptoms suggestive of endophthalmitis without delay.

IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
Ocular or Periocular Infections: OZURDEX® (dexamethasone intravitreal implant) is contraindicated in patients with active or suspected ocular or periocular infections including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases.

Glaucoma: OZURDEX® is contraindicated in patients with glaucoma, who have cup to disc ratios of greater than 0.8.

Torn or Ruptured Posterior Lens Capsule: OZURDEX® is contraindicated in patients whose posterior lens capsule is torn or ruptured because of the risk of migration into the anterior chamber. Laser posterior capsulotomy in pseudophakic patients is not a contraindication for OZURDEX® use.

Hypersensitivity: OZURDEX® is contraindicated in patients with known hypersensitivity to any components of this product.

Warnings and Precautions
Intravitreal Injection‐related Effects: Intravitreal injections, including those with OZURDEX®, have been associated with endophthalmitis, eye inflammation, increased intraocular pressure, and retinal detachments. Patients should be monitored regularly following the injection.

Steroid‐related Effects: Use of corticosteroids including OZURDEX® may produce posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses.

Corticosteroids are not recommended to be used in patients with a history of ocular herpes simplex because of the potential for reactivation of the viral infection.

Adverse Reactions
Diabetic Macular Edema
Ocular adverse reactions reported by greater than or equal to 1% of patients in the two combined 3-year clinical trials following injection of OZURDEX® for diabetic macular edema include: cataract (68%), conjunctival hemorrhage (23%), visual acuity reduced (9%), conjunctivitis (6%), vitreous floaters (5%), conjunctival edema (5%), dry eye (5%), vitreous detachment (4%), vitreous opacities (3%), retinal aneurysm (3%), foreign body sensation (2%), corneal erosion (2%), keratitis (2%), anterior chamber inflammation (2%), retinal tear (2%), eyelid ptosis (2%). Non-ocular adverse reactions reported by greater than or equal to 5% of patients include: hypertension (13%) and bronchitis (5%).

Increased Intraocular Pressure: IOP elevation greater than or equal to 10 mm Hg from baseline at any visit was seen in 28% of OZURDEX® patients versus 4% of sham patients. 42% of the patients who received OZURDEX® were subsequently treated with IOP-lowering medications during the study versus 10% of sham patients.

The increase in mean IOP was seen with each treatment cycle, and the mean IOP generally returned to baseline between treatment cycles (at the end of the 6-month period).

Cataracts and Cataract Surgery: The incidence of cataract development in patients who had a phakic study eye was higher in the OZURDEX® group (68%) compared with Sham (21%). The median time of cataract being reported as an adverse event was approximately 15 months in the OZURDEX® group and 12 months in the Sham group. Among these patients, 61% of OZURDEX® subjects versus 8% of sham-controlled subjects underwent cataract surgery, generally between Month 18 and Month 39 (Median Month 21 for OZURDEX® group and 20 for Sham) of the studies.

Retinal Vein Occlusion and Posterior Segment Uveitis
Adverse reactions reported by greater than 2% of patients in the first 6 months following injection of OZURDEX® for retinal vein occlusion and posterior segment uveitis include: intraocular pressure increased (25%), conjunctival hemorrhage (22%), eye pain (8%), conjunctival hyperemia (7%), ocular hypertension (5%), cataract (5%), vitreous detachment (2%), and headache (4%).

Increased IOP with OZURDEX® peaked at approximately week 8. During the initial treatment period, 1% (3/421) of the patients who received OZURDEX® required surgical procedures for management of elevated IOP.

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PRED FORTE® (prednisolone acetate ophthalmic suspension, USP) 1% sterile Important Information

INDICATIONS AND USAGE
PRED FORTE® is indicated for the treatment of steroid-responsive inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe.

CONTRAINDICATIONS
PRED FORTE® suspension is contraindicated in acute untreated purulent ocular infections, in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures.

PRED FORTE® suspension is also contraindicated in individuals with known or suspected hypersensitivity to any of the ingredients of this preparation and to other corticosteroids.

WARNINGS
Prolonged use of corticosteroids may result in posterior subcapsular cataract formation and may increase intraocular pressure in susceptible individuals, resulting in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Prolonged use may also suppress the host immune response and thus increase the hazard of secondary ocular infections.

If this product is used for 10 days or longer, intraocular pressure should be routinely monitored even though it may be difficult in children and uncooperative patients. Steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be checked frequently.

Various ocular diseases and long-term use of topical corticosteroids have been known to cause corneal and scleral thinning. Use of topical corticosteroids in the presence of thin corneal or scleral tissue may lead to perforation.

Acute purulent infections of the eye may be masked or activity enhanced by the presence of corticosteroid medication.

The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation.

Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex). Employment of a corticosteroid medication in the treatment of patients with a history of herpes simplex requires great caution; frequent slit lamp microscopy is recommended.

PRED FORTE® suspension contains sodium bisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people.

PRECAUTIONS
General
The initial prescription and renewal of the medication order beyond 20 milliliters of PRED FORTE® suspension should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy, and, where appropriate, fluorescein staining. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.

As fungal infections of the cornea are particularly prone to develop coincidentally with long-term local corticosteroid applications, fungal invasion should be suspected in any persistent corneal ulceration where a corticosteroid has been used or is in use. Fungal cultures should be taken when appropriate.

Information for Patients
Advise patients that if eye inflammation or pain persists longer than 48 hours or becomes aggravated, they should consult a physician.

Advise patients that to prevent eye injury or contamination, care should be taken to avoid touching the bottle tip to eyelids or to any other surface. The use of this bottle by more than one person may spread infection. Keep bottle tightly closed when not in use. Keep out of the reach of children.

Advise patients that PRED FORTE® suspension contains benzalkonium chloride, which may be absorbed by soft contact lenses. Contact lenses should be removed prior to application of PRED FORTE® and may be reinserted 15 minutes following its administration.

Carcinogenesis, Mutagenesis, Impairment of Fertility
No studies have been conducted in animals or in humans to evaluate the potential of these effects.

Pregnancy
Prednisolone has been shown to be teratogenic in mice when given in doses 1-10 times the human dose. Dexamethasone, hydrocortisone, and prednisolone were ocularly applied to both eyes of pregnant mice five times per day on days 10 through 13 of gestation. A significant increase in the incidence of cleft palate was observed in the fetuses of the treated mice. There are no adequate well-controlled studies in pregnant women. Prednisolone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers
It is not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. Because of the potential for serious adverse reactions in nursing infants from prednisolone, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use
The safety and effectiveness in pediatric patients have been established. Use in pediatric patients is supported by evidence from adequate and well-controlled studies of prednisolone acetate ophthalmic suspension in adults with additional data in pediatric patients.

Geriatric Use
No overall differences in safety or effectiveness have been observed between elderly and younger patients.

ADVERSE REACTIONS
The following adverse reactions have been identified during use of PRED FORTE®. Because reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Adverse reactions include elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage, posterior subcapsular cataract formation, and delayed wound healing.

The development of secondary ocular infection (bacterial, fungal, and viral) has occurred. Fungal and viral infections of the cornea are particularly prone to develop coincidentally with long-term applications of steroids. The possibility of fungal invasion should be considered in any persistent corneal ulceration where steroid treatment has been used (see PRECAUTIONS).

Other adverse reactions reported with the use of prednisolone acetate ophthalmic suspension include: allergic reactions; dysgeusia; eye pain; foreign body sensation; headache; pruritus; rash; transient burning and stinging upon instillation and other minor symptoms of ocular irritation; urticaria; and visual disturbance (blurry vision).

Keratitis, conjunctivitis, corneal ulcers, mydriasis, conjunctival hyperemia, loss of accommodation and ptosis have occasionally been reported following local use of corticosteroids. Corticosteroid-containing preparations have also been reported to cause acute anterior uveitis and perforation of the globe.

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RESTASIS® and RESTASIS MultiDose® Important Information

INDICATIONS AND USAGE
RESTASIS® and RESTASIS MultiDose® ophthalmic emulsion are indicated to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs.

IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
RESTASIS® and RESTASIS MultiDose® are contraindicated in patients with known or suspected hypersensitivity to any of the ingredients in the formulation.

WARNINGS AND PRECAUTIONS
Potential for Eye Injury and Contamination: Be careful not to touch the container tip to your eye or other surfaces to avoid potential for eye injury and contamination.

Use with Contact Lenses: RESTASIS® and RESTASIS MultiDose® should not be administered while wearing contact lenses. If contact lenses are worn, they should be removed prior to the administration of the emulsion. Lenses may be reinserted 15 minutes following administration of RESTASIS® and RESTASIS MultiDose® ophthalmic emulsion.

ADVERSE REACTIONS
In clinical trials, the most common adverse reaction following the use of cyclosporine ophthalmic emulsion 0.05% was ocular burning (upon instillation)—17%. Other reactions reported in 1% to 5% of patients included conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging, and visual disturbance (most often blurring).

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TRUETEAR® Important Information

INDICATION
TrueTear® provides a temporary increase in tear production during neurostimulation to improve dry eye symptoms in adult patients with severe dry eye symptoms.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS
Do not prescribe TrueTear® to patients with a cardiac demand pacemaker, implanted or wearable defibrillator, or other implanted metallic or electronic device within head or neck; a known hypersensitivity to the hydrogel device material; or chronic or recurrent nosebleeds, or bleeding disorder/condition that can lead to increased bleeding.

WARNINGS
Do not apply stimulation around electronic monitoring equipment (eg, cardiac monitors, ECG alarms), in the bath/shower, while driving, operating machinery, during activity in which sneezing/watery eyes may cause risk, areas other than the nose, within 3 feet of shortwave or microwave therapy equipment, around flammable anesthetics mixture (air, oxygen or nitrous oxide). Persistent use on irritated nasal tissue may cause injury. The device is limited only to the improvement in dry eye symptoms, as the safety and effectiveness for neither the treatment of dry eye disease nor use for periods longer than 6 months has been established. Safety not established in pregnancy, patients under 22 years of age, patients with nasal or sinus surgery (including nasal cautery) or significant trauma; severe nasal airway obstruction or vascularized polyp; active, severe systemic or chronic seasonal allergies; rhinitis or sinusitis requiring treatment; untreated nasal infection; and disabling arthritis, neuropathy, severe dexterity impairment or limited motor coordination. Use only manufacturer’s supplied accessories.

PRECAUTIONS
Consult patients to discontinue use if pain, discomfort or numbness in the nose persists after adjusting for high levels/long sessions; to remove studs, nose rings, or other nose jewelry before use; to not use prescription eye medications or nasal sprays 30 minutes before or after using TrueTear®. Suspected or diagnosed heart disease patients should follow doctor’s precautions. Keep away from children. Clean as directed. Failure to replace the tip as directed will cause the device to not work properly.

ADVERSE EVENTS
Nasal pain, discomfort or burning (10.3%); transient electrical discomfort (5.2%); nosebleed (5.2%); nasal congestion (3.1%); headaches (2.1%); trace blood, dot heme in nostril (2.1%); facial pain (2.1%); sore eye (1.0%); sinus pain (1.0%); periorbital pain (1.0%); runny nose (1.0%); nasal ulcers (1.0%); and light-headedness (1.0%).

Caution: Federal law restricts this device to sale by or on the order of a licensed physician. Proper patient training on use of the device is required before home use. For the full Directions for Use, please visit www.allergan.com/truetear/usa.htm or call 1-800-678-1605. Please call 1-800-433-8871 to report an adverse event.

Please click here for the full Instructions for Use for TrueTear®.



XEN® Gel Stent Important Information

INDICATIONS
The XEN® Glaucoma Treatment System (XEN® 45 Gel Stent preloaded into a XEN® Injector) is indicated for the management of refractory glaucomas, including cases where previous surgical treatment has failed, cases of primary open-angle glaucoma, and pseudoexfoliative or pigmentary glaucoma with open angles that are unresponsive to maximum tolerated medical therapy.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS
XEN® Gel Stent is contraindicated in angle-closure glaucoma where angle has not been surgically opened, previous glaucoma shunt/valve or conjunctival scarring/pathologies in the target quadrant, active inflammation, active iris neovascularization, anterior chamber intraocular lens, intraocular silicone oil, and vitreous in the anterior chamber.

WARNINGS
XEN® Gel Stent complications may include choroidal effusion, hyphema, hypotony, implant migration, implant exposure, wound leak, need for secondary surgical intervention, and intraocular surgery complications. Safety and effectiveness in neovascular, congenital, and infantile glaucoma has not been established. Avoid digital pressure following implantation of the XEN® Gel Stent to avoid the potential for implant damage.

PRECAUTIONS
Examine the XEN® Gel Stent and XEN® Injector in the operating room prior to use. Monitor intraocular pressure (IOP) postoperatively and if not adequately maintained, manage appropriately. Stop the procedure immediately if increased resistance is observed during implantation and use a new XEN® system. Safety and effectiveness of more than a single implanted XEN® Gel Stent has not been studied.

ADVERSE EVENTS
The most common postoperative adverse events included best-corrected visual acuity loss of ≥ 2 lines (≤ 30 days 15.4%; > 30 days 10.8%; 12 months 6.2%), hypotony IOP < 6 mm Hg at any time (24.6%; no clinically significant consequences were associated, no cases of persistent hypotony, and no surgical intervention was required), IOP increase ≥ 10 mm Hg from baseline (21.5%), and needling procedure (32.3%).

Caution: Federal law restricts this device to sale by or on the order of a licensed physician. Please click here for the full Directions for Use. Please call 1-800-433-8871 to report an adverse event.

Please click here for the full Directions for Use.



ZYMAXID® (gatifloxacin ophthalmic solution) 0.5% Important Information

INDICATION
ZYMAXID® is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms:

Aerobic gram-positive bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus mitis group*, Streptococcus oralis*, Streptococcus pneumoniae.

Aerobic gram-negative bacteria: Haemophilus influenzae.

*Efficacy for these organisms were studied in fewer than 10 infections.

IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
ZYMAXID® is contraindicated in patients with a history of hypersensitivity to gatifloxacin, to other quinolones, or to any of the components in this medication.

WARNINGS AND PRECAUTIONS
Hypersensitivity
Some patients receiving topical ophthalmic gatifloxacin experienced hypersensitivity reactions including anaphylactic reactions, angioedema (including pharyngeal, laryngeal, or facial edema), dyspnea, urticaria, and itching, even following a single dose. Rare cases of Stevens-Johnson Syndrome were reported in association with topical ophthalmic gatifloxacin use. If an allergic reaction to gatifloxacin occurs, discontinue the drug.

Growth of Resistant Organisms with Prolonged Use
Prolonged use of ZYMAXID® may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, discontinue use and institute alternative therapy. Whenever clinical judgment dictates, examine the patient with the aid of magnification, such as slit lamp biomicroscopy and where appropriate, fluorescein staining.

Corneal Endothelial Cell Injury
ZYMAXID® is for topical ophthalmic use. ZYMAXID® may cause corneal endothelial cell injury if introduced directly into the anterior chamber of the eye.

Adverse Reactions
In clinical studies of patients with bacterial conjunctivitis treated with ZYMAXID® (N=717), the most frequently reported adverse reactions occurring in ≥ 1 % of patients were: worsening of the conjunctivitis, eye irritation, dysgeusia, and eye pain.

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