A. Most topical eye drops are formulated as WEAK BASES. This is for better penetration and bioavailability of the medicated drop.

D. The cycloplegic effect from Tropicamide is DEPENDENT on concentration. The remaining options are correct.

B. Of the options, Scopolamine has the longest mydriatic effect. Recall, ASH CiTy for length of cycloplegia and mydriasis with the cholinergic antagonists.

C. Adie’s Tonic Pupil. Since the iris sphincter is desensitized in Adie’s, it will respond to even a low concentration of pilocarpine. Recall that ADie’s is an Acutely Dilated pupil normally found in young females.

D. Echothiophate, an irreversible drug, is used to diagnose and treat accommodative ET. Pilocarpine is reversible and considered a direct cholinergic agonist. The “-stigmine” drugs are used in the treatment of Myasthenia Gravis. Edrophonium is used to test for MG.

B. Use of Pilocarpine may cause a MYOPIC shift. Other side effects include: brow aches, headaches, miosis, cataracts, retinal detachment, and secondary angle closure.

C. Phenylephrine is an adrenergic agonists that acts only on ⍺1. Brimonidine is highly selective for ⍺2 and Apraclonidine acts on ⍺2 receptors with limited ⍺1 activity. Naphazoline and Tetrahydrolozine are non-specific alpha receptor agonists.

C. Timolol may mask the signs of HYPOglycemia in Diabetic patients. Timolol is also known to mask signs and symptoms of hypothyroidism as well as increasing symptoms of muscle weakness in patients with myasthenia gravis. Long term drift describes an increase of IOP after chronic use of Timolol. Short term escape is an initial lowering of IOP before no longer having an effect. D describes the “crossover” effect.

B. Betaxolol is β1 selective with limited β2 activity. It is also known for neuroprotective qualities although there is limited clinical evidence. Recall that Betaxolol is cardioselective. The remaining options are non-selective.

B. Use of Apraclonidine to an eye affected by Horner’s will cause dilation. This is due to the “starved” nature of the eye. Cocaine will only cause dilation in a normal, unaffected eye. Both Cocaine and Apraclonidine are used to confirm Horner’s diagnosis. Hydroxyamphetamine and Phenylephrine 1% are used to determine location of lesions. Dilation with hydroxyamphetamine means the eye is healthy or there has been damage to the preganglionic nerve. Dilation with phenylephrine indicates postganglionic lesion.

A/B/D. PG analogs, alpha agonists, and pilocarpine (a direct cholinergic agonist) all lower IOP by increasing aqueous outflow.

C/D: CAIs are known for several side effects. The most important to note include: metabolic acidosis, aplastic anemia, myopia shifts, bone marrow suppression, and depression. Other SE include metallic taste, tingling of limbs, thrombocytopenia, ED, and anorexia.

E. Grave’s disease is not considered a contraindication for PG use. The remaining options describe conditions associated with inflammation. Recall that PGs are produced naturally in response to inflammation in the body.

D. Proparacaine blocks nerve conduction by stopping influx of NA+ ions leading to anesthesia. Steroids inhibit phospholipase A2. CAIs inhibit carbonic anhydrase. Acid reflux medications work by inhibiting proton pumps in the gastric system.

A. Optivar is the only allergy eye drop listed here that is a combination of H1 inhibition and stabilization of mast cells. Mast cells stabilizers work by preventing Ca2+ from binding mast cells. Calcium serves to initiate degranulation of mast cells leading to allergy symptoms. Recall, BEZPOP for combination antihistamines.

C. Chronic corticosteroid use leads to development of posterior SUBCAPSULAR cataracts. PCO develops after a PCIOL has been in an eye for a period of time. The remaining options are correct facts.

B. Loteprednol is considered the safest steroid for prescribing. Unfortunately, many cases of inflammation are severe and require stronger prescription steroids. In these cases, it is important to educate patients about proper use and follow up schedules to avoid rebound inflammation.

E. Cromolyn Sodium is classified as a mast cell stabilizer. The remaining options are NSAIDs. Recall that “-fenac” and “-rolac” help identify generic equivalents.

A. Restasis, used in the treatment of dry eye, works by ceasing production of IL-2 leading to inhibition of T-cell activation. This is one of the final steps of the dry eye cascade.

C. Corneal melts are most common with either topical NSAIDs or anesthetics. Delayed wound healing is related to steroid use. Skin darkening is a side effect of prostaglandin analogs. Follicular conjunctivitis is an uncommon finding with Brimonidine and CL solutions.

C. EDTA is a Calcium ion chelating agent that can be used in treatment of Gout and Band Keratopathy. BAK is infamous for causing SPK with the benefit of increased corneal penetration. Thimerosal is considered very toxic as it contains mercury. SP is found in artificial tears/ointment and is considered less toxic.

D. Muro 128 is used to reduce corneal edema in conditions such as Fuch’s. The remaining conditions can lead to ulceration of cornea with use of Muro 128.

B. Macugen is an anti-neoplastic agent that prevents angiogenesis through inhibition of VEGF. PEDF has the opposite effect and is required to be in the proper balance of concentration as VEGF.

C. Difluprednate, also known as Durezol, is the most dangerous topical steroid drop. This drop should be avoided in arthritic patients due to its potency.

B. Combigan is composed of Timolol (B-blocker) and Brimonidine (Alpha agonist). Cosopt is a combination of Timolol (B-blocker) and Dorzolamide (CAI). Latanoprost (PG) and Netarsudil (Rho Kinase inhibitor) make up a newer glaucoma medication, Rhopressa. Brinzolamide (CAI) and Brimonidine (Alpha agonist) compose Simbrinza.

A/B/C. Topamax, Carbonic Anhydrase Inhibitors, and Pilocarpine are all known to carry the risk of myopic shift.

C. Beta blockers reduce IOP by decreasing aqueous production. Cholinergic agonist (i.e.Pilocarpine) affects IOP by increasing corneoscleral outflow. Alpha agonists both decrease aqueous production and increase uveoscleral outflow. CAIs decrease aqueous production. PGs increase uveoscleral outflow.

A/D. Alpha 1 and Beta 2 receptors in the eye are the targets for topical glaucoma meds. B1 receptors are located in the heart. Alpha 2 are located in the brain and peripheral nerves.

B. Tropicamide, a cholinergic antagonist, works by preventing binding of acetylcholine at muscarinic sites. Direct stimulation of cholinergic receptors is the MOA for Pilocarpine. Anesthetics act by preventing influx of Na+ ions.

A. Dilation withOUT cycloplegia. Phenylephrine is an adrenergic agonist that causes dilation with no effect on ciliary muscles. When used to differentiate, vessels will become blanched with episcleritis. With diagnosis of Horner’s Syndrome, it helps determine if lesion is pre- or post ganglionic. 10% Phenyl is used to break old or severe PAS.

C. All topical anesthetics are considered esters for their shorter duration and ability to be metabolized locally. Amides have a longer duration and are metabolized by the LIVER.

B. Emadine is considered only an antihistamine with no mast cell stabilizer action. The remaining choices all work by preventing mast cell degranulation by preventing binding of Ca²⁺.

A. Erythromycin is applied topically for newborns to prevent opthalmia neonatorum.

B. Sulfonamides act by inhibiting DHP synthase, the first step of folic acid synthesis. Trimethoprim, Methotrexate, and Pyrimethamine all act by inhibiting DHF reductase, the second step of folic acid synthesis. Aminoglycasides and Tetracyclines function by binding and inhibiting 30s subunits. Penicillins and Cephalosporins inhibit transpeptidase.

A. Durezol, a steroid, is most likely to cause a PSC rather than ASC. To recall, “I made ‘A PACT’ with ASC”: -Azines, Pilocarpine, Amiodarone, CAIs, Trimethoprim.

E. Naloxone is not known to cause PTC (otherwise known as Idiopathic Intracranial Hypertension). To recall, “SCANT” or “CATS-N”: Synthroid, Contraceptives, Accutane, Nalidixic Acid (in kids), Tetracyclines”

A/B/C: These three medications may cause retinal pigmentary changes. When it comes to pigmentary changes throughout the eye, the drug class Phenothiazines (antipsychotics) are infamous for this adverse effect. From pigment on endothelium to the retina, the “-Azines” affect all regions of the eye.