Ocular therapeutics

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A volatile presentation covering almost all ocular drugs,...Hope it to be useful to you all,.. Haven't presented it yet to my department

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Ocular therapeutics

  1. 1. Ocular Therapeutics Ocular Therapeutics Dr Rajvin Samuel Ponraj
  2. 2. Pharmacodynamics <ul><li>Study of mechanisms of drug effects </li></ul><ul><li>Receptor - special types </li></ul><ul><li>based on transduction of signal </li></ul><ul><li>Regulation of receptors – Down regulation </li></ul><ul><li>Up regulation </li></ul><ul><li>Therapeutic index </li></ul>
  3. 3. Pharmacokinetics <ul><li>Quantitative study of drug movement in, through and out of the body </li></ul>
  4. 4. Transport across cell membrane <ul><li>Passive transport </li></ul><ul><li>Specialized transport </li></ul><ul><li>First Pass metabolism </li></ul><ul><li>Bioavailabilty </li></ul>
  5. 5. Distribution <ul><li>Barriers concerned with distribution </li></ul><ul><ul><li>Blood aqueous barrier </li></ul></ul><ul><ul><li>Blood retinal barrier </li></ul></ul><ul><ul><li>Corneal barrier </li></ul></ul><ul><ul><li>Tissue binding </li></ul></ul><ul><ul><li>Tissue perfusion </li></ul></ul>
  6. 6. Biotransformation <ul><li>Phase 1 reactions </li></ul><ul><li>Phase 2 reactions </li></ul>
  7. 7. Excretion of drugs <ul><li>Elimination kinetics - First order kinetics </li></ul><ul><li>Zero order kinetics </li></ul><ul><li>Clearance </li></ul><ul><li>Half life </li></ul>
  8. 8. ADVERSE DRUG EFFECTS <ul><li>SIDE EFFECTS </li></ul><ul><li>TOXIC EFFECTS </li></ul><ul><li>INTOLERANCE </li></ul><ul><li>TERATOGENICITY </li></ul>
  9. 9. Routes of administration <ul><li>Local topical </li></ul><ul><li>Periocular </li></ul><ul><li>Intraocular </li></ul><ul><li>Systemic oral </li></ul><ul><li>injection </li></ul>
  10. 10. Topical drug methods <ul><li>Eye drops </li></ul><ul><li>Eye ointment </li></ul><ul><li>Gels </li></ul><ul><li>Ocuserts </li></ul><ul><li>Soft contact lens </li></ul>
  11. 11. Drug penetration <ul><li>Topically : -Lipid and water solubility </li></ul><ul><li>-Contact time , viscosity , </li></ul><ul><li>- isotonicity </li></ul><ul><li>Systemically : - Lipid solubility </li></ul><ul><li>- eye inflammation </li></ul><ul><li>- protein binding </li></ul><ul><li>-molecular weight </li></ul>
  12. 12. Ocular anaesthetics <ul><li>MOA :- Reduce nerve impulse conduction by reducing membrane </li></ul><ul><li>to sodium ions. </li></ul><ul><li>Common local anaestheitics :- </li></ul><ul><li>Ester type = Tetracaine 0.5 % , propacaine 0.75 % </li></ul><ul><li>Amide type = Lidocaine 2 % , Bupivacaine 0.75 % </li></ul>
  13. 13. Topical anaesthetic <ul><li>Aim :- To block nerves of superficial cornea </li></ul><ul><li>Advantages :- No needle insertion </li></ul><ul><li>No haemorrage </li></ul><ul><li>Systemic anticoagulants can use </li></ul><ul><li>Patient alert </li></ul><ul><li>Disadvantages :- No akinesia </li></ul><ul><li>Not adequate anaesthesia </li></ul><ul><li>Adv effects :- Corneal stinging ,epithelial & endothelial toxicity </li></ul><ul><li>Allergy & contact dermatitis </li></ul><ul><li>Contraindications :- Nystagmus , uncooperative patients </li></ul>
  14. 14. Retrobulbar block <ul><li>Aim :- To block 3 rd cranial nerve in posterior intraconal space </li></ul><ul><li>Site of injection :- Above inferior orbital rim </li></ul><ul><li>midway of lateral canthus & temporal limbus </li></ul><ul><li>Advantages :- Excellent akinesia </li></ul><ul><li>quick onset of block </li></ul><ul><li>Disadvantages:- High complication rate </li></ul><ul><li>Complications :- Retrobulbar Haemorrhage </li></ul><ul><li>Globe perforation </li></ul><ul><li>Optic nerve contusion </li></ul><ul><li>Oculocardiac reflex </li></ul><ul><li>Respiratory depression </li></ul>
  15. 16. Peribulbar block <ul><li>Aim :- To block extraconally the nerves </li></ul><ul><li>Site of injection :- midway b/w temporal limbus & lateral canthus </li></ul><ul><li>-Inferomedial to superior orbital notch </li></ul><ul><li>Advantages :- All that of retrobulbar block </li></ul><ul><li>Less complications </li></ul><ul><li>Disadvantages :- More than one injection needed </li></ul><ul><li>Only good akinesia , anesthesia </li></ul><ul><li>Longer time for anesthesia </li></ul><ul><li>Chemosis </li></ul>
  16. 18. Sub tenon’s block <ul><li>At 1 or 2 ‘0’ clock positions from corneal limbus [7-8 mm away] </li></ul><ul><li>Using a 30 mm radius flexible cannula after perforating conjunctiva </li></ul><ul><li>Passed beyond equator b/w tenon’s capsule & sclera </li></ul><ul><li>Most frequent site is inferotemporal . </li></ul>
  17. 19. Intraocular injections <ul><li>Intracameral or intravitreal </li></ul><ul><li>E.g. </li></ul><ul><ul><li>Intracameral acetylcholine (miochol) during cataract surgery </li></ul></ul><ul><ul><li>Intravitreal antibiotics in cases of endophthalmitis </li></ul></ul><ul><ul><li>Intravitreal steroid in macular edema </li></ul></ul><ul><ul><li>Intravitreal Anti-VEGF for DR </li></ul></ul>INTRA-OCULAR INJECTIONS
  18. 20. Mydriatics & Cycloplegics <ul><li>Anticholinergic drugs :- Atropine 1 % - 1 week </li></ul><ul><li>Homatropine 2 % - 24 hrs </li></ul><ul><li>Cyclopentolate 1 % - 24 hrs </li></ul><ul><li>Tropicamide 0.5 % - 4 hrs </li></ul><ul><li>Indications :- corneal ulcer , uveitis , cycloplegic refraction </li></ul><ul><li>Side effects :- blurry vision , photophobia ,precipitates </li></ul><ul><li>angle closure glaucoma </li></ul><ul><li>Sympathomimetics :- Phenylephrine 5 % </li></ul><ul><li>I ndications - Along with mydriatic in Preoperative </li></ul><ul><li>cataract preparation , fundus examination </li></ul><ul><li>Side effects - Stinging , rise in Blood pressure </li></ul>
  19. 21. Anti glaucoma drugs <ul><li>- B adrenergic blockers : </li></ul><ul><li>MOA - Reduce aqueous production – </li></ul><ul><li>down regulation of Adenylcyclase </li></ul><ul><li>Advan : NO pupil change, induced myopia </li></ul><ul><li>No headache, nor IOT fluctuation </li></ul><ul><li>Side eff : Stinging,burning ,allergy,.. </li></ul><ul><li>Bronchospasm,Heart block </li></ul><ul><li>Timolol – Non selective 0.5 % </li></ul><ul><li>Betaxolol - B 1 selective </li></ul>
  20. 22. <ul><li>MIOTICS : </li></ul><ul><li>Pilocarpine –cholinomimetic drug </li></ul><ul><li>MOA : increases tone of ciliary muscles </li></ul><ul><li>-pull trabecular meshwork - outflow of </li></ul><ul><li>aqueous </li></ul><ul><li>Advant : Rapid but short acting </li></ul><ul><li>Disadv : IOT fluctuation ,dim visual loss </li></ul><ul><li>Side eff : Spasm of accomadation ,brow ache, </li></ul><ul><li>git disturbances </li></ul><ul><li>0.5 % - drops , ocuserts, gel </li></ul>
  21. 23. Adrenergic agonists <ul><li>Epinephrine </li></ul><ul><li>MOA - On alpha , beta receptors – reduce aqueous formation </li></ul><ul><li>increases aqueous outflow </li></ul><ul><li>Side effects : Burning , stinging , Conjunctival </li></ul><ul><li>blanching , CME , Endothelial toxicity </li></ul><ul><li>follicular conjunctivitis [0.5 -2 %] </li></ul><ul><li>tachycardia , hypertension </li></ul><ul><li>Contradicted in aphakic & Closed angle glaucoma </li></ul><ul><li>Apraclonidine </li></ul><ul><li>MOA- On alpha 1,2 receptors –reduce aqueous formation </li></ul><ul><li>Side eff : Itching ,dryness in mouth, follicular </li></ul><ul><li>conjunctivitis, mydriasis </li></ul><ul><li>Use : to reduce IOT after laser trabeculoplasty </li></ul><ul><li>[0.25 – 1 %] </li></ul><ul><li>Brimonidine – alpha 2 selective </li></ul><ul><li>Side eff :- dryness in mouth ,fall in Bp, </li></ul>
  22. 24. Carbonic anhydrase inhibitors <ul><li>ACETAZOLAMIDE </li></ul><ul><li>MOA - inhibits bicarbonate ion production , osmotic gradient </li></ul><ul><li>reduce aqueous formation </li></ul><ul><li>Side effects – Paraesthesia, anorexia, malaise ,Gi irritation </li></ul><ul><li>Oral 0.25 gms BD </li></ul><ul><li>DORZOLAMIDE – 2 % DROPS </li></ul><ul><li>PROSTOGLANDINS </li></ul><ul><li>LATANOPROST </li></ul><ul><li>MOA – On prostanoid FB receptors Increase uveoscleral flow </li></ul><ul><li>& permeability of CBM </li></ul><ul><li>Side effects – eye irritation , pain, blurry vision </li></ul><ul><li>0.005 % drops </li></ul>
  23. 25. Hypertonic agents <ul><li>MOA - Raises the osmotic pressure to reduce intra ocular </li></ul><ul><li>pressure </li></ul><ul><li>Glycerol [ 10 % infusion / 1 gm /kg oral ] </li></ul><ul><li>Side effects : nauseating sweet taste ,diarrhoea,headache </li></ul><ul><li>Mannitol [ 20 % infusion ] </li></ul><ul><li>Side effects : Hypervolemia , pulmunory edema </li></ul>
  24. 26. Drugs during glaucoma surgery <ul><li>ANTIFIBROBLASTIC AGENTS – 5 FU & MITOMYCIN C </li></ul><ul><li>MOA -Inhibit collagen and protein synthesis by interfering with </li></ul><ul><li>DNA transcription and replication </li></ul><ul><li>Side effects : 5 FU – keratopathy </li></ul><ul><li>Mitomycin - scleral ulcer & iritis </li></ul><ul><li>Administration : 5 FU - 50 mg/ml Sponge / sub conjunctival </li></ul><ul><li>mitomycin – 0.5 mg/ml topically </li></ul>
  25. 27. Antibacterials <ul><li>PENICILLINS </li></ul><ul><li>MOA :- Bactericidal Destroys cell wall </li></ul><ul><li>[gram + , gram – cocci,spirochetes] </li></ul><ul><li>- penicillin G [1 lakh U/ml topical] </li></ul><ul><li>[0.5 M U/ ml sub conj inj ] </li></ul><ul><li>[5 M U / 4 hrs IV] </li></ul><ul><li>- Cloxacillin [penicillinase resistant] </li></ul><ul><li>[50-100 mg/kg] 6 hrly oral [staphylococci] </li></ul><ul><li>- Amoxycillin </li></ul><ul><li>[25-50 mg/kg] 6 hrly oral [ gram +,- bacteria] </li></ul><ul><li>Adverse eff :- Hypersensitivity reactions , rash ,.. </li></ul>
  26. 28. QUINOLONES <ul><li>MOA :- [ Bacterial ] Anti DNA gyrase – inhibits division & supercoiling </li></ul><ul><li>[gram -- bacteria , gram + bacteria ,chlamydia, mycoplasma] </li></ul><ul><li>- Ciprofloxacin :- 0.3 % topical , 500 mg BD oral , 5-10 mg/kg IV </li></ul><ul><li>200 mg /ml intravitreal </li></ul><ul><li>Uses :- Keratoconjunctivitis, ulcers,blepharitis, </li></ul><ul><li>dacryocystitis , infectious endoophthalmitis </li></ul><ul><li>S/E :- Arthropathy in children ,GIT irritation, </li></ul><ul><li>Photosensitivity ,rash, liver damage </li></ul><ul><li>- Gatifloxacin :- </li></ul>
  27. 29. CEPHALOSPORINS <ul><li>MOA :- Bactericidal – destroys cell wall </li></ul><ul><li>1 st generation :- gram + cocci & gram – bacilli </li></ul><ul><li>Cephazolin – 0.5 – 1 g/ml 8 hrly IM /IV </li></ul><ul><li>2000 ug Intravitreal , 100 mg S/C </li></ul><ul><li>Cefadroxil – 0.5 -1 g BD oral </li></ul><ul><li>S/E :- GIT disturbances ,hypoprothrombinemia </li></ul><ul><li>2 nd generation :- gram – bacteria ,some anaerobes </li></ul><ul><li>Cefuroxime axetil – 250-500 mg BD oral </li></ul><ul><li>Cefoxitin – 1-2 gm 8 hrly IM/IV </li></ul><ul><li>S/E :- GIT disturbances , migraines, headache </li></ul><ul><li>3 rd generation :- gram – bacteria </li></ul><ul><li>Cefixim – 200-400 mg bd oral </li></ul><ul><li>ceftazidim -1-2 gm 8 hrly IM/IV </li></ul><ul><li>S/E: diarrhoea , neutropenia, thrombocytopenia </li></ul>
  28. 30. <ul><li>4 th generation :- against many bacteria ,highly resistant to </li></ul><ul><li>B –lactamases </li></ul><ul><li>Cefepime & cefpirome :- 1-2 gm 8 hrly IM/IV </li></ul><ul><li>S/E : allergic reactions , breathing difficulty, </li></ul><ul><li>swelling of face ,.. </li></ul><ul><li>Uses :- along with aminoglycosides In endoophthalmitis and </li></ul><ul><li>bacterial corneal ulcers,.. </li></ul>
  29. 31. Chloramphenicol <ul><li>MOA :- Bacteriostatic , Inhibits Protein synthesis by binding </li></ul><ul><li>to 50 S ribosomal subunit </li></ul><ul><li>[gram +,- aerobes , chlamydia,ricketssia,mycoplasma] </li></ul><ul><li>0.5 % ointment, 50 mg /kg 4 times oral </li></ul><ul><li>2 mg/ml intravitreal </li></ul><ul><li>Uses :- Intraocular infections </li></ul><ul><li>Conjunctivitis </li></ul><ul><li>Side eff :- Bone marrow depression </li></ul><ul><li>Aplastic anemia , agranulocytosis </li></ul>
  30. 32. Tetracycline <ul><li>MOA :- Bacteriostatic - inhibits protein synthesis by binding to </li></ul><ul><li>30 S Ribosome </li></ul><ul><li>- 250-500 mg 4 hrly oral </li></ul><ul><li>- 1 % topical </li></ul><ul><li>Uses :- Chlamydial diseases </li></ul><ul><li>phlyctenular conjunctivitis </li></ul><ul><li>Toxoplasmosis </li></ul><ul><li>ocular rosacea </li></ul><ul><li>Side eff :- GIT disturbances </li></ul><ul><li>discolouration of teeth </li></ul><ul><li>photosensitivity , rashes </li></ul><ul><li>nephrotoxicity </li></ul>
  31. 33. AMINOGLYCOSIDES <ul><li>MOA :- Bacteriocidal - inhibits protein synthesis ,binding 30 S </li></ul><ul><li>ribosome sub unit </li></ul><ul><li>[gram negative bacteria & staph aureus </li></ul><ul><li>ADR : Ototoxicity , nephrotoxicity ,corneal , retinotoxicity,.. </li></ul><ul><li>Gentamycin :- 0.3 % drops, 20 mg sub conjunctival inj </li></ul><ul><li>200 ug/ml intravitreal inj </li></ul><ul><li>Uses :- Endoophthalmitis , ocular injuries ,retained FB </li></ul><ul><li>conjunctival necrosis </li></ul><ul><li>Amikacin :- 0.3 % drops , 15 mg / kg 8 hrly IV , 0.4 mg intravitreal </li></ul><ul><li>Uses :- along vancomycin in post op endophthalmitis </li></ul><ul><li>Tobramycin :- including proteus,pseudomonas </li></ul><ul><li>0.3 % drops , 3 - 5 mg /kg /day IV , 150-200 ug /ml </li></ul>
  32. 34. SULPHONAMIDES <ul><li>MOA :- Bacteriostatic - Inhibits folate synthesis </li></ul><ul><li>[PABA folic acid ] </li></ul><ul><li>[gram - ,+ bacteria] </li></ul><ul><li>Sulfacetamide , Sulfamethoxazole , sulfadiazine </li></ul><ul><li>Topically 10% ,20 % ,30 % drops </li></ul><ul><li>Oral 2-4 gm/day TDS </li></ul><ul><li>COTRIMOXAZOLE </li></ul><ul><li>MOA :- Inhibits Dihydro folate reductase in conversion of </li></ul><ul><li>DHF THF </li></ul><ul><li>Sulfamethoxazole [400 mg ] + trimethoprim [80 mg] </li></ul>
  33. 35. <ul><li>USES :- In trachoma </li></ul><ul><li>along with pyrimethamine in toxoplasmosis </li></ul><ul><li>S/E :- GIT disturbances , Hypersensitivity reactions , urticaria , </li></ul><ul><li>renal toxicity-crystalluria. </li></ul>
  34. 36. Antifungals <ul><li>Polyene antibiotics :- </li></ul><ul><li>MOA - Selective action on ergosterol of fungal cell membrane </li></ul><ul><li>forming micropores – increase permeability </li></ul><ul><li>Amphotericin B – Against yeast ,filamental fungi [0.25 % topical ] </li></ul><ul><li>[ 0.25 mg/kg oral] </li></ul><ul><li>Nystatin - against candida [ 1 lakh u/gm oint] </li></ul><ul><li>Natamycin – against candida , aspergillus ,fusarium [ 5 % suspension] </li></ul><ul><li>Uses in keratomycosis and endophthalmitis[5-10 ug intravitreal] </li></ul><ul><li>Common side effects : allergic hypersensitivity reactions </li></ul>
  35. 37. <ul><li>Imidazoles :- </li></ul><ul><li>MOA - Block fungal cytochrome P-450 enzyme in ergosterol </li></ul><ul><li>[increase permeability tru membrane] </li></ul><ul><li>Clotrimazole :- [1 % topical] </li></ul><ul><li>Miconazole :- [ 1 % drops,2 % oint, 5-10 mg sub conj ] </li></ul><ul><li>Ketoconazole :- [200-800 mg oral daily , 0.5 mg intravitreal] </li></ul><ul><li>Uses :- candida,fungal , endoophthalmitis </li></ul><ul><li>Side effect:- liver toxicity </li></ul><ul><li>Triazoles :- </li></ul><ul><li>Fluconazole - [100-200 mg oral] </li></ul><ul><li>[0.2% topical] </li></ul><ul><li>[0.1 mg intravitreal] </li></ul><ul><li>Uses :- Candida,cryptococcus </li></ul>
  36. 38. Anti virals <ul><li>PYRIMIDINE DERIVATIVES </li></ul><ul><li>Idoxuridine :- 0.1 % drops hrly / 0.5 % ointment </li></ul><ul><li>TRIFLUOROTHYMIDINE :- 1 % drops </li></ul><ul><li>MOA : By incorporation - inhibition of viral DNA synthesis </li></ul><ul><li>Uses :- Dendritic ulcer , herpes simplex keratoconjunctivitis </li></ul><ul><li>Side effects :- with corticosteroids – SPK, follicular conjunctivitis,.. </li></ul>
  37. 39. PURINE DERIVATIVES <ul><li>ADENINE ARABINOSIDE </li></ul><ul><li>MOA :- Blocking DNA synthesis of virus </li></ul><ul><li>Acyclovir - 3 % ointment , 400-800 mg 5 times/day a week </li></ul><ul><li>Uses :- EB virus, CMV ,Herpes zoster virus,.. </li></ul><ul><li>S/E :- Allergic reactions,.. </li></ul><ul><li>Valacyclovir - 1000 mg TDS </li></ul><ul><li>Famciclovir - 500 mg TDS </li></ul><ul><li>S/E :- GIT disturbances </li></ul><ul><li>Ganciclovir - 5-6 mg intravitreal inj , 5 mg IV </li></ul><ul><li>S/E :- bone marrow depression , rashes </li></ul>
  38. 40. Ocular antiallergics <ul><li>MOA – Competitive antagonist of H1 receptors </li></ul><ul><li>Uses - vernal keratoconjunctivitis , Giant papillary conjunctivitis </li></ul><ul><li>Allergic conjunctivitis </li></ul><ul><li>CPM – 4 times /day topical </li></ul><ul><li>Azelastine - 2 times/day </li></ul><ul><li>Loratadine/ cetrizine – at bed time </li></ul><ul><li>Mast cell stabilizers </li></ul><ul><li>MOA – Stabilizes mast cells and prevent release of histmaine </li></ul><ul><li>Cromolyn sodium [2-4 % ] 6 hrly </li></ul><ul><li>Olapatadine [0.1 % ] 12 hrly </li></ul>
  39. 41. Corticosteroids <ul><li>MOA : </li></ul>
  40. 42. <ul><li>In general : Anti inflammatory action - fibroblast formation </li></ul><ul><li>reduce capillary permeable </li></ul><ul><li>Topical steroids : </li></ul><ul><li>1 % prednisolone </li></ul><ul><li>0.1 % FML </li></ul><ul><li>0.1 % dexamethasone in conjunction to </li></ul><ul><li>antibiotic </li></ul><ul><li>Uses : </li></ul><ul><li>Allergic conjunctivitis , iritis, keratitis ,episcleritis </li></ul><ul><li>Injection steroids : </li></ul><ul><li>40 mg Triamcinolone acetate - periocular </li></ul><ul><li>1 mg dexamethasone - intravitreal </li></ul><ul><li>Uses : </li></ul><ul><li>Endoophthalmitis, Cysotid macular edema ,… </li></ul>
  41. 43. <ul><li>Oral steroids : </li></ul><ul><li>1 - 2 mg /kg /wt - orbital inflammation </li></ul><ul><li>post operative inflammation </li></ul><ul><li>panuveitis </li></ul><ul><li>Adverse drug reaction : </li></ul><ul><li>Prolonged use - posterior sub capsular cataract </li></ul><ul><li>glaucoma </li></ul>
  42. 44. NSAID <ul><li>E.g. ketorolac 0.5 % , flurbiprofen 0.03 %,.. </li></ul><ul><li>Mechanism: inactivation of cyclo-oxygenase </li></ul><ul><li>Uses: postoperatively </li></ul><ul><li>mild allergic conjunctivitis </li></ul><ul><li>episcleritis, mild uveitis, cystoid macular edema </li></ul><ul><li>Side effects: stinging , burning </li></ul>
  43. 45. Anti VEGF <ul><li>MOA : Inhibits vascular EGF in retinal ischaemia </li></ul><ul><li>Uses : Diabetic retinopathy , macular edema , ROP </li></ul><ul><li>ARMD </li></ul><ul><li>- Intravitreal inj - Pegaptanib [macugen ] </li></ul><ul><li>Ranibizumab [ lucentis ] </li></ul>
  44. 46. Drugs for dry eye <ul><li>Characteristics of ideal tear drops : </li></ul><ul><li>- Soothing effect </li></ul><ul><li>- proper wetting agent , viscious </li></ul><ul><li>- No epithelial toxicity </li></ul><ul><li>- Alkaline p H </li></ul><ul><li>MOA : mucomimetic - bind to corneal epithelium form </li></ul><ul><li>hydrophilic layer to stabilize tear film . </li></ul><ul><li>Hydroxy propyl methyl cellulose – 0.5 - 1 % </li></ul><ul><li>Polyvinyl alcohol -- 1.4 % </li></ul><ul><li>Carboxy methyl cellulose -- 0.5 % </li></ul>
  45. 47. Viscoelastics <ul><li>Properties - optical </li></ul><ul><li>- cohesive [ space maintaining </li></ul><ul><li>tissue manipulation in surgery] </li></ul><ul><li>- dispersive [ Coating ocular surface </li></ul><ul><li>protecting corneal endothelium </li></ul><ul><li>lower surface tension] </li></ul><ul><li>- Elasticity </li></ul><ul><li>Sodium hyaluronate 1 % </li></ul><ul><li>Sodium hyaluronate 3 % & chondroitin sulphate 4 % </li></ul><ul><li>Hydroxy propyl methyl cellulose 3 % </li></ul><ul><li>Uses :- </li></ul><ul><li>- In gonioscopy </li></ul><ul><li>- in intra ocular surgeries </li></ul>
  46. 48. IRRIGATING SOLUTIONS <ul><li>Characteristics of an ideal solution : </li></ul><ul><li>-- Maintain moisture of & cleanse ocular tissues </li></ul><ul><li>-- Isotonicity electrolyte and p H same as aqueous </li></ul><ul><li>-- Maintain pressure of globe </li></ul><ul><li>-- Protect delicate ocular structures </li></ul><ul><li>-- Endothelial nourishment </li></ul><ul><li>Available preparations :- Balanced salt solution[BSS] </li></ul><ul><li>BSS plus </li></ul><ul><li>Dextran containing soln </li></ul><ul><li>Glucose fortified BSS plus </li></ul><ul><li>USES :- Intraocular – in cataract surgery </li></ul><ul><li>Extraocular – FB removal,tonometry,gonioscopy </li></ul>
  47. 49. Ocular diagnostic drugs <ul><li>Fluorescein dye </li></ul><ul><ul><li>Available as drops or strips </li></ul></ul><ul><ul><li>Uses : stain corneal abrasions, applanation tonometry, detecting wound leak, NLD obstruction, fluorescein angiography </li></ul></ul><ul><ul><li>Caution: </li></ul></ul><ul><ul><ul><li>stains soft contact lens </li></ul></ul></ul><ul><ul><ul><li>Fluorescein drops can be contaminated by Pseudomonas sp. </li></ul></ul></ul>Ocular Diagnositic Drugs
  48. 50. <ul><li>Rose bengal stain </li></ul><ul><ul><li>Stains devitalized epithelium </li></ul></ul><ul><ul><li>Uses: severe dry eye, herpetic keratitis </li></ul></ul>
  49. 51. Ocular toxicology : <ul><li>Amiodarone :- Vortex keratopathy </li></ul><ul><li>Digitalis :- Chromatopsia [seeing yellow colour ] </li></ul><ul><li>Chloroquine :- Bull’s eye maculopathy </li></ul><ul><li>Ethambutol :- Optic neuropathy , colour vision disturbed </li></ul><ul><li>Corticosteroids :- Posterior sub capsular cataracts </li></ul><ul><li>Thioridazine :- Pigmentary retinopathy </li></ul><ul><li>Copper, Gold :- Lenticular opacities </li></ul><ul><li>Rifabutin :- Anterior uveitis </li></ul>
  50. 52. <ul><li>THANK YOU </li></ul>

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