Transcript Onset and duration of action

Topical Anesthetics
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useful for diagnostic and therapeutic
procedures, including tonometry, removal of
foreign bodies or sutures, gonioscopy,
conjunctival scraping, and minor surgical
operations on the cornea and conjunctiva
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Proparacaine, tetracaine, and benoxinate are
the most commonly used topical anesthetics.
equivalent anesthetic potency
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Note:
Topical anesthetics should never be prescribed for
home use, since prolonged application may
cause corneal complications
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Proparacaine Hydrochloride (Ophthaine)
Preparation: Solution, 0.5%.
Dosage: 1 drop and repeat as necessary. Onset
and duration of action: Anesthesia begins within
20 seconds and lasts 10–15 minutes.
Comment: Least irritating of the topical
anesthetics.
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Tetracaine Hydrochloride (Pontocaine)
Preparations: Solution, 0.5%, and ointment,
0.5%.
Onset and duration of action: Anesthesia occurs
within 1 minute and lasts for 15–20 minutes.
Comment: Stings considerably on instillation
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Benoxinate Hydrochloride
Preparation (as Fluress): Solution, 0.4%.
Onset and duration of action: Anesthesia begins
within 1 or 2 minutes and lasts for 10–15
minutes.
Local Anesthetics
for Injection
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Lidocaine, procaine, and mepivacaine are
commonly used local anesthetics for eye
surgery.
Longer-acting agents such as bupivacaine and
etidocaine are often mixed with other local
anesthetics to prolong the duration of effect.
the physician must be aware of the potential
systemic toxic action when rapid absorption
occurs from the site of the injection, with
excessive dosage, or following inadvertent
intravascular injection
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The addition of hyaluronidase encourages
spreading of the anesthetic and shortens the onset
to as little as 1 minute. For these reasons,
hyaluronidase is commonly used in retrobulbar
and peribulbar injections prior to cataract
extraction.
Injectable anesthetics are used by
ophthalmologists most commonly in older
patients, who may be susceptible to cardiac
arrhythmias; therefore, l-epinephrine should not
be used in concentrations greater than 1:200,000
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Lidocaine Hydrochloride (Xylocaine)
Owing to its rapid onset and longer action (1–2 hours),
lidocaine has become the most commonly used local
anesthetic. It is approximately twice as potent as procaine.
Up to 30 mL of 1% solution, without epinephrine, may be
used safely. In cataract surgery, 15–20 mL is usually more
than adequate. The maximum safe dose is 4.5 mg/kg
without epinephrine and 7 mg/kg with epinephrine.
Intracameral lidocaine in a 1% solution without
preservatives is employed for anesthesia in cataract surgery.
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Procaine Hydrochloride (Novocaine)
Duration of action: 45–60 minutes.
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Mepivacaine Hydrochloride (Carbocaine)
Duration of action: Approximately 2 hours.
Comment: Carbocaine is similar to lidocaine in
potency.
It is usually used in patients who are allergic to
lidocaine.
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Bupivacaine Hydrochloride (Marcaine,
Sensorcaine)
Onset and duration of action: The onset of action
is slower than that of lidocaine, but it persists
much longer (up to 6–10 hours).
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Etidocaine Hydrochloride (Duranest)
Onset and duration of action: The onset of action
is slower than that of lidocaine but more rapid
than that of bupivacaine. The duration of
action is approximately twice as long as that of
lidocaine (4–8 hours).
Mydriatics &
Cycloplegics
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Mydriatics and cycloplegics both dilate the pupil.
In addition, cycloplegics cause paralysis of
accommodation .
Their prime uses are (1) for dilating the pupils to
facilitate ophthalmoscopy; (2) for paralyzing the
muscles of accommodation, particularly in young
patients, as an aid in refraction; and (3) for dilating
the pupil and paralyzing the muscles of
accommodation in uveitis to prevent synechia
formation and relieve pain and photophobia.
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Since mydriatics and cycloplegics both dilate
the pupil, they should be used with extreme
caution in eyes with narrow anterior chamber
angles since cause angle-closure glaucoma .
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Phenylephrine Hydrochloride (Neo-Synephrine)
Preparations: Solution, 0.12%, 2.5%, and 10%.
Onset and duration of action: The effect usually occurs within 30
minutes after instillation and lasts 2–3 hours.
Comment: facilitate ophthalmoscopy, in treatment of uveitis, and
to dilate the pupil prior to cataract surgery.
The 10% solution should not be used in newborn infants, in
cardiac patients, or in patients receiving reserpine, guanethidine,
or tricyclic antidepressants, because of increased susceptibility to
the vasopressor effects
Phenylephrine is a mydriatic with no cycloplegic effect
Cycloplegics
(Parasympatholytics)
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Preparations: Solution, 0.5–3%; ointment, 0.5% and 1%.
Dosage: For refraction in children, instill 1 drop of 0.25–
0.5% solution in each eye twice a day for 1 or 2 days
before the examination and then 1 hour before the
examination;
Onset and duration of action: The onset of action is
within 30–40 minutes. A maximum effect is reached in
about 2 hours. The effect lasts for up to 2 weeks .
cycloplegia in children, treatment of iritis. It is also
used to maintain a dilated pupil after intraocular
surgical procedures.
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Toxicity:
Atropine drops must be used with caution to
avoid toxic reactions resulting from systemic
absorption. Restlessness and excited behavior
with dryness and flushing of the skin of the
face, dry mouth, fever, inhibition of sweating,
and tachycardia are prominent toxic
symptoms, particularly in young children.
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Preparation: Solution, 0.25%.
Dosage: 1 drop two or three times daily.
Onset and duration of action: Cycloplegia occurs
in about 40 minutes and lasts for 3–5 days
when scopolamine is used as an aid to
refraction .
Toxicity: dizziness and disorientation, mainly
in older people.
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Preparations: Solution, 2% and 5%.
Dosage: For refraction, 1 drop in each eye and
repeat two or three times at intervals of 10–15
minutes.
Onset and duration of action: Maximal cycloplegic
effect lasts for about 3 hours, but complete
recovery time is about 36–48 hours. In certain
cases, the shorter action is an advantage over
scopolamine and atropine.
Toxicity: Sensitivity and side effects associated
with the topical instillation of homatropine are
rare.
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Preparations: Solution, 0.5%, 1%, and 2%.
Dosage: For refraction, 1 drop in each eye and
repeat after 10 minutes.
Onset and duration of action: The onset of dilatation
and cycloplegia is within 30–60 minutes. The
duration of action is less than 24 hours.
Comment: Cyclopentolate is more popular than
homatropine and scopolamine in refraction
because of its shorter duration of action
Occasionally, neurotoxicity may occur, manifested
by incoherence, visual hallucinations, slurred
speech, and ataxia. These reactions are more
common in children.
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Preparations: Solution, 0.5% and 1%; 0.25% with 1%
hydroxamphetamine hydrobromide (Paremyd).
Dosage: 1 drop of 1% solution two or three times at
5-minute intervals.
Onset and duration of action: The time required to
reach the maximum cycloplegic effect is usually
20–25 minutes, and the duration of this effect is
only 15–20 minutes; therefore, the timing of the
examination after instilling tropicamide is
important. Complete recovery requires 5–6 hours.
Comment: Tropicamide is an effective mydriatic
with weak cycloplegic action and is therefore most
useful for ophthalmoscopy.
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Preparations: Solution, 0.2% cyclopentolate
hydrochloride and 1% phenylephrine hydrochloride.
Dosage: 1 drop every 5–10 minutes for two or three
doses.
Onset and duration of action: Mydriasis and some
cycloplegia occur within the first 3–6 minutes. The
duration of action is usually less than 24 hours.
This drug combination is of particular value for
pupillary dilation in examination of premature and
small infants
Glaucoma
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The concentration used and the frequency of
instillation should be individualized on the
basis of tonometric measurements. Use the
smallest dosage that effectively controls the
intraocular pressure and prevents optic nerve
damage.
All parasympathomimetics decrease
intraocular pressure by increasing the outflow
of aqueous humor through the trabecular
meshwork.
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Pilocarpine Hydrochloride & Nitrate
Comment: Pilocarpine was introduced in 1876
and is still a commonly used antiglaucoma
drug.
Carbachol, Topical
Comment: Carbachol is poorly absorbed
through the cornea and usually is used if
pilocarpine is ineffective.
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Physostigmine Salicylate & Sulfate (Eserine)
Comment: A high incidence of allergic reactions has limited the
use of this old and seldom-used antiglaucoma drug. The miosis
produced is extreme; ciliary spasm and myopia are common.
Local irritation is common, and phospholine iodide is believed to
be cataractogenic in some patients. Pupillary block may occur.
Echothiophate Iodide (Phospholine Iodide)
Systemic toxicity may occur in the form of cholinergic stimulation,
including salivation, nausea, vomiting, and diarrhea. Ocular side
effects include cataract formation, spasm of accommodation, and
iris cyst formation.
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Demecarium Bromide (Humorsol)
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Epinephrine has the advantages of long
duration of action (12–72 hours) and no miosis,
which is especially important in patients with
incipient cataracts (effect on vision not
accentuated).
effects on both alpha and beta receptor sites.
primarily acts by increasing outflow of
aqueous humor. However, it also has an ability
to decrease production of aqueous humor
following long-term use.
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Apraclonidine Hydrochloride (Iopidine)
Preparation: Solution, 0.5% and 1%. Dosage: 1 drop of 1% solution before anterior segment
laser treatment and a second drop upon completion of the procedure. One drop of 0.5%
solution two or three times a day as short-term adjunctive treatment in glaucoma
patients receiving other medications.
Comment: applied topically for prevention and management of intraocular pressure
elevations after anterior segment laser procedures. It is also used as adjunctive therapy
in patients on maximally tolerated medical therapy who need further reduction of
intraocular pressure.
Apraclonidine lowers intraocular pressure by decreasing aqueous humor formation. It
may also improve aqueous outflow. Unlike clonidine, apraclonidine does not appear to
penetrate blood-tissue barriers easily and produces few side effects. The reported
systemic side effects include occasional decreases in diastolic blood pressure,
bradycardia, and central nervous system symptoms of insomnia, irritability, and
decreased libido.
Ocular side effects include conjunctival blanching, upper lid elevation, mydriasis, and
burning.
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Brimonidine Tartrate (Alphagan-P)
relatively specific alpha 2 adrenergic agonist that
lowers intraocular pressure by decreasing aqueous
production and perhaps also by increasing outflow
through the uveoscleral pathway. It has only
minimal effect on heart rate and blood pressure.
Preparation: Solution, 0.15%. Dosage: 1 drop two or
three times daily. Frequently used as a
replacement drug in patients unable to tolerate
beta-blockers.
Toxicity: Dry mouth, stinging, and redness are the
most common side reactions.
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Timolol Maleate (Timoptic; Timoptic XE, Betimol)
Preparations: Solution, 0.25% and 0.5%; gel, 0.25% and 0.5%.
Dosage: 1 drop of 0.25% or 0.5% in each eye once or twice daily if
needed. One drop of gel once daily.
Comment: nonselective beta-adrenergic blocking agent applied
topically for treatment of open-angle glaucoma, aphakic
glaucoma, and some types of secondary glaucoma. A single
application can lower the intraocular pressure for 12–24 hours.
Timolol has been found to be effective in some patients with
severe glaucoma inadequately controlled by maximum tolerated
antiglaucoma therapy with other drugs. The drug does not affect
pupillary size or visual acuity.
Although timolol is usually well tolerated, it should be prescribed
cautiously for patients with known contraindications to systemic
use of beta-adrenergic blocking drugs (eg, asthma, heart failure).
Systemic Side Effects of Timolol
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If the lacrimal outflow system is functioning, an estimated 80% of
a timolol eye drop is absorbed from the nasal mucosa and passes
almost directly into the vascular system. This is called the firstorder pass effect and is true for all drugs that can be easily
absorbed through mucosal tissue in the head.
whereas if given orally, its first pass includes absorption via the
gastrointestinal tract and then the liver, where 80–90% is
detoxified before reaching the right atrium.
Cardiopulmonary histories should be taken for candidates of betablocker glaucoma therapy. Pulmonary function studies should be
considered in patients with bronchoconstrictive disease, and
electrocardiograms should be ordered on selected patients with
cardiac disease. Patients with known bronchial asthma, chronic
respiratory or cardiovascular disease, or sinus bradycardia may
need screening before using timolol.
The drug should be used with caution in patients receiving other
systemic beta-blocking agents.
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Betaxolol Hydrochloride (Betoptic; Betoptic S)
Comment: Its relative 1 receptor selectivity reduces the risk
of pulmonary side effects, particularly in patients with
reactive airway disease.
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Levobunolol Hydrochloride (Betagan)
Comment: Levobunolol is a nonselective 1 and 2 blocker.
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Metipranolol Hydrochloride (Optipranolol)
Comment: Metipranolol is a nonselective 1 and 2 blocker .
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Carteolol Hydrochloride (Ocupress)
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Inhibition of carbonic anhydrase in the ciliary body reduces the secretion
of aqueous.
useful in reducing the intraocular pressure in selected cases of open-angle
glaucoma and can be used with some effect in angle-closure glaucoma.
sulfonamide derivatives. Oral administration produces the maximum
effect in approximately 2 hours; intravenous administration, in 20
minutes. The duration of maximal effect is 4–6 hours following oral
administration.
in patients whose intraocular pressure cannot be controlled with eye
drops.
They are valuable for this purpose but have many undesirable side
effects, including potassium depletion, gastric distress, diarrhea,
exfoliative dermatitis, renal stone formation, shortness of breath, fatigue,
acidosis, and tingling of the extremities.
Since the advent of timolol, topical carbonic anhydrase inhibitors, other
newer glaucoma medications, and laser therapy, systemic carbonic
anhydrase inhibitors are being used less frequently.
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Acetazolamide (Diamox)
Preparations and dosages: Oral: Tablets, 125 mg and
250 mg; give 125–250 mg two to four times a day
(dosage not to exceed 1 g in 24 hours). Sustainedrelease capsules, 500 mg; give 1 capsule once or
twice a day. Parenteral: May give 500-mg ampules
intramuscularly or intravenously for short periods
in patients who cannot tolerate the drug orally.
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Methazolamide (Neptazane)
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Dichlorphenamide (Daranide)
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Dorzolamide Hydrochloride (Trusopt)
Preparation: Solution, 2%. Dosage: 1 drop two to four
times daily.
Toxicity: Local reactions include burning and stinging,
superficial punctate keratopathy, and allergic reactions
of the conjunctiva. Bitter after-taste is common.
Systemic side reactions associated with oral carbonic
anhydrase agents are rare.
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Brinzolamide Ophthalmic Suspension (Azopt)
Preparation: Suspension, 1%.
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increasing outflow of aqueous humor, mainly via the uveoscleral
pathway.
Latanoprost (Xalatan)
Dosage: 1 drop daily.
Travoprost (Travatan)
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Bimatoprost (Lumigan)
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Unoprostone Isopropyl (Rescula)
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Dosage: Two drops daily.
Toxicity: All four preparations are associated with increased brown pigmentation of the
iris, conjunctival hyperemia, punctate epithelial keratopathy, and a foreign body
sensation.
In addition, they may aggravate ocular inflammation and have been associated with the
development of cystoid macular edema.
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improve compliance but not necessarily resulting in as large
a reduction in intraocular pressure as expected from
summation of the effects of the individual agents
administered separately.
Xalacom (latanoprost 0.005% and timolol 0.5%) once daily
in the morning,
Cosopt (dorzolamide 2% and timolol 0.5%) twice daily
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Combigan (brimonidine 0.2% and timolol 0.5%) twice daily,
Duotrav (travoprost 0.004% and timolol 0.5%) once daily,
Ganfort (bimatoprost 0.03% and timolol 0.5%) once daily
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reduce intraocular pressure by making the plasma hypertonic to aqueous humor.
in the management of acute (angle-closure) glaucoma and occasionally in preoperative
or postoperative surgery when reduction of intraocular pressure is indicated. The dosage
for all is approximately 1.5 g/kg.
Glycerin (Osmoglyn)
Preparations and dosage: Glycerin is usually given orally as 50% solution with water,
orange juice, or flavored normal saline solution over ice .
Onset and duration of action: Maximum hypotensive effect occurs in 1 hour and lasts 4–5
hours. Toxicity: Nausea, vomiting, and headache occasionally occur.
Comment: Oral administration and the absence of diuretic effect are significant
advantages of glycerin over the other hyperosmotic agents.
Isosorbide (Ismotic)
Comment: Unlike glycerin, isosorbide does not produce calories or elevated blood sugar.
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Mannitol (Osmitrol)
Preparation: 5–25% solution for injection. Dosage: 1.5–2 g/kg intravenously, usually in
20% concentration.
Onset and duration of action: Maximum hypotensive effect occurs in about 1 hour and lasts
5–6 hours.
Comment: Problems with cardiovascular overload and pulmonary edema are more
common with this agent because of the large fluid volumes required.
Urea (Ureaphil)
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Toxicity: Accidental extravasation at the injection site may cause local reactions ranging
from mild irritation to tissue necrosis.
Topical
Corticosteroids
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Indications
inflammatory conditions of the anterior segment of the globe: allergic conjunctivitis,
uveitis, episcleritis, scleritis, phlyctenulosis, superficial punctate keratitis, interstitial
keratitis, and vernal conjunctivitis.
Administration & Dosage
The corticosteroids and certain derivatives vary in their anti-inflammatory activity. The
relative potency of prednisolone to hydrocortisone is 4 times; of dexamethasone and
betamethasone, 25 times.
The duration of treatment will vary with the type of lesion and may extend from a few
days to several months.
Initial therapy for a severely inflamed eye consists of instilling drops every 1 or 2 hours
while awake. When a favorable response is observed, gradually reduce the dosage and
discontinue as soon as possible.
Caution: Side effects of local steroid therapy are exacerbation of herpes
simplex keratitis, fungal keratitis, cataract formation (unusual), and open-angle
glaucoma (common). These effects are produced to a lesser degree with systemic steroid
therapy. Any patient receiving topical ocular corticosteroid therapy or long-term
systemic corticosteroid therapy should be under the care of an ophthalmologist
Nonsteroidal Anti-Inflammatory
Agents
(NSAIDs)
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Oral NSAIDs—indomethacin 75 mg daily, flurbiprofen 150 mg daily, or
ibuprofen 600 mg daily—are the first-line treatment for scleritis. Gastric
irritation and hemorrhage are a risk.
Topical ophthalmic preparations of several NSAIDs provide ocular
bioavailability with little toxicity. These agents act primarily by blocking
prostaglandin synthesis through inhibition of cyclooxygenas.
flurbiprofen (Ocufen), and suprofen (Profenal) : for inhibition of miosis
during cataract surgery.
Ketorolac (Acular): seasonal allergic conjunctivitis.
Diclofenac (Voltaren) and ketorolac (Acular) were the first topically
applied NSAIDs approved for treatment of postoperative inflammation
following cataract surgery and for relief of pain and photophobia in
patients undergoing laser corneal refractive surgery.
In addition, two new topically applied NSAIDs, nepafenac suspension
(Nevanac) and Bromfenac solution (Xibrom), are now commercially
available.
topically applied NSAIDs are often used to prevent and treat cystoid
macular edema following cataract surgery.
Other Drugs Used
in the Treatment of
Allergic Conjunctivitis
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Cromolyn Sodium (Crolom)
Preparation: Solution, 4%. Dosage: 1 drop four to six times a day.
Comment: Cromolyn is useful in the treatment of many types of allergic conjunctivitis.
Response to therapy usually occurs within a few days but sometimes not until treatment
is continued for several weeks.
Cromolyn acts by inhibiting the release of histamine and slow-reacting substance of
anaphylaxis (SRS-A) from mast cells. It is not useful in the treatment of acute symptoms.
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Ketotifen Fumarate (Zaditor)
Dosage: Twice daily.
Comment: Ketotifen has antihistamine and mast cell–stabilizing activity.
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Lodoxamide Tromethamine (Alomide)
Dosage: 1 drop four times a day.
Comment: Lodoxamide is a mast cell stabilizer . It is indicated in the treatment of allergic
reactions of the external ocular tissues, including vernal conjunctivitis and vernal
keratitis. As with cromolyn, a therapeutic response does not usually occur until after a
few days of treatment.
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Nedocromil Sodium (Alocril)
Comment: rapid onset of an antihistamine and true mast cell–stabilizing
activity.
Olapadine Hydrochloride (Patanol)
Comment: Olapatadine has both antihistamine and mast cell–stabilizing
actions.
Levocabastine Hydrochloride (Livostin)
Comment: selective, potent histamine H1-receptor antagonist. It is useful in
reducing acute symptoms of allergic conjunctivitis. Relief of symptoms
occurs within minutes after application and lasts up to 2 hours.
Emedastine Difumarate (Emadine)
H1-antagonist
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Ketorolac Tromethamine (Acular)
only cyclooxygenase inhibitor approved for allergy by the FDA.
Vasoconstrictors & Decongestants
Anti-Infective
Ophthalmic Drugs
Topical Antibiotic
Solutions &
Ointments
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Bacitracin
Most gram-positive organisms are sensitive to bacitracin.
It is not used systemically because of its nephrotoxicity.
Erythromycin
particularly in staphylococcal conjunctivitis.
It may be used instead of silver nitrate in prophylaxis of
ophthalmia neonatorum.
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Neomycin
It is best known in ophthalmologic practice as Neosporin, in
which it is combined with polymyxin and bacitracin.
Contact skin sensitivity develops in 5% of patients if the drug is
continued for longer than a week.
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Polymyxin B
Effective against many gram-negative organisms.
Topical
Preparationsof
Systemic Antibiotics
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Topical use of the antibiotics commonly used
systemically should be avoided if possible
because sensitization of the patient may
interfere with future systemic use.
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Tetracyclines
limited uses in ophthalmology because their effectiveness is so often
impaired by the development of resistant strains. Ointment may be used
for prophylaxis of ophthalmia neonatorum.
Gentamicin (Garamycin, Genoptic, Gentacidin, Gentak)
corneal ulcers caused by gram-negative organisms. It is also effective
against many gram-positive staphylococci but is not effective against
streptococci.
Tobramycin (Tobrex, Aktop)
Similar antimicrobial activity to gentamicin but more effective against
streptococci. Best reserved for treatment of pseudomonas keratitis, for
which it is more effective.
Chloramphenicol (Chloromycetin, Chloroptic)
effective against a wide variety of gram-positive and gram-negative
organisms.
aplastic anemia have been associated with long-term therapy.
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Ciprofloxacin (Ciloxan)
For treatment of conjunctivitis, 1 drop every 2–4 hours. For
treatment of corneal ulcers, 1 drop every 15–30 minutes for
the first day, 1 drop every hour the second day, and 1 drop
every 4 hours thereafter.
Gatifloxacin (Zymar)
This fourth-generation fluoroquinolone is more effective
against a broader spectrum of gram-positive bacteria and
atypical mycobacteria than earlier fluoroquinolones.
Moxifloxacin (Vigamox)
fourth-generation fluoroquinolone
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mixture of antibiotics and bacteriostatic agents
Sulfonamides
most commonly used drugs in the treatment of
bacterial conjunctivitis. Their advantages include (1)
activity against both gram-positive and gram-negative
organisms, (2) relatively low cost, (3) low allergenicity,
and (4) the fact that their use is not complicated by
secondary fungal infections
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Sulfacetamide Sodium
Topical Antifungal
Agents
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Natamycin (Natacyn)
Initial drug of choice for most mycotic corneal ulcers.
Nystatin (Mycostatin)
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Nystatin is not available in ophthalmic ointment form, but the
dermatologic preparation (100,000 U/g) is not irritating to ocular tissues
and can be used in the treatment of fungal infection of the eye.
Amphotericin B (Fungizone)
more effective than nystatin but not available in ophthalmic ointment
form. Many patients have extreme ocular discomfort following
application of this drug.
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Miconazole (Monistat)
in the form of an intravenous preparation that may be instilled directly
into the eye.
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Fluconazole (Diflucan)
Antiviral Agents
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Idoxuridine (Herplex)
Used in the treatment of herpes simplex keratitis.
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Vidarabine (Vira-A)
In herpetic epithelial keratitis, apply four times daily for 7–10 days. It
is effective in some patients unresponsive to idoxuridine. interferes with
viral DNA synthesis. The drug is effective against herpetic corneal
epithelial disease and has limited efficacy in stromal keratitis or uveitis. It
may cause cellular toxicity and delay corneal regeneration. The cellular
toxicity is less than that of idoxuridine.
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Trifluridine (Viroptic)
Acts by interfering with viral DNA synthesis. More soluble than either
idoxuridine or vidarabine and probably more effective in stromal disease.
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Acyclovir (Zovirax)
Preparations: 200, 400, and 800 mg. Comment: Acyclovir is an antiviral
agent with inhibitory activity against herpes simplex types 1 and 2,
varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus. which
inhibits viral DNA polymerase.
Acyclovir has low toxicity.
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Ganciclovir (Vitrasert)
Preparation: Intravitreal implant, 4.5 mg.
Comment: treatment of cytomegalovirus
retinitis without the adverse effects of systemic
therapy.
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Fluorescein Sodium
for detection of corneal epithelial defects, in
applanation tonometry, and in fitting contact
lenses.
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Rose Bengal
Used in diagnosis of keratoconjunctivitis sicca;
the mucous shreds and devitalized corneal
epithelium stain with rose bengal.
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Methylcellulose and related chemicals,
polyvinyl alcohol and related chemicals, and
gelatin are used in the formulation of artificial
tears, ophthalmic lubricants, contact lens
solutions, and gonioscopic lens solutions.
These agents are particularly useful in the
treatment of keratoconjunctivitis sicca
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The active ingredients in these agents usually
are either ephedrine , naphazoline ,
phenylephrine
constrict the superficial vessels of the
conjunctiva and relieve redness.
They also relieve minor surface irritation and
itching of the conjunctiva, which can represent
a response to noxious or irritating agents such
as smog, swimming pool chlorine, etc.
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reduce corneal edema by creating an osmotic
gradient in which the tear film is made
hypertonic to the corneal tissues. Temporary
clearing of corneal edema results.
Preparations: Anhydrous glycerin solution
(Ophthalgan); hypertonic sodium chloride 2%
and 5% ointment and solution (Absorbonac,
Ak-NaCl, Hypersal, Muro-128).
Ocular & Systemic
Side Effects of
Drugs

One important principle in avoiding systemic
side effects from topical ophthalmic
medications is to prevent overdosing. The
physician should prescribe the lowest
concentration of medication that will be
therapeutically effective
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The eyelids should be kept closed for 3 minutes
to prevent blinking.
The patient receiving multiple topical
medications should wait 10 minutes between
doses so that the first drug will not be washed
out of the eye by the second.