This document provides information on various drugs used in ophthalmology, including their mechanism of action, dose, duration of action, indications, side effects and contraindications. It discusses parasympatholytic agents like atropine and homatropine, spasmolytic agents like cyclopentolate, tropicamide, phenylephrine hydrochloride with tropicamide. It also covers parasympathomimetic drugs like pilocarpine, alpha agonists like brimonidine, beta blockers like timolol and betaxolol, prostaglandin analogues like latanoprost and various antibiotics. It provides details on anti-inflammatory drugs, local anesthetics, lubricating agents and

1. DRUGS IN
OPHTHALMOLOGY

2. ATROPINE
GROUP PARASYMPATHOLYTIC AGENT
MECHANISM OF
ACTION
Competitive antagonism of Ach at muscarinic receptors
DOSE CONC. Solution-0.5 to 4% topical
IM injection-0.3,0.4,0.6 mg/ml
DURATION OF
ACTION
2 weeks
INDICATION 1. Mydriatic&cycloplegic agent
2. Iritis-to prevent pain,release synechiae,gives rest to inflamed tissue
3. Ciliary block glaucoma
4. Treat amblyopia
5. Accomodative spasm
SIDE EFFECTS Contact dermatitis,dryness of mouth,flushing of skn,atropine delirium
CONTRAINDICATIONS 1. Narrow angle glaucoma
2. Solution should not be used in childrenas it causes systemic absorption through
nasolacrimal mucosa

3. HOMATROPINE
GROUP SYNTHETIC ALKALOID RESEMBLING ATROPINE
MECHANISM OF
ACTION
Similar to atropine
DOSE CONC. 2% solution topical
DURATION OF
ACTION
Starts-30 mins
Upto-24-48 hrs
INDICATION 1. Refraction
2. Iritis
3. Post-op conditions-to relieve spasm
SIDE EFFECTS Redness, lid odema
CONTRAINDICATIONS Angle closure glaucoma

4. CYCLOPENTOLATE
GROUP SYNTHETIC SPASMOLYTIC AGENT
MECHANISM OF
ACTION
Similar to atropine
DOSE CONC. 1% solution topical
DURATION OF
ACTION
Onset-20-45 mins
Upto-12-24 hrs
INDICATION 1. Short duration of action so more popular
2. Cycloplegic refraction
3. To relieve ciliary spasm
SIDE EFFECTS transient neurotoxic effect,visual hallucinations,incoherence
CONTRAINDICATIONS Narrow angle glaucoma

5. tropicamide
GROUP Parasympatholytic agent
MECHANISM OF
ACTION
Similar to atropine
DOSE CONC. 1% solution topical
DURATION OF
ACTION
Onset-15 mins
Upto-30 mins to 2 hrs
INDICATION 1. Rapidly acting
2. Refraction,fundus examination,fundus photography
SIDE EFFECTS Systemic hypersensitivity,increased IOP in angle closure glaucoma
CONTRAINDICATIONS 1. Narrow angle glaucoma
2. hypertension

6. PHENYLEPHRINE HYDROCHLORIDE+tropicamide
GROUP SYNTHETIC SYMPATHOMIMETIC
MECHANISM OF
ACTION
Selective alpha 1 agonist
DOSE CONC. 5%, 10% solution topical
DURATION OF
ACTION
Onset - 30mins
Upto 2-3 hrs
INDICATION 1. Ophthalmoscopy
2. Prior to surgery
3. Malignant glaucoma
CONTRAINDICATIONS New born infants, cardiac patients, patient receiving-reserpine, guanethidine, tricyclic
anti depressants

7. PILOCARPINE
GROUP PARASYMPATHOMIMETIC
MECHANISM OF
ACTION
1. Open angle glaucoma- increased outflow
2. Angle closure glaucoma – decrease in iris tissue density at the angle
DOSE CONC. 1%, 2%, 4% solution; 4% gel; ocuserts
DURATION OF
ACTION
4 – 8 hours
DOSAGE BD – QID
INDICATION 1. Primary open angle glaucoma
2. Acute angle closure
3. Chronic synechial angle closure glaucoma
SIDE EFFECTS Usually well tolerated, when associated with IMC- blurring of vision
CONTRAINDICATIONS Inflammatory glaucoma,malignant glaucoma, known allergy

8. BRIMONIDINE
GROUP ALPHA 2 SELECTIVE AGONIST
MECHANISM OF ACTION 1. Decrease aqueous humor production
2. Increased outflow
DOSE CONC. 0.15%,0.1%, 0.2% TOPICAL
DOSAGE BD
INDICATION 1. Chronic open-angle glaucoma
2. Prevention of ocular hypertension following laser surgery
3. Acute angle closure glaucoma (before laser iridectomy)
SIDE EFFECTS ocular-allergic conjunctivitis,xerostomia, drowsiness, fatigue
Systemic-arrythemia, tachycardia, hypertension

9. TIMOlol
GROUP NON SELECTIVE BETA1 AND BETA2 ADRENERGIC ANTAGONIST
MECHANISM
OF ACTION
Decrease the effect of circulating catecholamines on beta2 receptors in ciliary epithelium
Inactivation of chloride pump Decrease in aqueous humor formation
DOSE CONC. 0.25% and 0.5% solution topical
DOSAGE BD
INDICATION Glaucoma-open angle, angle closure, secondary
Young patients, cataract, hypertensive
SIDE EFFECTS Occular-occasional allergy,corneal punctate epithelial erosion,reduced aqueous tear secretion
Systemic-Asthma, COPD, heart block, mental changes in elderly
SHORT TERM ESCAPE-marked initial fall in IOP followed by transient rise and then moderate fall
LONG TERM DRIFT-slow rise in IOP who were well controlled
CONTRAINDI
CATIONS
Patients with airway diseases, cardiac failure,heart block, cardiogenic shock

10. BETAXOLOL
GROUP SELECTIVE BETA1 ADRENERGIC ANTAGONIST
MECHANISM OF
ACTION
Decrease the effect of circulating catecholamines on beta2 receptors in ciliary
epithelium Inactivation of chloride pump Decrease in aqueous humor
formation
DOSE CONC. 0.5% solution topical
DOSAGE BD
INDICATION 1. Air way diseases
2. Safe in CVS diseases
3. Reduce CNS side effects
SIDE EFFECTS Decreased effect when compared to timolol, burning sensation

11. latanoprost
GROUP PGF2 alpha DERIVATIVE
MECHANISM OF ACTION Increase the outflow of aqueous humor
DOSE CONC. 0.005% topical
DOSAGE OD
INDICATION Open angle glaucoma,exfoliation syndrome, pigment dispersion syndrome,
chronic angle-closure glaucoma
SIDE EFFECTS Occular irritation and pain
No systemic side effects
CONTRAINDICATION PREGNANCY

12. FLUOROQUINOLONES
CIPROFLOXACIN OFOXACIN MOXIFLOXACIN GATIFLOXACIN
GROUP fluoroquinolones fluoroquinolones fluoroquinolones fluoroquinolones
GENERATION second second fourth fourth
MECHANISM OF
ACTION
Inhibit bacterial DNA
synthesis
Inhibit bacterial DNA
synthesis
Inhibit bacterial
DNA synthesis
Inhibit bacterial
DNA synthesis
DOSE CONC.
Topical
systemic
0.3%
500mg BD
0.3%
200-400 mg BD
0.5%
400 mg OD
0.3%
400 mg OD
INDICATIONS-1.Acute bacterial conjunctivitis 2.blepharitis 3.gonococcal conjunctivitis/keratitis
4.bacterial keratitis 5. drug of choice-prophylaxis for post op endophthalmitis
SIDE EFFECTS- Burning, foreign body sensation, itching, phototoxicity
CONTRAINDICATIONS- Previous hypersensitivity to quinolones, in pregnancy

13. GENTAMICIN
GROUP AMINOGLYCOSIDE
MECHANISM OF ACTION Binding of aminoglycoside into bacterial ribosome inhibition of protein
synthesis
DOSE CONC. 0.3% topical
DOSAGE 6 times a day
INDICATION Primarily-aerobic gram negatives more active against Pseudomonas and Proteus
SIDE EFFECTS Ototoxicity, nephrotoxicity, neuromuscular blockade
CONTRAINDICATION Myasthenia gravis,hypersensitivity to tobramycin

14. tobramycin
GROUP AMINOGLYCOSIDE
MECHANISM OF ACTION Binding of aminoglycoside into bacterial ribosome inhibition of protein
synthesis
DOSE CONC. 0.3% topical
DOSAGE 6 times a day
INDICATION Primarily-aerobic gram negatives more active against Pseudomonas and Proteus
SIDE EFFECTS Ototoxic and nephrotoxic
CONTRAINDICATION Myasthenia gravis,hypersensitivity to tobramycin

15. FLURBIPROFEN
GROUP PROPIONIC ACID DERIVATIVE
MECHANISM OF
ACTION
Inhibit the cyclo-oxygenase enzyme
DOSE CONC. 0.03% topical
INDICATION 1. Inhibition of intraoperative miosis (uses every 5 mins for 2 hrs)
2. Cystoid macular edema(started 2 days pre op and continued 6-8 weeks post op)
SIDE EFFECTS 1. Transient burning
2. stinging
CONTRAINDICATIONS Dermatic keratitis,hypertensive,patient with bleeding tendency

16. LIGNOCAINE
GROUP TOPICAL ANASTHETIC REGIONAL INFILTRATION& PERIPHERAL NERVE
BLOCK
MECHANISM
OF ACTION
Compete with calcium ions for receptor site
control permeability reversible block of nerve
conduction
Compete with calcium ions for receptor site
control permeability reversible block of
nerve conduction
DOSE CONC. 2%, 4% solution 1,2,4% Solution
MAXIMUM
DOSE
3mg 7 mg/kg
DURATION
OF ACTION
Onset-1 min
Upto-15 mins
Onset-4-6 mins
Upto- 40-60 mins
INDICATION-Safe agent, FB removal,conjunctival tear suturing,
conjunctival suture removal and other procedures over conjunctiva
SIDE EFFECTS- Subjective burning sensation
CONTRAINDICATIONS- heart block,ADR to lignocaine

17. PROPARACAINE
GROUP LOCAL ANASTHETIC
MECHANISM OF ACTION Compete with calcium ions for receptor site control permeability
reversible block of nerve conduction
DOSE CONC. 0.5% topical
DURATION OF ACTION Onset-1 min
Upto-15 mins
MAXIMUM DOSE 10 mg(14 drops to each eye of 0.5% solution)
INDICATION Safe agent
FB removal,conjunctival tear suturing,conjunctival suture removal and other
procedures over conjunctiva
SIDE EFFECTS Least bactericidal topical agent,interfere with recovery in patients with
suppurative keratitis undergoing diagnostic corneal scraping
CONTRAINDICATION Active infection/inflammation hyperthyroidism

18. prednisolone
GROUP SYNTHETIC CORTICOSTERIOD
MECHANISM OF
ACTION
Inhibit odema,fibrin deposition,capillary dilatation& deposition of collagen and scar
formation
DOSE CONC. TOPICAL-10 mg SYSTEMIC-5 mg, 10 mg tabs
INDICATION Topical-Uveitis, scleritis, allergic conjunctivitis,allergic keratitis, cystoid macular edema
Systemic-post uveitis,VKH syndrome, pappilitis,retrobulbar neuritis,anterior ischemic
optic atrophy,malignant exophthamos
SIDE EFFECTS Ocular-Increased IOP with ooptic nerve damage systemic- hypertension
Visual field defect peptic ulcer
PSC formation osteoporosis
CONTRAINDICATIONS 1. Acute untreated purulent ocular infection
2. dentritic keratitis
3. Viral and fungal diseases of eye

19. FLUROMETHALONE
GROUP CORTICOSTERIOD
MECHANISM OF ACTION Inhibit odema,fibrin deposition,capillary dilatation& deposition of collagen
and scar formation
DOSE CONC. 0.1% Suspension topical
INDICATION Uveitis, scleritis, allergic conjunctivitis,allergic keratitis, cystoid macular
edema
SIDE EFFECTS Glaucoma, cataract,dry eye, ptosis
CONTRAINDICATIONS 1. Acute untreated purulent ocular infection
2. dentritic keratitis
3. Viral and fungal diseases of eye

20. Povidine iodine
ACTION 1. Surfactants
2. Non irritating antibacterial agent
3. Fumigating agent
USES Pre-operative preparation
DOSE CONC. 0.5%

21. CARBOXY METHYL CELLULOSE
GROUP Cellulose derivative made of glucopyranose, hydroxyl groups, bound to
carboxymethyl group
MECHANISM OF ACTION It binds to surface of corneal epithelial cells via its glucopyranose
subunits to GLUT-1 receptor
DOSE CONC. 0.5% topical
DOSAGE 6 Times a day
INDICATION 1. Ohpthalmic lubricant
2. Relief for burning,itching and discomfort due to dryness or exposure
to wind or sun

22. Hydroxy propyl methyl cellulose
GROUP VISCOELASTIC SUBSTANCE
DOSE CONC. 1% and 2% solution
DOSAGE 4 times a day topical
INDICATION 1. Lubricant for the gonioscopy lens
2. Base for eye drops
3. It can be applied over IOL and injected into AC before lens insertion
SIDE EFFECTS Irritation, blurring of vision, stickiness

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