This document discusses miotics and mydriatics used in ophthalmology. Miotics like pilocarpine are parasympathomimetic drugs that cause pupil constriction (miosis) by stimulating muscarinic receptors. Common miotics discussed include pilocarpine, acetylcholine, and carbachol. Mydriatics like phenylephrine and atropine cause pupil dilation (mydriasis) by stimulating adrenergic receptors or blocking cholinergic receptors. Uses, mechanisms of action, and side effects of various miotics and mydriatics are provided. Diagnostic tests for conditions like Horner's syndrome using these agents are also summarized.
MYDRIATIC AND MIOTIC AGENTS AND DRUGS USED IN GLAUCOMA Rishabh Sharma
A brief Pathophysiology Presentation on the topic " MYDRIATIC AND MIOTIC AGENTS AND DRUGS USED IN GLAUCOMA "
Includes Both Open Angle and Closed Angle Glaucoma , their Mechanism Of Onset , Pathophysiology and Treatment ( Drugs Used In Glaucoma )
MYDRIATIC AND MIOTIC AGENTS AND DRUGS USED IN GLAUCOMA Rishabh Sharma
A brief Pathophysiology Presentation on the topic " MYDRIATIC AND MIOTIC AGENTS AND DRUGS USED IN GLAUCOMA "
Includes Both Open Angle and Closed Angle Glaucoma , their Mechanism Of Onset , Pathophysiology and Treatment ( Drugs Used In Glaucoma )
Bacterial conjunctivitis is a common type of pink eye, caused by bacteria that infect the eye through various sources of contamination. The bacteria can be spread through contact with an infected individual, exposure to contaminated surfaces or through other means such as sinus or ear infections.The most common types of bacteria that causes bacterial conjunctivitis includes Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa. Bacterial conjunctivitis usually produces a thick eye discharge or pus and can affect one or both eyes.
Glaucoma types, Pathogenesis, Diagnosis and TreatmentPranatiChavan
Glaucomas are ocular disorders characterized by changes in the optic nerve head (optic disk) and by loss of visual sensitivity and field.
There are two major types of glaucoma: open-angle glaucoma, which accounts for most cases and closed-angle glaucoma.
Lecture covers the pharmacology of anticholinergic drugs. Includes classification, therapeutic uses, adverse effects of anticholinergics. Atropine has been described as prototype drug.
Ocular allergy are a group of external ocular conditions resulting from one or more types of hypersensitivity reactions to allergens.
Anti Allergic eye drops are liquid medicine used to treat symptoms of eye allergies.
Bacterial conjunctivitis is a common type of pink eye, caused by bacteria that infect the eye through various sources of contamination. The bacteria can be spread through contact with an infected individual, exposure to contaminated surfaces or through other means such as sinus or ear infections.The most common types of bacteria that causes bacterial conjunctivitis includes Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa. Bacterial conjunctivitis usually produces a thick eye discharge or pus and can affect one or both eyes.
Glaucoma types, Pathogenesis, Diagnosis and TreatmentPranatiChavan
Glaucomas are ocular disorders characterized by changes in the optic nerve head (optic disk) and by loss of visual sensitivity and field.
There are two major types of glaucoma: open-angle glaucoma, which accounts for most cases and closed-angle glaucoma.
Lecture covers the pharmacology of anticholinergic drugs. Includes classification, therapeutic uses, adverse effects of anticholinergics. Atropine has been described as prototype drug.
Ocular allergy are a group of external ocular conditions resulting from one or more types of hypersensitivity reactions to allergens.
Anti Allergic eye drops are liquid medicine used to treat symptoms of eye allergies.
drug relative to eyes with their meiotic and mydriatic effect.
In the presentation discus about spasm of accommodation and cycloplegic action on eye . pharmacological action , dosage also discussed of condition developed on eye i.e. Glaucoma
Miotics are drugs that cause constriction of pupil.
The commonly used miotics belong to two groups
a) parasympathomimetics (contraction of circular fibres of iris)
b) sympatholytics (relaxing dilator pupillae muscle)
Mydriatics are drugs that dilate the pupil while cycloplegics are agents that cause paralysis of ciliary muscle (paralysis of accommodation)
The commonly used mydriatics belong to two groups
a) sympathomimetics
b) parasympatholytics
MIOTICS
Agents which cause constriction of pupil
These are used in the management of glaucoma and the treatment of esotropias and accommodation insufficiency.
Pilocarpine
Direct acting parasympathomimetic drug
Duplicates the muscarinic effects of acetylcholine (M3 receptor), but has no nicotinic effects.
It is effective in the treatment of glaucoma by decreasing intraocular tension
improves the aqueous humor outflow
Decreases aqueous secretion.
Onset of miosis occurs within 10-30 mins and lasts for 4-8 hours following topical application.
Indications and Usage
The control of intra-ocular pressure in angle closure glaucoma.
To reverse mydriasis caused by a cycloplegic agent.
In the treatment of accommodative strabismus.
Controversial role in the treatment of hyphaema.
After cataract extraction in cases of intra capsular cataract extraction
Adverse effects
Visual blurring
poor dark adaptation caused by the failure of the pupil to dilate in reduced illumination
Brow pain
Nausea
Diarrhoea
Sweating
Bronchospasm
Dosage and Administration
Pilocarpine nitrate, a sterile ophthalmic solution is available as 1%, 2% or 4% drops
To aid in emergency miosis, 1 to 2 drops of one of the higher concentrations should be used.
Carbachol
Carbachol is a direct acting parasympathomimetic that is used when allergy or resistance to pilocarpine develops
It has both nicotinic and muscarinic actions and also partially inhibits cholinesterase
Available as 0.75 % - 3 % drops.
Used for lowering intra-ocular pressure and pupillary constriction in the treatment of glaucoma.
When instilled into the eye, it mimics the effects of Ach, causing miosis and spasm of accommodation in which the ciliary muscle of the eye remains in a constant state of contraction.
Onset of action = 10-20min
Intraocular pressure is reduced for 4-8hrs.
Adverse effects
Little or no side effects occur due to lack of systemic penetration
Dosage and Administration
It is administered three to four times per day.
Physostigmine Sulphate
An indirectly acting parasympathomimetic agent which is reversible anticholine-esterase.
Given as 0.25% eye drops with 2% pilocarpine nitrate.
The mechanism of action involves inhibition of choline-esterase with consequent accumulation of acetylcholine at the neuromuscular junctions.
Topical application produces miosis which lasts for 6-24hrs.
Dosage and Administration
0.1-1% eye drops
It is administered every 4 to 6 hours
Adverse Reaction
Twitching
Irritation
allergic reaction
Depigmentation of the eye lid skin
Parasympatholytics are the drugs that block or inhibit the actions of acetylcholine at postganglionic nerve endings and cholinergic receptors. They are also referred to as anticholinergics or cholinergic blocking agents or antispasmodics.
Anticholinergic drugs include atropine and related drugs- atropine is the prototype. Atropine is obtained from the plant Atropa belladonna. Atropine and scopolamine (hyoscine) are the belladonna alkaloids. They compete with acetylcholine for muscarinic receptors and block this receptors-they are muscarinic antagonists.
Myopia management in Children is Challenging. Many options are available for treatment of myopia in children. Myopia is becoming increasingly common due to recent increase of computer use for online meetings, online school, online tutions etc.
Excessive screen time can lead to digital eye strain or computer vision syndrome. Symptoms may include eye discomfort, dryness, blurred vision, and headaches. To reduce the impact, take regular breaks, adjust screen brightness and posture, and follow the 20-20-20 rule (look at something 20 feet away for 20 seconds every 20 minutes). Consult an eye doctor if you experience persistent discomfort.
Dr Gargi Merchant is Senior Pediatric Ophthalmologist in Mumbai.
for details please visit
www.drgargimerchant.in
#DigitalEyeStrain
#ScreenTimeEyes
#EyeRedness, #ComputerVisionSyndrome, #EyeHealth, #BlueLightProtection, #EyeCare, #HealthyEyes, #DigitalDetox, #ProtectYourEyes
#eyes #eyehealthjourney #eyehealth #eyecare #eyedoctor #eyespecialist #andheriwest #drmerchant
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Muscles of the iris:
•DILATOR PUPILLAE
•Dual nerve supply.
•Sympathetic α1
adrenergic are
stimulatory while
parasympathetic are
inhibitory.
•SPHINCTER PUPILLAE
•Dual nerve supply.
•Parasympathetic
muscarinic are
stimulatory while
sympathetic are
inhibitory.
3. Miotics
Parasympathomimetic drugs
Choliergic drugs.
Classified as-
1. Directly acting or agonists. Eg-acetylcholine, bethanechol, pilocarpine.
2. Indirectly acting or cholinesterase inhibitors.
a. Reversible. Eg- physostigmine, neostigmine, edrophonium.
b. Irreversible. Eg- ecothiophate iodide, demecarium, diisopropylfluro phosphate.
3. Dual action: having bothmuscarinic and weak cholinesterase action. Eg-
carbachol.
4. Reactivation of acetylcholinesterase: pralidoxime.
4. • Five types of muscarinic receptors:
• The M1 receptors are located in the nervous system.
• The M2 receptors are located in the heart, and slow the heart
rate and force of contraction.
• The M3 receptors are located at the endothelial cells of blood vessels
and cause vasodilatation, lungs causing bronchoconstriction the
smooth muscles of the GIT to increase intestinal motility and dilating
sphincters, glands to stimulate secretion in salivary glands, detrusor
muscle and urothelium of the bladder, causing contraction. They are
present in the ciliary muscle and the iris.
• The M4 receptors: Postganglionic cholinergic nerves, possible CNS
effects
• The M5 receptors: Possible effects on the CNS
5. Stimulation of the M3 receptors in the eye causes-
1. Contraction of the pupil (miosis) and alters the relationship
of the iris with thee lens behind and the anterior chamber
angle in front.
2. They contract the longitudinal fibres of the ciliary body and
cause opening of the trabecular meshwork and increase
the aqueous outflow.
3. They cause contraction of the circular muscles of the ciliary
body thus causing the zonules to relax and allow the lens
to assume a more spherical shape (accommodation).
6. Pilocarpine hydrochloride:
• It is a parasympathomimetic alkaloid obtained
from the leaves of tropical South American
shrubs from the genus Pilocarpus. It is a non-
selective muscarinic receptor agonist.
• It was introduced in 1877 for the treatment of
glaucoma.
• When applied topically it is largely degraded
in the cornea. Only 3% enters the aqueous.
• It is available in 0.12%, 0.25%, 0.5%, 1%, 2%,
3% ,4%, 6%.
7. •Pilocarpine ocular therapeutic system (ocusert)
is available as ocusert P-40 or P-20 or
incorporated into soft contact lenses.
•Is also available in a polymer vehicle as a gel
that prolongs the duration of action.
•The ocusert releases 3 times the dose for 1 hour
and then declines to required value over 6
hours.
•Are to be placed in the cul de sac before
sleeping, so that the induced myopia wanes
away by morning.
8. Uses:
1. It causes complete miosis on intracameral administration.
Used in cataract sx after lens extraction, in penetrating
keratoplasty, iridectomy, etc.
2. 0.12% is used diagnostically to confirm Adie’s tonic pupil.
In this condition there is defective parasympathetic
innervation to the iris and ciliary body due to post
ganglionic denervation. The affected muscles exhibit
hypersensitivity to pilocarpine and hence contract, while
normal iris does not react to this low concentration.
3. 0.25% to 6% are used in the management of primary open
angle glaucoma. It is contraindicated in acute angle
closure glaucoma because it cause anterior movement of
lens iris diaphragm.
9. 4. As it causes increase in tear secretion and punctal
stenosis as side effects, it is used in aqueous tear
deficiency (ATD) dry eye. Due to increased
salivation and lacrymal secretion it is used in
Sjgrens’s syndrome and also for dry eye and
xerostomia as an effect of radiation therapy for
head and neck cancer.
5. Used to differentiate pharmacological mydriasis
from neurological mydriasis. In pharmacological as
the receptors are saturated the pupil will remain
dilated while in third nerve palsy or Adie’s tonic
pupil it will constrict even with very dilute
solution.
10. 6. Used to reduce glare in patients with intra
ocular lens Implantation.
7. Pilocarpine is used to stimulate sweat glands
in a sweat test to measure the concentration
of chloride and sodium that is excreted in
sweat. It is used to diagnose cystic fibrosis.
11. Adverse effects:
1. Contraction of the ciliary body can cause traction on the pars
plana as well causing retinal tear or rhegmatogenous retinal
detachment.
2. Catarctogenesis.
3. Drug induced contraction of the ciliary body causes increased
convexity of the lens and shifts the lens forward. Hence causes
induced myopia. This causes brow ache.
4. Reduced vision during night time due to miosis. Reduced field
of vision.
5. Higher concentration use causes miotic iris cysts
6. Increased lacrimal secretion and punctal stenosis can cause
epiphora.
7. Increased bleeding during surgery.
12. 8. It causes break down of the blood aqueous barrier hence
can cause severe fibrinous iridocyclitis post operative.
Hence it is contraindicated in uveitic glaucoma.
9. Posterior synechiae formation.
10. It is known to cause idiosyncratic reaction, allergic
reaction, pseudopemphigoid.
11. Systemic- salivation, diarrhoea, urinary urgency,
vomiting, bronchospasm, bradycardia, diaphoresis,
flushing.
12. Succinyl choline should be avoided in patients who have
used these drugs recently.
13. Acetylcholine Carbachol
• Used only intracamerally as
it is not active if used
topically.
• Available as a powder. Fresh
solution has to be prepared.
When given intracamerally
it causes miosis in seconds.
• Rapidly degraded by
cholinesterases in aqueous.
Hence v short acting.
• It is 100 times effective and
longer acting than
acetylcholine.
• Lesser fluctuations in IOP.
Effect last upto 8 hours.
• ADR- corneal clouding,
bullous keratopathy, iritis,
injection, ciliary spasm,
retinal detachment.
• Topical- 0.75%, 1.5%, 2.5%,
3%. 3 times a day
• Intracameral- 0.01%
14. Physostigmine Demecarium
•Acetylcholinesterase
inhibitor.
•Same actions, uses.
•Used in patients who
fail to respond to
directly acting
cholinergic agents.
•0.25-0.5% up to 4 times
a day. Eye ointment also
available.
•Same as physostigmine.
•Also used for
accommodative
esotropia. 0.125% once
a day for 3-4 weeks.
Miosis may interfere.
•Prolonged action. Twice
daily usage. Severe ADR.
•0.125% twice a day.
•Avoid overdosing.
15. Ecothiophate
• Depresses plasma & erythrocyte cholinesterase.
• Used in subacute or chronic angle closure glaucoma.
• Topical solution is prepared by reconstituting powder
form. Concentrations available are 0.03, 0.06, 0.125 and
0.25%.
• Tolerance may develop on chronic use.
• As it is an insecticide it is also used for lice infestations of
the eye lashes.
16. Mydriatics
• Mydriatics are agents who dilate the pupil and
cycloplegics are agents which cause paralysis off
the ciliary body.
• Two classes of mydriatics are available-
1. Adrenergic agonists- adrenaline, cocaine,
phenylephrine, hydroxyamphetamine.
They cause pupillary dilatation, increase in aqueous
outflow, decreased aqueous formation, and relaxation
of ciliary muscles.
1. Cholinergic antagonists- tropicamide.
Causes mydriasis and cycloplegia.
17.
18. Adrenaline (epinephrine) Cocaine
• Causes mydriasis.
• 1:1000 solution used.
Repeated in 5 minutes.
• Used for open angle
glaucoma.
• Can be used with procaine
and atropine in severe
iritis.
• Alkaloid
• 2 and 4% solution.
• Toxic to corneal epithelium
(hence increased
penetration).
• Inhibits the action of
amine oxidases and hence
reduces the uptake of NE.
• Used to diagnose Horner’s
syndrome.
19. Horner’s syndrome.
It is caused due to a lesion in the oculosympathetic
pathway.
Characterised by ipsilateral miosis, ptosis and
anhidrosis.
The light reflex is normal in these patients but the
pupil is slow to redilate in dim light.
20. It can be tested pharmacologically as—
Step 1: Instill 2 drops of 4% cocaine in both eyes.
It inhibits reuptake of nor epinephrine from the post
ganglionic segment. Hence causes mydriasis. But in
Horner’s there is no NE. Hence no dilatation.
Post cocaine anisocoria of 1mm is diagnostic.
Apraclonidine has weak α1 agonistic action. In normal
eyes it has little effect on pupil. But in Horner’s
syndrome there is supersensitivity and the pupil
dilates.
21. •Step 2: once diagnosis is established,
hydroxyamphetamine is used to localise the
lesion.
•Normal pupil dilates with
hydroxyamphetamine. If the Horner’s pupil
does not dilate means lesion is in the
preganglionic segment. But if it does dilate
lesion is in the preganglionic segment.
22. Phenylephrine hydrochloride
•Causes pupil dilatation and conjunctival
vasoconstriction causing blanching.
•Action can be reversed by thymoxamine 0.1%.
•2.5 and 10% concentrations. 2.5% used most
commonly.
•Sufficient mydriasis occurs in 15-30 mins,
maximum dilation in 45-60 mins and remains for 4-
6 hours.
•Since sphincter pupillae muscles are stronger than
dilator, mydriasis caused by phenylephrine is
largely overcome by light reflex.
23. Phenylephrine hydrochloride
Uses
• Used mainly for pupil dilation for diagnostic purposes
and in pathological conditions like uveitis, for
cycloplegic refraction, before intraocular surgery and
in conjunction with miotics.
• As an ocular decongestant.
• Used to diagnose Horner’s syndrome. In Horner’s
syndrome, phenylephrine 1% solution administered
causes mydriasis more than that in the normal eye,
because of denervation hypersensitivity.
24. Adverse effects
•Ocular- transient
stinging, blurring, rarely
maculopathy in aphakic
patients.
•Systemic-
• Palpitations.
• Tachycardia.
• Extrasystoles.
• Arrhythmias.
• Hypertension.
• Headache.
• Browache.
• Reflex bradycardia
• Stroke.
• Myocardial infarction.
10% solution contains 5mg
of drug per drop. Systemic
dose for hypotension is 50-
100 micro gram.
25. Contraindicated in-
• Narrow angle glaucoma.
• Hypertensives.
• Type 1 diabetes mellitus.
• Aneurysms.
• Cardiac diseases.
• Old debilitated patients
• Patients on reserpine, TCAs MAO inhibitors or cocaine.
• Infants. As it increases BP (dose per unit weight is high)
26. Hydroxyamphetamine hydrobromide
•Indirect acting adrenergic agent.
•It releases nor- epinephrine from post
ganglionic nerves.
•Minimal cycloplegia.
•1% concentration equivalent to 2.5%
phenylephrine.
•25-40 minutes for max dilatation. Lasts 4-6
hours.
27. Uses-
•To dilate the pupil for ocular examination.
•To differentiate post ganglionic Horner’s
syndrome from pre ganglionic Horner’s
syndrome. Post ganglionic lesions fail to dilate.
28. Tropicamide
•Blocks the effect of acetyl choline released.
•Causes mydriasis and cycloplegia both.
•0.5 or 1% acts within 20-30 minutes and
effect lasts for 6-8 hours.
•Mydriasis is more pronounced. It prevents
pupil constriction in response to indirect
ophthalmoscopy and retinal photography.
•Independent of iris pigmentation.
29. Uses and Adverse reactions
•Since it has no vasopressor action it can be
used safely in cardiac patients.
•It is the first choice of mydriatic because it is
rapid acting, short acting, and strong intensity
of action.
•Commonly used as a combination with
phenylephrine or hydroxyamphetamine.
30. Mydriatics and cycloplegics
•Atropine, homatropine, scopolamine and
cyclopentolate are cycloplegics that are used in
uveitis or acute anterior segment inflammation to
reduce the formation of posterior synechiae.
•They also reduce the permeability of blood aqueous
barrier and help to reduce inflammation apart from
causing cycloplegia.
•They can be used as occlusion therapy for
amblyopia.