2. CONTENT
MODES OF ADMINISTRATION
TOPICAL INSTILLATION
PERIOCULAR INJECTION
INTRAOCULAR INJECTION
SYSTEMIC ADMINISTRATION
COMMON DRUGS USED IN
OPHTHALMOLOGY
MYDRIATRICS AND CYCLOPLEGICS AGENTS
ANTI-VIRAL DRUGS
ANTI-FUNGAL DRUGS
ANTI-INFLAMMATORY AGENTS
LUBRICATING AGENTS AND ARTIFICIAL TEAR
INTRAOCULAR AND IRRIGATING SOLUTIONS
OTHER DRUGS AFFECTING EYE
DRUG
3. DRUG
In pharmacology, a pharmaceutical drug,also
called a medication or medicine, is a chemical
substance used to treat, cure, prevent, or
diagnose, a disease or to promote well-being.
5. Ocuserts
DRUG DELIVERY IN EYES
Topical Periocular Intraocular Systemic
Drop
Ointment
Gel
Soft contact lens
Subconj.
Subtenon
Peribulbar
Retrobulbar
Intracameral
Intravitreal
Oral
Intravenous
Intramuscular
6. STANDARD COLOURS FOR DRUG
LABELING & BOTTLE CAP
โข Yellow,, Blue : B blocker
โข Red : Mydriatics and cycloplegics
โข Green : Miotics
โข Orange : Carbonic anhydrase inhibitors
โข Brown or tan : Anti-infective agents
โข Gray : NSAIDS
โข Pink : Steroids
8. MYDRIATRICS AND CYCLOPLEGICS
AGENTS
โข MYDRIATICS
โ Only mydriasis
โ Care should be taken in older patients
โข Phenylephrine
โข CYCLOPLEGICS
โ Along with mydriasis paralysis of accommodation
โข Atropine sulfate
โข Homatropine hydrobromide
โข Cyclopentolate hydrochloride
โข Tropicamide
9. PHENYLEPHRINE
โข Direct acting drug
โข Pupil dilation for diagnostic purpose
โข Indication
โ COAG
โ Subacute or chronic ACG after iredectomy
โ Refused surgery cases
โข Contraindication
โ Narrow angle glaucoma.
โ Hypertensives.
โ Type 1 diabetes mellitus.
โ Aneurysms.
โ Cardiac diseases
โ Patients on reserpine
โ Infants
โข Adverse effects
โ Mild stinging
โ HTN, headache, browache
โข Dosage
โ 1 or 2 drops for each refraction
10. ATROPINE
โข Atropine sulfate is anticholinergic โ 0.5%, 1%,3%
โข Strongest drug in cycloplegics
โข Inhibitor of muscarinic action of acetylcholine
โข Indication
โ Mydriasis & cycloplegia
โ Pupil dilation in inflammatory condition of iris
โ Amblyopia therapy
โข Contraindication
โ 1ห glaucoma
โ Hypersensitive
โข Adverse effects
โ Allergic responses
โ Blurred vision
โ Photophobia
โ Dryness of skin & mouth
โ Skin rash
โข Dosage
โ 1 or 2 drops 0.5% to each eye, twice daily for 1 to 3 days prior to examination
11. HOMATROPINE
โข First anticholinergic
โข Directly blocks muscarinic action of acetylcholine
โข Its effect last for longer time
โข Indication
โ Cycloplegic refraction
โ Treatment of inflammatory uveal tract condition
โข Contraindication
โ Tendency with occludable angles
โ Patient who have allergic to atropine
โข Adverse reaction
โ Follicular conjunctivitis
โ Vascular congestion
โ Edema exudate
โข Dosage
โ 1 or two drops repeated in 5 to 10 minute if necessary
12. CYCLOPENTOLATE
โข Cyclopentolate hydrochloride 1% is an anticholinergic
โข Indication
โ Cycloplegics of children under the age 12 to 20 yrs
โข Contraindication
โ Narrow angle glaucoma
โ Hypersensitive
โ Children with emosional problems
โข Adverse effects
โ Increased IOP, blurring of vision, photophobia
โ Psychotic reaction
โ Dryness of mouth, headache or allergic reactions
โข Dosage
โ One drop followed by second drop in 5 minutes of arc
13. TROPICAMIDE
โข Most common anticholinergic medriatric drug
โข Stronger โ 1%, paralysis accomodation
0.5% produce mydriasis with slight cycloplegia
โข Indication
โ Diagnostic process
โ Pre and post operative stages
โ Infants โ combination with phenylephrine
โข Contraindication
โ Narrow angle glaucoma
โ Hypersensitive
โข Adverse effect
โ Stinging sensation
โ Confusion or hyperactivity
โข Dosage
โ 2 drops of 1% in each eye 2 to 3 times at 5 min intervals
14. Onset & Recovery
DRUG AGE
STRENGTH OF
SOLUTION %
MYDRIASIS
MAXIMAL RECOVERY
Atropine <5 years 1% 30 - 40min 7 - 10 days
Homatropine 5 โ 8 years 2% 30 - 40min 1 - 3 days
Cyclopentolate 8 โ 20 years 0.5 - 1% 30 - 60min 24 hours
Tropicamide - 0.5 - 1% 20 - 40min 6 hours
DRUG AGE
STRENGTH OF
SOLUTION %
PARALYSIS OF
ACCOMODATION
MAXIMAL RECOVERY
Atropine <5 years 1% 1 - 3 hours 6 - 12 days
Homatropine 5 โ 8 years 2% 30 - 40min 1 - 3 days
Cyclopentolate 8 โ 20 years 0.5 - 1% 30 - 60min 24 hours
Tropicamide - 0.5 - 1% 30 min 6 hours
15. ANTI - VIRAL DRUGS
โข Locally given to the eye
โข HSV, HZV, CMV retinitis
โข Common drugs
โ Acyclovir
โ Vidarabine
โ Ganciclovir
16. ACYCLOVIR
โข Can enter the sequence of DNA formation only in cells infected by virus
โข Used as topical therapy of viral keratitis
โข Systemically used in Herpes zoster ophthalmicus & acute retinal necrosis
โข Contraindicated in person with hypersensitivity
โข Adverse reaction
โ Local โ SPK
โ Systemic โ nausea, vomiting, headache, anorexia, dizziness and fatigue
intravenous can potentiate nephrotoxicity
โข Dosage
โ Topical โ 3%, 5 times/day
โ Systemc โ 800mg, 5 times daily for 7 โ 10 days
โ Intravitreal โ 10 โ 40ฮผg/0.1ml
17. VIDARABINE
โข For the topical treatment of keratitis caused by HSV
โข Indication
โ Acute keratoconjunctivitis
โ Recurrent epithelial
โ Supeficial keratitis caused by HV which is not respond to Idoxuridine
โข Contraindication
โ Hypersensitivity patient
โข Adverse reaction
โ Lacrimation
โ Fb sensation conjunctival inflammation
โ Burning
โ Irritation
โ SPK
โ Pain
โ Photophobia
โ Punctal occlusion
โ Sensitive
โข Dosage : ยฝ an inch of ointment (3%) into lower conj. sac 5 times daily at
3hr intervals
18. GANCICLOVIR
โข Indication
โข CMV retinitis
โข 10 โ 25 times more effective than Acyclovir
โข Progressive outer retinal necrosis
โข Contraindication
โข Pregnant women
โข Hypersensitivity patient
โข Adverse effects
โข Myelosuppression
โข Nephrotoxicity
โข Elevation of liver enzymes
โข Dosage
โข Oral โ 10mg/kg body wt/dose 4-5 times/day
โข Intravenous โ 5mg/kg over 1 hr every 12hr for 14 โ 21 days
โข Intrvitreal โ 2000 - 400ฮผg/0.1ml
19. ANTI โ FUNGAL DRUGS
โข Common drugs
โ Natamycin
โ Amphotericin B
20. NATAMYSIN
โข Derived from Streptomyces natalensis
โข Topical administration produces effective conc. of natamycin in corneal
stroma but not in the intra ocular fluid
โข Indication
โ Fungal blepheritis
โ Conjunctivitis
โ Keratitis
โข Contraindication
โ Hypersensitivity
โข Adverse reaction
โ Conjunctival chemosis
โ Hyperemia
โ Allergic
โข Dosage
โ 1 drop hourly or 2 hourly intervals for 14 โ 21 days
21. AMPHOTERICIN B
โข Derived from a strain of Streptomyces nodusus
โข Bind to sterol in fungal cell membrane
โข Cause both toxicity &anti-biotic effect
โข Indication
โ Sterilization of corneal ulcers
โ Mycotic keratitis
โ Intraocular histoplasmosis
โ Candida keratitis
โข Contraindication
โ Patient with nephropathy
โ Hypersensitive
โข Adverse effects
โ Local irritation
โ Nausea
โ Vomitting
โ Diarrhoea
โ Renal damage โ if dosage exceeds 3mg
โข Dosage
โ Topical โ 0.15%
โ Subconjunctival โ 0.5mg to 1mg
โ Systemic โ intravenous : 0.1mg/cc
intravitreal : 5-10ฮผg/0.1ml
25. FLUOROMETHELONE
โข Metabolized in cornea
โข Indication
โ Primarily used in mild ant. segment
inflammation
โ Post-LASIK surgery
โข Dosage
โ available in 5ml vials in 0.1% & 0.25%
26. PREDNISOLONE
โข Synthetic corticosteroid
โข Inhibits edema, fibrin deposition, capillary dilatation & deposition
of collagen and scar formation
โข Contraindication
โ Acute untreated purulent ocular infection
โ Dendritic keratitis
โ Viral disease of cornea & conjunctiva
โ Fungal diseases of eye
โข Adverse effects
โ Increased IOP with optic nerve damage
โ Visual field defect
โ PSC formation
โข Dosage
โ 1-2drops for 2-4 times daily
27. LUBRICATING AGENT AND
ARTIFICIAL TEAR
โข Indication
โ Ocular irritations in various diseases
โ Dry eyes
โข Commonly available commercial tear substitutes
โ REFRESH TEARS
โ TEARS PLUS
โ ARTIFICIAL TEARS
โข Warning
โ Discontinue using if any irritation produces
โข Direction for use
โ 1 or 2 drops as frequently as required
28.
29. INTROCULAR AND IRRIGATING
SOLUTIONS
โข Contain concentration of inorganic &
organic constituents
โข Mainly used in surgery procedure
โข Keep the glob inflated
31. OTHER DRUGS AFFECTING EYE
DRUG USE SIDE EFFECT
Amiodarone A cardiac arrhythmia drug Corneal vortex keratopathy
Optic neuropathy
Digitalis A cardiac failure drug Chromatopsia
Chloroquines Malaria, Rheumatoid Arthritis,
SLE
Corneal verticillata
Retinopathy
Thioridazine A psychiatric drug Pigmentary retinopathy
Ethambutol An anti-TB drug Optic neuropathy
Chorpromazine A psychiatric drug Corneal punctate epithelial opacities
Lens surface opacities