Study guide
Ontario optometry prescribing scope for the TPAO (O. Reg. 112/11)
What an Ontario optometrist may prescribe under O. Reg. 112/11 Schedule 1, the glaucoma standards, oral-drug limits and the scope traps that appear on the TPAO.
Updated October 22, 2026 · IGOEE Prep
This is a study summary of O. Reg. 112/11, Designated Drugs and Standards of Practice (Optometry Act, 1991), Schedule 1. e-Laws currency date checked: 2026-10-19 (last amendment O. Reg. 17/17). Regulations change: always check the current regulation.
Why Ontario's rules matter for the TPAO
The TPAO (Therapeutics Prescribing Assessment for Optometry) is built on the scope of an Ontario optometrist, whatever province you plan to work in. Many questions hinge less on the best drug than on whether an Ontario optometrist may prescribe it, for how long, and when the patient must be referred.
The rules of the regulation
- Training. No drug may be prescribed without the pharmacology training approved by the College's Council (s. 3).
- Recording. Every prescription must be recorded in the health record with the drug, dosage and route, and the counselling given (s. 4).
- Non-prescription drugs. Any drug that can lawfully be bought without a prescription may be recommended in the course of practice (s. 5).
- Glaucoma drugs. Glaucoma may only be treated with drugs in the Antiglaucoma Agents category (s. 6).
- Primary open-angle glaucoma. May be treated by the optometrist when not complicated by a concurrent medical condition or a potentially interacting drug (s. 7(1)).
- Complicated open-angle glaucoma. Only in collaboration with an ophthalmologist with whom a co-management model of care has been established (s. 7(2)).
- Any other glaucoma. Refer immediately to a physician or hospital (s. 8(1)).
- Angle-closure glaucoma. Treatment may be started only in an emergency when no physician is available; refer immediately once the emergency ends or a physician becomes available, whichever comes first (s. 8(2)–(3)).
Schedule 1: what may be prescribed
| Group | Route | Drugs | Limit |
|---|---|---|---|
| Antibacterials Anti-infective agents | Topical | azithromycin, besifloxacin, ciprofloxacin, erythromycin, framycetin, fusidic acid, gatifloxacin, gentamicin, moxifloxacin, ofloxacin, polymyxin B/gramicidin/neomycin, polymyxin B/neomycin/bacitracin, polymyxin B/trimethoprim, sulfacetamide, tetracycline, tobramycin | None stated |
| Antifungals Anti-infective agents | Topical | natamycin | None stated |
| Antivirals Anti-infective agents | Topical | trifluridine, acyclovir | None stated |
| Antibacterials Anti-infective agents | Oral | amoxicillin, amoxicillin/clavulanic acid, azithromycin, cephalexin, ciprofloxacin, clarithromycin, clindamycin, cloxacillin, doxycycline, erythromycin, levofloxacin, minocycline, moxifloxacin, tetracycline | Corneal or eyelid infections only, for no more than 14 days |
| Antivirals Anti-infective agents | Oral | acyclovir, famciclovir, valacyclovir | Corneal or eyelid infections only |
| Corticosteroids Anti-inflammatory agents | Topical | dexamethasone, difluprednate, fluorometholone, loteprednol, prednisolone, rimexolone | None stated |
| Corticosteroids Anti-inflammatory agents | Topical | triamcinolone | Conditions of the eye and adnexa |
| Immunomodulators Anti-inflammatory agents | Topical | cyclosporine | None stated |
| NSAIDs Anti-inflammatory agents | Topical | bromfenac, diclofenac, ketorolac, nepafenac | None stated |
| Antibacterial–corticosteroid combinations Anti-infective / anti-inflammatory | Topical | framycetin/gramicidin/dexamethasone, gentamicin/betamethasone, neomycin/fluorometholone, neomycin/polymyxin B/dexamethasone, neomycin/bacitracin/polymyxin B/hydrocortisone, sulfacetamide/prednisolone, tobramycin/dexamethasone | None stated |
| Mydriatics and cycloplegics Mydriatics | Topical | atropine, cyclopentolate, homatropine, tropicamide | None stated |
| Anti-allergic agents Anti-allergic agents | Topical | bepotastine, emedastine, ketotifen, levocabastine, lodoxamide, nedocromil, olopatadine | None stated |
| Anti-allergic agents Anti-allergic agents | Topical | tacrolimus | Conditions of the eye and adnexa, for no more than 42 days |
| Beta-blockers Antiglaucoma agents | Topical | betaxolol, levobunolol, timolol | None stated |
| Carbonic anhydrase inhibitors Antiglaucoma agents | Topical | brinzolamide, dorzolamide | None stated |
| Miotics Antiglaucoma agents | Topical | carbachol, pilocarpine | None stated |
| Prostaglandin analogues Antiglaucoma agents | Topical | bimatoprost, latanoprost, tafluprost, travoprost | None stated |
| Alpha-adrenergic agonists Antiglaucoma agents | Topical | apraclonidine, brimonidine | None stated |
| Fixed combinations Antiglaucoma agents | Topical | brimonidine/timolol, brinzolamide/timolol, dorzolamide/timolol, latanoprost/timolol, travoprost/timolol | None stated |
| Carbonic anhydrase inhibitor Antiglaucoma agents | Oral | acetazolamide | To lower intraocular pressure only, and the patient must be referred immediately to a physician or hospital |
| Secretagogue Secretagogues | Oral | pilocarpine | Sjögren's syndrome only, in collaboration with a physician under an established co-management model of care |
Scope traps that appear on exams
- No oral corticosteroids: giant cell arteritis, optic neuritis and severe inflammation are referred.
- Oral antibacterials are for corneal or eyelid infections and 14 days at most, so long-term doxycycline or azithromycin for MGD or rosacea is outside scope.
- Oral acetazolamide is the only oral CAI listed (no methazolamide), and its use always triggers an immediate referral.
- Lifitegrast, netarsudil and latanoprostene bunod are not on Schedule 1.
- Topical anaesthetics are for in-office use; they are not listed for prescribing.
- Tacrolimus is limited to 42 days.
Practise it
Every TPAO case in IGOEE Prep includes scope questions, and the app has a searchable Schedule 1 browser. Try a sample TPAO case.
Questions
Can an Ontario optometrist prescribe oral antibiotics?
Yes, but only the oral antibacterials listed in Schedule 1, only for corneal or eyelid infections, and for no more than 14 days. Long-term doxycycline or azithromycin for meibomian gland dysfunction or rosacea falls outside that limit.
Can an Ontario optometrist prescribe oral corticosteroids?
No. No oral corticosteroid is on Schedule 1, so conditions such as giant cell arteritis or severe inflammation needing systemic steroids are referred.
Which glaucoma can an Ontario optometrist treat?
Uncomplicated primary open-angle glaucoma may be treated by the optometrist. Complicated open-angle glaucoma only in collaboration with an ophthalmologist under a co-management model; any other glaucoma must be referred immediately. Angle closure may be treated only in an emergency when no physician is available, with immediate referral.
Can optometrists in Ontario prescribe oral acetazolamide?
Only to lower intraocular pressure, and the patient must be referred immediately to a physician or hospital.
Are topical anesthetics on Schedule 1?
No. They are for in-office use and aren't listed for prescribing.