What are the recommended eye drops for an inpatient experiencing burning and redness in the eye?

Management of Eye Burning and Redness in Inpatients

For an inpatient experiencing burning and redness in the eye, preservative-free artificial tears should be used as first-line treatment, applied every 2 hours during the acute phase. 1

Initial Assessment and First-Line Treatment

• Preservative-free artificial tears are the recommended first-line treatment for patients with ocular surface irritation presenting with burning and redness 1
• For frequent application (more than four times daily), which is often needed in acute cases, non-preserved tear substitutes are generally recommended to avoid preservative toxicity 1
• Common preservative-free options include hyaluronate or carmellose eye drops 1, 2
• Initial dosing should be every 2 hours in acute cases to provide adequate ocular surface lubrication 1

Treatment Algorithm Based on Severity

Mild Eye Irritation

• Start with preservative-free artificial tears every 2-4 hours 1
• If used less than four times daily, preserved tears may be sufficient for patients with otherwise healthy ocular surfaces 1
• Fixed dosing (four times daily) may provide better symptomatic relief than as-needed dosing 3

Moderate Eye Irritation

• Continue preservative-free artificial tears with increased frequency 1
• Consider adding topical antihistamine eye drops if symptoms persist:
  • Ketotifen (for patients ≥3 years): 1 drop twice daily 1, 4
  • Olopatadine (for patients ≥3 years): 1 drop twice daily 1
  • Epinastine hydrochloride (for patients ≥12 years): 1 drop twice daily 1

Severe Eye Irritation or Inflammation

• Continue frequent preservative-free artificial tears 1
• Consider a short course of topical corticosteroids under appropriate supervision:
  • Loteprednol etabonate 0.5%: One drop four times daily 1, 5
  • Non-preserved dexamethasone 0.1%: Apply twice daily 1
• Limit corticosteroid use to short-term therapy to avoid complications such as increased intraocular pressure and cataract formation 1, 6

Special Considerations

• For blepharitis-associated redness and burning:

  • Add warm compresses and lid hygiene to the treatment regimen 1
  • Consider topical cyclosporine 0.05% for patients with posterior blepharitis 1

• For patients with Stevens-Johnson syndrome or severe ocular surface disease:

  • Daily ophthalmological review is necessary during acute illness 1
  • Apply non-preserved hyaluronate or carmellose eye drops every 2 hours 1
  • Consider topical corticosteroid drops under ophthalmological supervision 1

• For patients with dry eye disease:

  • Thicker agents (gels, ointments) provide longer-lasting effect but may blur vision 1
  • Polyethylene glycol/propylene glycol with hydroxypropyl guar (Systane Ultra) has shown effectiveness in managing dry eye symptoms 7, 8
  • Consider switching from preserved to preservative-free artificial tears, which has been shown to decrease severity of dry eye disease and reduce superficial punctate keratitis 2

Monitoring and Follow-up

• Monitor for response to treatment within 24-48 hours 1
• If using topical corticosteroids, monitor for potential adverse effects including increased intraocular pressure 1, 6
• Consider ophthalmology consultation for:
  • Symptoms that don't respond to initial therapy within 48-72 hours 1
  • Severe eye pain, vision changes, or worsening symptoms 1
  • Need for prolonged corticosteroid therapy (>1-2 weeks) 1, 6

Cautions and Contraindications

• Avoid long-term use of preserved eye drops in patients requiring frequent application 1
• Use topical corticosteroids with caution and for limited duration due to risk of increased intraocular pressure and cataract formation 1, 6
• Corticosteroids can mask signs of corneal infection and should be used with caution in the presence of corneal epithelial defects 1