Eye, Ear, Nose and Throat Medicines: Classes, Uses and Nursing Care
Medicines acting on the eye, ear, nose and throat include local and systemic preparations used to prevent, diagnose or treat disorders of these specialised organs. Local preparations—drops, ointments, gels, sprays, irrigations, gargles and lozenges—can deliver a high medicine concentration at the affected site with less systemic exposure. However, they can still be absorbed, cause serious adverse effects, interact with other medicines or damage delicate tissues when used incorrectly.
The nurse must therefore understand not only which medicine is used, but also its mechanism, indication, correct anatomical site, preparation strength, administration technique, contraindications, adverse effects, monitoring requirements and referral limits. A red eye, discharging ear, blocked nose or sore throat is a symptom rather than a diagnosis; medicine should follow appropriate assessment.
Core safety principle: Never treat loss of vision, severe ocular pain, penetrating injury, sudden hearing loss, mastoid swelling, stridor, drooling or rapidly progressive facial/neck swelling as an ordinary minor complaint. Stabilise urgent threats, avoid harmful instillation and arrange prompt specialist or emergency referral.
Learning Objectives
By the end of this lesson, the learner should be able to:
- Classify ophthalmic, otic, nasal and oropharyngeal medicines according to their therapeutic action.
- Explain the mechanisms, indications, administration, contraindications, adverse effects and important interactions of the major classes.
- Assess the patient and distinguish uncomplicated presentations from conditions requiring urgent referral.
- Administer eye drops, eye ointment, ear drops and nasal preparations safely using infection-prevention principles.
- Monitor therapeutic response, recognise medicine-related harm and educate patients for safe self-administration.
- Develop a practical nursing care plan with measurable outcomes, interventions and rationales.
- Apply antimicrobial stewardship and Uganda-relevant prescribing and referral principles.
Anatomical and Pharmacological Foundations
Why Local Medicines Behave Differently
- Small treatment surface: A single drop usually exceeds the capacity of the conjunctival sac. Extra drops mainly overflow or drain through the nasolacrimal duct; they do not necessarily improve effect.
- Rapid drainage: Blinking, tears and nasal clearance shorten contact time. Ointments remain longer but blur vision.
- Systemic absorption: Eye drops can enter the nasal mucosa through the nasolacrimal duct; nasal and throat preparations can be swallowed; inflamed ear or nasal mucosa can absorb more medicine. Topical beta-blockers, sympathomimetics and corticosteroids may therefore cause systemic effects.
- Barrier penetration: The intact cornea, tympanic membrane and skin protect deeper structures. Trauma, ulceration or perforation changes both penetration and toxicity.
- Vehicle matters: Solutions act quickly, suspensions require shaking, gels and ointments prolong contact, and preservative-free products reduce exposure to sensitising preservatives when use is frequent.
General Assessment Before Administration
- Confirm the complaint and urgency: Ask about onset, pain, discharge, itch, trauma, foreign body, fever, visual or hearing change, breathing and swallowing.
- Verify the prescription: Apply the rights of medicine administration, including the correct organ and side—right eye, left eye, both eyes, right ear or left ear.
- Check patient factors: Age, pregnancy, breastfeeding, allergies, contact-lens use, glaucoma, asthma, heart block, hypertension, diabetes, renal/liver disease, immunosuppression and recent surgery.
- Review other products: Include prescribed medicines, over-the-counter preparations, herbal remedies and previous partially used drops. Multiple products may duplicate ingredients or interact.
- Inspect the product: Check name, concentration, expiry date, seal, appearance, storage and date opened. Do not use a cloudy solution unless it is formulated as a suspension.
Medicines Acting on the Eye
Ophthalmic Dosage Forms
| Form | Advantages | Limitations and Nursing Implications |
|---|---|---|
| Solution | Rapid action, easy instillation and little blurring. | Short contact time. More frequent dosing may be needed. One correctly placed drop is generally sufficient unless the prescription states otherwise. |
| Suspension | Permits delivery of poorly soluble medicines. | Must be shaken well to redistribute particles; otherwise early doses may be weak and later doses too concentrated. |
| Ointment | Long contact time; useful at night and in children who cannot cooperate with frequent drops. | Temporarily blurs vision and may interfere with daytime activity. Apply after drops when both are prescribed. |
| Gel or insert | Prolonged effect and sometimes less frequent dosing. | May cause transient blurring, foreign-body sensation or difficulty with correct placement. |
1. Ocular Lubricants and Tear Substitutes
Examples: Hypromellose, carmellose, polyvinyl alcohol, hyaluronic-acid preparations, lubricating gels and petrolatum/mineral-oil ointments.
- Mechanism: Supplement the tear film, reduce friction between the eyelid and ocular surface, retain moisture and protect damaged epithelium.
- Indications: Dry-eye symptoms, exposure-related dryness, minor irritation, reduced blinking, some postoperative states and lubrication during impaired eyelid closure.
- Administration: Drops are useful during the day; thicker gels or ointments are often used at bedtime. Preservative-free preparations are preferable when dosing is frequent or the ocular surface is sensitive.
- Adverse effects: Brief stinging, sticky lids, temporary blurred vision and sensitivity to preservatives.
- Nursing point: Persistent unilateral redness, significant pain, photophobia, purulent discharge or reduced vision is not simple dry eye and requires assessment.
2. Ocular Antibacterial Medicines
Examples: Chloramphenicol, tetracycline eye ointment, gentamicin, tobramycin, ciprofloxacin, ofloxacin and other locally approved preparations.
- Mechanism: Chloramphenicol and tetracyclines inhibit bacterial protein synthesis; aminoglycosides interfere with the 30S ribosomal subunit; fluoroquinolones inhibit bacterial DNA gyrase and topoisomerase.
- Indications: Selected bacterial conjunctivitis, blepharitis, corneal bacterial infection under appropriate supervision, neonatal prophylaxis/treatment according to national protocol, and perioperative prophylaxis where prescribed.
- Selection: Depends on likely organism, severity, corneal involvement, contact-lens use, age, allergy and local resistance. Severe keratitis requires corneal sampling and intensive specialist therapy.
- Adverse effects: Burning, allergy, eyelid swelling, contact dermatitis, surface toxicity and selection of resistant organisms. Aminoglycosides may be epitheliotoxic with prolonged use.
- Stewardship: Many adult infectious conjunctivitis cases are viral and self-limited; antibiotics neither treat viruses nor prevent every complication. Avoid leftover or shared drops and review failure rather than extending treatment blindly.
- Urgent groups: Neonates with eye discharge, contact-lens wearers with a painful red eye, patients with corneal opacity/ulcer, gonococcal-like copious discharge or reduced vision need urgent evaluation.
3. Ocular Antiviral and Antifungal Medicines
- Antivirals: Aciclovir eye ointment, ganciclovir gel and systemic aciclovir/valaciclovir are used for selected herpes simplex or varicella-zoster ocular disease. They inhibit viral DNA replication. Adverse effects include local irritation and superficial corneal toxicity.
- Antifungals: Natamycin and specialist-selected azoles or compounded agents may be used for fungal keratitis. Risk is greater after plant/soil trauma, prolonged topical steroid use or immunosuppression.
- Critical precaution: Ocular herpes and fungal keratitis can resemble other red-eye conditions. Unsupervised corticosteroid drops may accelerate infection, thin the cornea and threaten sight.
4. Ocular Corticosteroids and Non-steroidal Anti-inflammatory Drugs
Corticosteroid examples: Prednisolone acetate, dexamethasone, betamethasone and fluorometholone. Non-steroidal anti-inflammatory drug (NSAID) examples: Ketorolac, diclofenac and nepafenac.
- Corticosteroid mechanism: Suppress inflammatory gene expression, capillary permeability and leukocyte activity. They are used for selected uveitis, severe non-infectious inflammation and postoperative inflammation under ophthalmic supervision.
- Corticosteroid hazards: Raised intraocular pressure, steroid-induced glaucoma, posterior subcapsular cataract, delayed epithelial healing, corneal thinning and worsening of bacterial, fungal or herpetic infection.
- Monitoring: Confirm indication, duration and taper plan. Prolonged therapy requires review of intraocular pressure, lens and cornea. Do not stop prolonged intensive therapy abruptly unless directed.
- NSAID mechanism and use: Cyclo-oxygenase inhibition reduces prostaglandins, pain and postoperative inflammation. Risks include stinging, delayed healing and rare corneal complications, especially in compromised ocular surfaces.
5. Anti-allergy Eye Medicines
- Mast-cell stabilisers: Sodium cromoglicate reduces release of inflammatory mediators and works best with regular preventive use rather than as immediate rescue.
- Antihistamine/mast-cell stabiliser combinations: Olopatadine or ketotifen reduce histamine-mediated itch, redness and watering and also reduce mediator release.
- Supportive measures: Cold compresses, allergen avoidance, tear substitutes and avoidance of eye rubbing.
- Precaution: Vasoconstrictor “redness-relief” drops may cause rebound redness and do not treat the underlying allergy. Persistent unilateral disease, pain or visual loss suggests another diagnosis.
6. Mydriatics, Cycloplegics and Miotics
| Class | Action and Uses | Adverse Effects and Precautions |
|---|---|---|
| Antimuscarinic mydriatics/cycloplegics Atropine, cyclopentolate, tropicamide | Block muscarinic activity, dilating the pupil; stronger agents also paralyse accommodation. Used for refraction, examination and selected uveitis to relieve ciliary spasm and prevent adhesions. | Photophobia, blurred near vision, raised intraocular pressure in susceptible narrow angles and systemic anticholinergic effects—dry mouth, flushing, fever, tachycardia, confusion—especially in children. |
| Sympathomimetic mydriatic Phenylephrine | Stimulates alpha receptors in the iris dilator muscle, producing mydriasis without marked cycloplegia; used diagnostically and perioperatively. | Can raise blood pressure and cause palpitations; use cautiously in cardiovascular disease, hyperthyroidism and small infants. |
| Miotic Pilocarpine | Muscarinic agonist that constricts the pupil and increases trabecular aqueous outflow; used in selected glaucoma situations. | Brow ache, headache, blurred/dim vision, induced myopia and rare retinal complications. It is not a substitute for complete emergency management of acute angle closure. |
7. Local Anaesthetics and Diagnostic Agents
- Local anaesthetics: Tetracaine or proxymetacaine blocks corneal nerve conduction for examination, tonometry, foreign-body removal or minor procedures. Repeated self-use is dangerous because it masks deterioration, delays epithelial healing and can cause corneal ulceration.
- Fluorescein: A diagnostic dye that reveals epithelial defects and assists tear-film or contact-lens assessment. It is not a treatment. Examine with the appropriate blue light and document staining pattern.
- Nursing responsibility: Protect the anaesthetised cornea until sensation returns; instruct the patient not to rub the eye.
8. Medicines for Glaucoma
Glaucoma treatment lowers intraocular pressure to protect the optic nerve. The patient may feel no immediate benefit, so adherence and follow-up are essential. Choice depends on glaucoma type, target pressure, comorbidity, pregnancy, cost, availability and response.
| Class and Examples | Mechanism and Role | Important Adverse Effects, Contraindications and Nursing Care |
|---|---|---|
| Prostaglandin analogues Latanoprost, travoprost, bimatoprost | Increase mainly uveoscleral outflow. Long duration and strong pressure reduction make them common first-line agents for chronic open-angle disease. | Conjunctival redness, iris/periocular pigmentation, eyelash growth and periorbital fat changes. Usually given once daily. Avoid contaminating the tip; monitor response and adherence. |
| Beta-blockers Timolol, betaxolol | Reduce aqueous-humour production. | Bradycardia, hypotension, fatigue, heart block and bronchospasm. Timolol is particularly concerning in asthma, severe chronic obstructive pulmonary disease and conduction disease. Check pulse/history and use punctal occlusion to reduce systemic absorption. |
| Alpha-2 agonists Brimonidine | Reduce aqueous production and may increase outflow. | Dry mouth, fatigue, hypotension and allergic conjunctivitis. Can cause severe central nervous system depression in young children; observe age restrictions. |
| Topical carbonic anhydrase inhibitors Dorzolamide, brinzolamide | Reduce bicarbonate formation and aqueous secretion. | Stinging, bitter taste and local allergy. Review sulfonamide hypersensitivity history and corneal/endothelial disease. |
| Systemic carbonic anhydrase inhibitor Acetazolamide | Rapidly reduces aqueous production; used in selected acute or refractory situations. | Paraesthesia, diuresis, metabolic acidosis, potassium disturbance, renal stones and sulfonamide reactions. Review renal function, electrolytes and contraindications. |
| Hyperosmotic agents Intravenous mannitol | Create an osmotic gradient that reduces ocular volume in selected emergencies. | Fluid shifts, pulmonary oedema, electrolyte disturbance and renal risk. Requires prescribed emergency monitoring and careful assessment of cardiac/renal status. |
Acute angle-closure warning: Severe eye pain, headache, halos, nausea/vomiting, a red eye, cloudy cornea and a fixed or poorly reactive mid-dilated pupil require immediate ophthalmic emergency care. Pressure-lowering medicines are temporising measures; definitive treatment is usually procedural.
9. Anti-vascular Endothelial Growth Factor Medicines
Intravitreal bevacizumab, ranibizumab or aflibercept inhibits vascular endothelial growth factor and is used by specialists for conditions such as neovascular age-related macular degeneration, diabetic macular oedema and retinal vein occlusion. Nursing care includes consent support, aseptic preparation, post-injection education and urgent recognition of endophthalmitis—worsening pain, redness, photophobia or visual loss.
Procedure: Instilling Eye Drops and Ointment
| No. | Action | Rationale |
|---|---|---|
| 1 | Check the prescription, patient, medicine, concentration, expiry date and correct eye; assess allergies, vision, pain and appearance. | Prevents wrong-patient, wrong-eye and wrong-strength errors and establishes a baseline for evaluating response or deterioration. |
| 2 | Explain the procedure, provide privacy, perform hand hygiene and position the patient sitting or supine with the head supported. | Promotes cooperation, reduces sudden movement and prevents transfer of organisms. |
| 3 | If discharge is present, clean from inner to outer canthus using a fresh swab for each stroke and separate materials for each eye. | Removes material that may obstruct the medicine and limits cross-infection. |
| 4 | Shake suspensions. Ask the patient to look upward; gently pull the lower lid down to expose the conjunctival sac. | Redistributes suspended medicine and creates a safe pocket away from the cornea. |
| 5 | Hold the dropper about 1–2 cm above the sac and instil the prescribed drop without touching lashes, lid or eye. | Prevents injury and contamination. Direct corneal instillation is uncomfortable and triggers blinking. |
| 6 | Ask the patient to close the eye gently; apply light pressure over the nasolacrimal duct for about 1–2 minutes when appropriate. | Prolongs ocular contact and reduces systemic absorption through the nasal mucosa. |
| 7 | When several drops are prescribed, separate different preparations by the recommended interval; apply drops before ointment. For ointment, place a thin ribbon from inner to outer lower sac without touching the tip. | Prevents one medicine washing out another. Ointment forms a barrier and would reduce penetration of drops applied afterward. |
| 8 | Replace the cap immediately, clean excess medicine, reassess comfort/vision and document medicine, dose, eye, time, response and teaching. | Maintains product sterility and creates an accurate record for evaluation and handover. |
Eye Red Flags and Immediate Actions
- Chemical exposure: Begin immediate copious irrigation with clean water or normal saline; do not delay for history, referral or a preferred fluid. Remove contact lenses if easily possible and continue irrigation while arranging urgent assessment.
- Penetrating injury or embedded object: Do not remove the object or apply pressure/drops. Protect with a rigid shield, keep the patient nil by mouth if surgery is possible and refer urgently.
- Sudden visual loss: Treat as time-critical even without pain.
- Painful red eye with photophobia or corneal opacity: Consider keratitis, uveitis or acute glaucoma rather than simple conjunctivitis.
- Contact-lens-related painful red eye: Remove lenses, avoid re-use and arrange urgent corneal assessment.
- Neonatal discharge: Urgent evaluation is required because gonococcal, chlamydial or other infection may damage the cornea or indicate systemic infection.
Medicines Acting on the Ear
Assessment Before Ear Medicines
- Differentiate external-ear canal disease from middle-ear disease. Ask about pain on moving the pinna/tragus, swimming, discharge, fever, hearing loss, trauma, foreign body and previous surgery.
- Inspect the canal and tympanic membrane when trained and equipment is available. Do not assume the membrane is intact when discharge is present.
- Ask about diabetes and immunosuppression because severe otitis externa can progress to invasive disease.
- Review concurrent ototoxic medicines and baseline hearing or balance problems.
1. Antibacterial Ear Drops
Examples: Ciprofloxacin or ofloxacin; aminoglycosides such as neomycin or gentamicin in selected preparations.
- Mechanism: Fluoroquinolones inhibit bacterial DNA enzymes; aminoglycosides inhibit the 30S ribosome.
- Indications: Bacterial otitis externa and selected discharging ears based on examination and local protocol. Aural toilet and keeping the canal dry are important.
- Tympanic membrane caution: When perforation, grommet or open middle ear is possible, use only a preparation considered non-ototoxic and approved for that situation. Aminoglycoside exposure to the middle/inner ear may damage hearing or balance, particularly with prolonged/repeated use.
- Adverse effects: Burning, irritation and allergic contact dermatitis; neomycin is a recognised sensitiser.
2. Antibiotic–Corticosteroid Combinations
Preparations combining an antibacterial with hydrocortisone or dexamethasone treat infection plus marked canal inflammation. The steroid reduces swelling and itch, improving medicine penetration when the canal is inflamed. Use only for a diagnosed indication and prescribed duration; combination products can mask fungal infection, sensitise skin and promote resistance when used indiscriminately.
3. Antifungal Ear Medicines
Clotrimazole or another locally approved antifungal may be used for otomycosis. Typical clues include intense itch, fullness, characteristic debris and failure of antibacterial therapy. Effective care combines gentle professional cleaning, dryness, correction of risk factors and the appropriate antifungal. Persistent pain, granulation, cranial-nerve signs or systemic illness requires referral.
4. Cerumenolytics
Approved wax-softening preparations may contain sodium bicarbonate, oil-based agents or other cerumenolytics. They soften impacted wax before natural expulsion or removal. Do not instil them when perforation, grommet, recent ear surgery, foreign body, infection, severe pain or discharge is suspected unless a qualified clinician has assessed the ear.
5. Analgesics and Medicines for Middle-ear Disease
- Paracetamol or ibuprofen: Provide pain and fever relief when appropriate. Calculate paediatric doses by weight, check maximum daily dose and avoid duplicating combination products.
- Acute otitis media: This is behind the tympanic membrane; ordinary antibiotic ear drops do not automatically treat it. Many uncomplicated cases improve with analgesia and observation, while selected children or severely unwell patients require systemic antibiotics under guideline criteria.
- Otitis media with effusion: Antibiotics, antihistamines, decongestants and oral/nasal corticosteroids do not routinely restore hearing from uncomplicated effusion; hearing assessment and follow-up are more important.
Ototoxic Medicines
Aminoglycosides, loop diuretics, platinum chemotherapy and some other systemic medicines can damage cochlear or vestibular function. Risk rises with high exposure, renal impairment, combinations and pre-existing disease. Ask about tinnitus, new hearing loss, imbalance, oscillopsia or vertigo; review renal function and medicine levels where required and escalate early.
Procedure: Instilling Ear Drops
| No. | Action | Rationale |
|---|---|---|
| 1 | Verify the prescription, affected ear, allergy history, expiry date and tympanic-membrane status. | Prevents wrong-ear errors and avoids potentially ototoxic drops when the middle ear is exposed. |
| 2 | Perform hand hygiene and warm the closed bottle in the hands; do not heat directly. | Cold fluid can stimulate the vestibular apparatus and cause vertigo or nausea. |
| 3 | Position the affected ear upward. Gently pull the pinna up and back in adults/older children and down and back in young children. | Straightens the external auditory canal for effective delivery. |
| 4 | Instil the prescribed drops along the canal wall without touching the tip. Gently press the tragus if appropriate. | Reduces contamination and helps move drops through the canal without creating painful pressure. |
| 5 | Keep the patient in position for several minutes. Insert a wick only when prescribed and within competence. | Provides adequate contact time; an ear wick may carry medicine past severe canal swelling. |
| 6 | Reassess pain, dizziness and hearing; document administration and any discharge or reaction. | Detects immediate intolerance and tracks response. |
Ear Red Flags
- Post-auricular tenderness/swelling, protruding pinna or suspected mastoiditis.
- Sudden sensorineural hearing loss, facial weakness, severe vertigo or neurological deficit.
- Button battery or penetrating foreign body; do not irrigate a battery.
- Clear fluid after head trauma, significant bleeding or suspected basal skull injury.
- Severe night pain or granulation in a patient with diabetes/immunosuppression.
- Persistent foul discharge, cholesteatoma suspicion or failure of correctly used therapy.
Medicines Acting on the Nose
1. Saline Drops, Sprays and Irrigation
Isotonic or hypertonic saline moisturises mucosa, loosens thick secretions and assists mechanical clearance in rhinitis and sinus symptoms. It has no antimicrobial resistance risk. Use sterile commercially prepared saline or water prepared safely according to local infection-prevention advice for irrigation devices. Clean the device and avoid sharing.
2. Intranasal Corticosteroids
Examples: Beclometasone, budesonide, fluticasone and mometasone.
- Mechanism: Suppress local inflammatory cells, cytokines, mucosal oedema and secretion.
- Indications: Persistent allergic rhinitis, nasal polyps and selected inflammatory sinus disease.
- Use: Benefit is greatest with regular correct use and may take several days. Clear the nose first, aim away from the septum and avoid hard sniffing.
- Adverse effects: Dryness, irritation, sore throat and epistaxis. Septal injury is uncommon but more likely with repeated spraying directly onto the septum. Systemic steroid effects are uncommon at recommended doses but become more relevant with high doses, prolonged use and multiple steroid routes.
- Monitoring: Review technique, adherence, nasal bleeding, growth in children receiving prolonged high exposure and total corticosteroid burden.
3. Antihistamines
- Oral agents: Cetirizine and loratadine reduce sneezing, itch and watery rhinorrhoea. Older agents such as chlorphenamine cause more sedation, blurred vision, dry mouth and urinary retention.
- Intranasal agents: Azelastine has faster local onset and can help allergic rhinitis, but may cause bitter taste and drowsiness.
- Nursing care: Warn about driving, alcohol and other sedatives with sedating antihistamines; use caution in older adults, glaucoma and prostatic urinary retention.
4. Nasal Decongestants
Examples: Topical xylometazoline or oxymetazoline; systemic pseudoephedrine where authorised.
- Mechanism: Alpha-adrenergic vasoconstriction reduces mucosal swelling and rapidly opens the nasal airway.
- Limitation: Topical products should generally be limited to a few days. Longer use can cause rhinitis medicamentosa—rebound congestion that encourages repeated dosing.
- Adverse effects: Dryness, irritation, palpitations, tremor, insomnia and increased blood pressure. Accidental ingestion can be dangerous in children.
- Contraindications/cautions: Uncontrolled hypertension, significant heart disease, hyperthyroidism, narrow-angle glaucoma, urinary retention and interacting monoamine oxidase inhibitors. Follow age restrictions.
5. Other Nasal Medicines
- Ipratropium nasal spray: Antimuscarinic that reduces watery rhinorrhoea but has little effect on congestion; may cause dryness and epistaxis.
- Leukotriene-receptor antagonists: Montelukast may help selected patients with asthma plus allergic rhinitis but is not a routine replacement for intranasal corticosteroids; counsel about possible neuropsychiatric effects.
- Antibiotics: Most acute sinusitis is viral. Consider antibacterial treatment only when clinical pattern and guideline criteria support bacterial disease or complications. Avoid automatic antibiotics for coloured mucus alone.
Procedure: Using a Nasal Spray
- Prepare: Verify the product, shake/prime as directed and ask the patient to blow the nose gently.
- Position: Keep the head upright or slightly forward; close the opposite nostril.
- Direct correctly: Use the opposite hand where helpful and aim the nozzle outward toward the ear, away from the septum.
- Administer: Spray during a gentle inward breath; do not sniff forcefully because medicine will run into the throat.
- Finish: Wipe the nozzle, replace the cap, avoid sharing and record response. Review technique whenever treatment appears ineffective.
Epistaxis Medicines and First Aid
For uncomplicated anterior nosebleed, sit the patient forward, ask them to spit blood out and compress the soft part of the nose continuously for 10–15 minutes. A topical vasoconstrictor may be used by a trained clinician when appropriate. Persistent bleeding may require cautery, packing, tranexamic-acid-based protocols or specialist intervention. Heavy bleeding, airway compromise, haemodynamic instability, anticoagulant use or a posterior source requires urgent escalation.
Nasal and Sinus Red Flags
- Button battery or paired magnets in the nose—urgent removal; do not delay because tissue necrosis can occur.
- Unilateral foul discharge in a child suggesting a foreign body.
- Periorbital swelling, painful eye movement, reduced vision, severe frontal headache, altered consciousness or neurological signs suggesting orbital/intracranial complication.
- Recurrent unilateral bleeding, mass or persistent obstruction requiring investigation.
Medicines Acting on the Throat and Oropharynx
1. Analgesics and Antipyretics
Paracetamol or ibuprofen, when not contraindicated, reduces pain and fever in pharyngitis/tonsillitis. Verify the patient’s weight in children, calculate accurately, check maximum daily dose and look for duplicate ingredients in cold-and-flu products. Ibuprofen requires caution with dehydration, renal disease, peptic ulcer, bleeding risk and some asthma histories.
2. Lozenges, Gargles, Local Anaesthetics and Antiseptics
- Warm saline gargles and soothing fluids may reduce discomfort.
- Lozenges increase salivation and may contain mild antiseptic, anti-inflammatory or local anaesthetic agents.
- Benzocaine, lidocaine or benzydamine preparations can reduce pain temporarily but excessive local anaesthesia may impair protective swallowing and conceal deterioration.
- Do not give lozenges to a child who cannot safely manage them because of choking risk. Follow product age limits and avoid swallowing mouthwash.
3. Antibiotics for Bacterial Pharyngitis/Tonsillitis
Most acute sore throats are viral. Use clinical assessment and local testing/guidelines to identify patients likely to benefit from antibiotics. When prescribed, select the recommended narrow-spectrum agent, verify allergy, give the correct weight-based paediatric dose and complete the course. Unnecessary broad-spectrum therapy causes adverse effects and resistance.
4. Antifungals for Oropharyngeal Candidiasis
Nystatin suspension, clotrimazole preparations or systemic fluconazole may be used depending on age, severity and immune status. Teach adequate contact time before swallowing where relevant. Review inhaled-corticosteroid technique, denture hygiene, diabetes, antibiotics and immunosuppression. Persistent or oesophageal symptoms require evaluation.
Throat and Airway Red Flags
- Stridor, drooling, cyanosis, severe respiratory distress or inability to swallow secretions—manage as an airway emergency; do not force throat examination in a distressed child with suspected epiglottitis.
- Trismus, muffled “hot-potato” voice, unilateral swelling or uvular deviation—possible peritonsillar/deep-neck abscess.
- Neck swelling, toxic appearance, rapidly progressive pain or crepitus.
- Persistent hoarseness, unexplained weight loss, neck mass, haemoptysis or progressive dysphagia—refer for malignancy assessment.
Special Populations and High-risk Situations
- Children: Use weight-based systemic doses, age-appropriate formulations and careful drop counts. Avoid adult decongestant products unless specifically authorised. Small children are more vulnerable to systemic effects of ophthalmic anticholinergics, alpha agonists and nasal sympathomimetics.
- Pregnancy and breastfeeding: Confirm necessity and select preparations with established safety. Reduce systemic absorption of eye drops with punctal occlusion. Avoid assuming that every topical product is safe.
- Older adults: Review polypharmacy, cognition, dexterity and vision. Sedating antihistamines and anticholinergic medicines increase falls, confusion, constipation and urinary retention.
- Renal/hepatic impairment: Local drugs may still be absorbed; systemic antivirals, antibiotics, acetazolamide and other agents may require dose adjustment or avoidance.
- Contact-lens users: Remove lenses for active infection or as the product directs. Preservatives may bind to soft lenses. Replace contaminated lenses/cases and resume only after recovery and professional advice.
Important Interactions and Avoidable Errors
- Ophthalmic timolol plus systemic beta-blocker: Additive bradycardia, hypotension or bronchospasm.
- Several anticholinergic products: Increased dry mouth, blurred vision, constipation, confusion and urinary retention.
- Decongestants plus stimulants or monoamine oxidase inhibitors: Risk of severe hypertension and cardiovascular effects.
- Multiple corticosteroid routes: Greater cumulative systemic exposure; record eye, nasal, inhaled, oral and injected steroids.
- Wrong bottle/wrong route: Ear and eye labels can look similar. Eye preparations require ophthalmic sterility; never put a product in the eye unless labelled/prescribed for ophthalmic use.
- Touching the tip: Contaminates the container and can transmit infection. Never share bottles between patients.
- Ignoring opening date: Multidose containers have a limited usable period after opening. Label and discard according to the manufacturer/facility policy.
Nursing Care and Responsibilities
Comprehensive Nursing Assessment
- Subjective data: Onset, duration, pain severity/character, itch, discharge, visual/hearing change, nasal obstruction, swallowing, fever, trauma, exposure, allergies, previous episodes, medicine use and effect on sleep/eating/work.
- Objective data: Vital signs; general appearance; visual acuity before eye treatment where possible; pupil response; eye/ear/nose/throat appearance; airway sounds; hydration; lymph nodes; facial/orbital swelling; neurological findings and response to initial treatment.
- Laboratory/diagnostic review: Culture, staining, hearing tests, intraocular pressure, slit-lamp or imaging findings where ordered. Confirm that specimens are obtained correctly without delaying emergency treatment.
Priority Nursing Problems and Expected Outcomes
- Acute pain related to inflammation or infection: Patient reports reduced pain to an agreed level and rests without new danger signs.
- Disturbed sensory perception related to visual or auditory dysfunction: Patient remains safe, communicates needs and shows no deterioration.
- Risk for spread of infection: Patient demonstrates hand hygiene and avoids sharing contaminated items; no cross-infection occurs.
- Deficient knowledge/ineffective self-management: Patient correctly demonstrates administration, states timing/duration and identifies warning signs.
- Risk for injury related to blurred vision, vertigo or sedation: Patient avoids falls, driving or hazardous activity until effects resolve.
Nursing Interventions with Rationales
| No. | Nursing Intervention | Rationale and Evaluation |
|---|---|---|
| 1 | Measure baseline pain, visual acuity/hearing function where appropriate, vital signs and appearance before the first dose. | Creates a comparison point and prevents medicine administration from delaying recognition of deterioration. |
| 2 | Check the medicine, concentration, side/site, allergies, contraindications and last dose at every administration. | ENT and eye preparations have similar containers and multiple strengths; systematic checks prevent high-impact errors. |
| 3 | Use aseptic non-touch technique and separate equipment for infected eyes/ears. | Prevents contaminating the product, worsening infection or transferring organisms to another site/person. |
| 4 | Administer in the correct order and interval; document omitted/refused doses and the reason. | Maintains therapeutic concentration and prevents one topical product reducing another’s absorption. |
| 5 | Monitor local and systemic adverse effects—rash, swelling, wheeze, bradycardia, severe dizziness, hypertension, worsening pain or sensory loss. | Topical medicines can produce systemic toxicity and severe allergy; early recognition limits harm. |
| 6 | Provide pain relief, cold/warm compresses only when appropriate, quiet/dim environment for photophobia and falls assistance for vertigo/blurred vision. | Promotes comfort and prevents secondary injury while the underlying condition is treated. |
| 7 | Teach the patient to demonstrate the technique using their own container; correct hand position, tip contamination and dose timing. | Teach-back identifies practical errors that verbal instruction alone may miss. |
| 8 | Reassess at the expected review time and escalate no improvement, recurrence or danger signs. | Treatment failure may indicate wrong diagnosis, resistance, obstruction, poor technique, non-adherence or a complication. |
| 9 | Document assessment, exact preparation/strength, side, administration, patient response, education, referral and handover. | Ensures continuity, pharmacovigilance and legal accountability. |
Patient and Family Education
- Wash hands before and after treatment; never touch the nozzle/dropper tip.
- Do not share drops, towels, cosmetics, hearing devices or nasal equipment.
- Complete the prescribed duration; do not save leftovers for another illness.
- Keep an administration schedule when several preparations are prescribed.
- Store exactly as labelled and keep all medicines away from children.
- Do not drive when vision is blurred, vertigo is present or an antihistamine causes drowsiness.
- Return urgently for worsening pain, visual/hearing loss, severe headache, facial swelling, breathing/swallowing difficulty, rash or collapse.
Remember “S-I-T-E” before every local medicine:
S — Side and site: confirm the correct eye, ear, nostril or throat preparation.
I — Indication and integrity: confirm the diagnosis and check cornea, tympanic membrane or mucosa where relevant.
T — Tip and technique: maintain non-touch technique and use the correct position/order.
E — Evaluate: reassess effect, adverse reactions, adherence and emergency signs.
S — Side and site: confirm the correct eye, ear, nostril or throat preparation.
I — Indication and integrity: confirm the diagnosis and check cornea, tympanic membrane or mucosa where relevant.
T — Tip and technique: maintain non-touch technique and use the correct position/order.
E — Evaluate: reassess effect, adverse reactions, adherence and emergency signs.
Uganda and Resource-limited Setting Considerations
- Use the current Uganda Clinical Guidelines, Essential Medicines and Health Supplies List, authorised prescriber’s order and facility protocol.
- Choose affordable effective essential medicines while avoiding unlabelled mixtures, counterfeit products and harmful traditional substances placed in the eye or ear.
- Refer early when slit-lamp examination, intraocular-pressure measurement, audiology, microscopy, imaging or specialist surgery is unavailable.
- For chemical eye injury, irrigation comes before transfer and should not wait for a particular commercial fluid.
- Promote vaccination, facial cleanliness, safe water, eye protection, hearing conservation and avoidance of cotton buds/matchsticks as preventive care.
Revision Summary
- Local medicines can still cause systemic harm; dose, site, technique and monitoring matter.
- Pain, photophobia or visual loss is not ordinary conjunctivitis.
- Unsupervised ocular corticosteroids and repeated local anaesthetics may destroy the cornea.
- With possible tympanic-membrane perforation, use only an ear preparation known to be safe for the middle ear.
- Intranasal corticosteroids require regular correct technique; topical decongestants are short-term medicines.
- Most uncomplicated sore throats and many conjunctivitis/sinusitis presentations are viral; use antimicrobials selectively.
- Teaching by demonstration, infection prevention and timely escalation are central nursing responsibilities.
Authoritative References
- World Health Organization. Model List of Essential Medicines, 24th list (2025).
- Uganda Essential Medicines and Health Supplies List repository.
- CDC. Clinical Overview of Conjunctivitis.
- CDC. Treatment of Conjunctivitis.
- NICE. Otitis Media (Acute): Antimicrobial Prescribing.
- NICE. Otitis Media with Effusion in Under 12s.
- NICE. Sinusitis (Acute): Antimicrobial Prescribing.
- American Academy of Ophthalmology EyeWiki. Review of Topical Glaucoma Medications.
This educational article supports nursing learning and does not replace patient-specific assessment, an authorised prescription, local protocols or specialist care.