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OCULAR PHARMACOLOGY
Pharmacodynamics
• It is the biological and therapeutic effect of the drug
(mechanism of action)
• Most drugs act by binding to regulatory
macromolecules, usually neurotransmitters or
hormone receptors or enzymes
• If the drug is working at the receptor level, it can be
either
agonist antagonist
• If the drug is working at the enzyme level, it
can be
activator inhibitor
Pharmacokinetics
• It is the: ADEM
Absorption,
Distribution,
Metabolism, and
Excretion of the drug
• A drug can be delivered to ocular tissue as:
• Locally: Eye drop
Ointment
Periocular injection
Intraocular injection
• Systemically: Orally
Intravenous(I.V.)
Drug Delivery in Eyes
TOPICAL PERIOCULAR INTRAOCULAR SYSTEMIC
DROPS SUBCONJUNCTIVAL INTRACAMERAL ORAL
OINTMENT SUNTENON INTRAVITREAL INTRAVENOUS
GEL
PERIBULBAR/RETR
OBULBAR
INTRAMUSCULAR
Factors influencing local drug
penetration into ocular tissue
Drug concentration and solubility :
• The higher the concentration the better the penetration
e.g pilocarpine 1-4% but limited by reflex tearing
Viscosity:
Addition of methylcellulose and polyvinyl alcohol increases drug
penetration by increasing the contact time with the cornea and
altering corneal epithelium
Lipid solubility :
Because of the lipid rich environment of the epithelial cell
membranes, the higher lipid solubility the more the penetration
Amphipathic- epithelium/endothelium----lipophilic
stroma---hydrophilic
Factors influencing local drug
penetration into ocular tissue
Surfactants :
The preservatives used in ocular preparations alter cell membrane
in the cornea and increase drug permeability
e.g. benzylkonium and thiomersal
pH :
The normal tear pH is 7.4 and if the drug pH is much different, this
will cause reflex tearing
Drug tonicity :
When an alkaloid drug is put in relatively alkaloid medium, the
proportion of the uncharged form will increase, thus more
penetration
Molecular weight and size:
TOPICAL
Drop - simplest and more convenient
mainly for day time use
• 1 drop=50 microlitre
• Conjuctival sac capacity=7-13 micro liter so, even 1 drop is more than
enough
Method
-hold the skin below the lower eye lid
- pull it forward slightly
-INSTALL 1 drop
measures to increase drop absorption :
-wait 5-10 minutes between drops
-compress lacrimal sac -keep lids closed for 5 minutes after instillation
Ointments
 Increase the contact time of ocular
medication to ocular surface thus better effect
 It has the disadvantage of vision blurring
The drug has to be high lipid soluble with
some water solubility to have the maximum
effect as ointment
Peri-ocular injections
• They reach behind iris-lens diaphragm better than topical
application
E.g.
subconjunctival,
subtenon,
peribulbar, or
retrobulbar
• This route bypass the conjunctival and corneal epithelium
which is good for drugs with low lipid solubility (e.g.
penicillins)
• Also steroid and local anesthetics can be applied this way
Periocular
• Subconjunctival - To achieve higher concentration
-Drugs which can’t penetrate cornea due to
large size
-Penetrate via sclera
• Subtenon —
ant. Subtenon– disease ant to the Lens
Post Subtenon– disease posterior to the lens
Retrobulbar - Optic neuritis
Papillitis
Posterior uveitis
Anesthesia
• Peribulbar -- anesthesia
Intraocular injection
Intracameral or
intravitreal
E.g.
• Intracameral acetylcholine (miochol) during
cataract surgery
• Intravitreal antibiotics in cases of endophthalmitis
• Intravitreal steroid in macular edema
• Intravitreal Anti-VEGF for DR
Sustained-release devices
• These are devices that deliver an adequate
supply of medication at a steady-state level
E.g.
-Ocusert delivering pilocarpine
-Timoptic XE delivering timolol
-Ganciclovir sustained-release intraocular
device
-Collagen shields
Common ocular drugs
• Antibacterials (antibiotics)
• Antivirals
• Antifungal
• Mydriatics and cycloplegics
• Antiglaucoma
Corticosteroids
• Anti-inflammatory agents
NSAIDS
• Ocular Lubricants
• Ocular diagnostic drugs
• Local anesthetics
• Ocular Toxicology
Antibacterials( antibiotics)
• Penicillins
• Cephalosporins
• Sulfonamides
• Tetracyclines
• Chloramphenicol
• Aminoglycosides
• Fluoroquinolone
• Vancomycin
• macrolides
Antibiotics
• Used topically in prophylaxis (pre and postoperatively) and
treatment of ocular bacterial infections.
• Used orally for the treatment of preseptal cellulitis
e.g. amoxycillin with clavulonate, cefaclor
• Used intravenously for the treatment of orbital cellulitis
e.g. gentamicin, cephalosporin, vancomycin, flagyl
• Can be injected intravitrally for the treatment of
endophthalmitis
Specific antibiotic for almost each organisms
• Sulfonamiodes –
USES:
Chlamydial infections like TRACHOMA
INCLUSION CONJUNCTIVITIS
TOXOPLAMOSIS
Cephalosporins
• first generation- gm + cocci eg cephazolone
• second generation —Gm – ve and
antistaphylococcal— cefuroxime
• Third generation – Gm –ve bacilli –
ceftriaxones
• Side effects-
allergic reaction
Neutropenia
thrombocytopenia
Amino glycosides
• Mechanism of Action: Bacterial protein
synthesis inhibitors
• mainly against gm negative bacilli
• Gentamycin- 0.3% eye drop
• Tobramycin- Pseudomonas 1% eye drop
• Neomycin- 0.3-0.5% eye drop
Tetracycline
• Inhibit protein synthesis
• active against both gm+ and gm -, some fungi and
Chlamydia
Chloromphenicol
• Inhibit protein synthesis
• Broad spectrum ,bacteriostatic, gm+/gm-,
Chlamydia
• 0.5% Eye drop, ointment
Antibiotics
• Trachoma can be treated by topical and systemic
tetracycline or erythromycin, or systemic
azithromycin.
• Bacterial keratitis (bacterial corneal ulcers) can be
treated by topical fortified penicillins,
cephalosporins, aminoglycosides, vancomycin, or
fluoroquinolones.
• Bacterial conjunctivitis is usually self limited but
topical erythromycin, aminoglycosides,
fluoroquinolones, or chloramphenicol can be
used
Antivirals
Acyclovir
3% oinment 5 times-10-14 days
800mg oral 5 times 10-14 days
intravenous for Herpes zoster retinitis
Others INDICATIONS
Idoxuridine HZ keratitis
Vidarabine Viral uveitis
Cytarabine
Triflurothymidine
Gancyclovir
Cytomegalovirus Retinitis
Dendritic Ulcer
ANTIFUNGAL
INDICATIONS
• Fungal corneal ulcer
• Fungal retinitis/ Endophthalmitis
• Commonly used drugs are
Polyenes
-damage cell membrane of susceptible fungi
-e.g. amphotericin B, natamycin, nystatin
-side effect: nephrotoxicity
Imidazoles
increase fungal cell membrane permeability
• e.g. miconazole, ketoconazole,fluconazile
Flucytocine
act by inhibiting DNA synthesis
Fungal Ulcer
MYDRIATICS AND CYCLOPLEGIC
• MYDRIATICS- Dilate the pupil, by constriction of radial
muscles(sympathetic supply) e.g.Phenylepherine
• Cycloplegic – causes ciliary muscle paralysis(parasympathetic)
CLASSIFICATION
• Short acting- Tropicamide (4-6 hours)
• Intermediate- homatropine ( 24 hours)
• Long acting- atropine (2 weeks)
Indications
• corneal ulcer
• uveitis
• cycloplegic refraction
Antiglaucoma drugs
Beta blockers-
Selective – betaxolol
Non selective- timolol
Mechanism of Action:
reduces aqueous humour production
Reduces IOP
Side effect:
systemic ocular
Bradycardia Irritation
Sweating Frontal Headache
Anxiety Iris cyst
Follicular Conjunctivitis
Carbonic anhydrase inhibitors
Systemic Topical
• acetazoamide Dorzolamide
Brinzolamide
Mechanism of action-- reduce aqueous humour
formation
Side effect
Paresthesiae
Frequent urination
GI disturbances
Hypokalamia
• Hyperosmotic agent-
iv mannitol when IOP is very high 60-70
In adults the dose is 0.2 g/kg body weight.
In pediatric patients the dose is 0.2 g/kg body weight or 6 g/m² body surface area.
The infusion is given as a 15% to 25% solution over a period of 3 to 5 minutes to
produce a urine flow of at least 30 to 50 mL/hour.
• Prostaglandins
• Latanoprost (0.005% eye drop)
• increased aqueous out flow
• Reduced IOP
• Side effect– conjunctival redness,
iris and periocular pigmentation
hypertrichosis,
darkening of iris
ANTI INFLAMMATORY
• ANTI – INFLAMMATORY
Corticosteroids Non- steroidal
anti-inflammatory
drugs(NSAIDS)
CORTICOSTEROIDS
Corticosteroids
CLASSIFICATION
• Short acting
hydrocortisone,
cortisone,
prednisolone
• Intermediate acting :Trimcinolone,
Fluprednisolone
• Long acting
Dexamethasone ,betamethasone
Indications
• Topical
• allergic conjunctivitis,
• scleritis,
• uveitis,
• Allergic keratitis
• after intraocular and extra ocular surgeries
• Systemic (pathology behind the LENS)
• Posterior uveitis
• Optic neuritis
• corneal graft rejection
NEVER GIVE STEROID IF YOU ARE SUSPECTING ACTIVE INFECTION
Allergic Conjunctivitis
Episcleritis
Anterior Uveitis
Contraindications
Ocular
• Fungal Infections
• Glaucoma
• Corneal Epithelial defect
• Herpetic Epithelial Keratitis
Systemic
• Osteoporosis
• Diabetes Mellitus
• Congestive Heart Failure(CHF)
• Renal Filure
• Peptic Ulcer
Side effects
• Ocular
Glaucoma
Cataract
Activation of infection
Delayed wound healing
Pre-requisite
• BP
• Blood sugar
• Mantoux
• TC,DC,ESR
• CXR
NSAIDS
Topical use
• flurbiprofen
• indomethacine
• Ketorolac
Indications
• episcleritis and scleritis
• uveitis
• CME
• PRE operatively to maintain dilation of the pupil
Preservative used is Benzalkonium Chloride(BAK)
Ocular Lubricants
Indication
• ocular irritations in various diseases
• Dry eyes
Commonly available commercial tear substitutes
REFRESH TEARS
• TEAR PLUS
• MOISOL
• OCCUWET
• Genteal gel eye drops
Preservative used is Stabilized Oxycholrocomplex
Ocular diagnostic drugs
Fluorescein dye
Available as drops or strips
Dose: 2% Sodium Salt
Uses :
stain corneal abrasions,
applanation tonometry,
detecting wound leak,
NLD obstruction,
fluorescein angiography
Caution:
stains soft contact lens
Fluorescein drops can be contaminated by Pseudomonas sp.
Ocular diagnostic drugs
Rose bengal stain
Stains devitalized epithelium
Dose : 1%
Uses: severe dry eye, herpetic keratitis
Local anesthetics
Local anesthetics
• topical
E.g. Proparacaine—0.5%
tetracaine
Uses :
applanation tonometry,
goniscopy,
removal of corneal foreign bodies,
removal of sutures,
examination of patients who cannot open eyes because of pain
Adverse effects :
toxic to corneal epithelium,
allergic reaction rarely
Local anesthetics
• Orbital infiltration
-peribulbar or retrobulbar
-cause anesthesia and akinesia for intraocular
surgery
-e.g. Lidocaine—2%,
bupivacaine:0.5%
Orbital Infiltration
Ocular toxicology
Complications of topical administration
Mechanical injury from the bottle
e.g. corneal abrasion
Pigmentation: epinephrine
Ocular damage : e.g. topical anesthetics, benzylkonium
Hypersensitivity : e.g. atropine, neomycin, gentamicin
Systemic effect : topical phenylephrine can increase BP
Amiodarone
• A cardiac arrhythmia drug
• Causes optic neuropathy (mild decreased vision,
visual field defects, bilateral optic disc swelling)
• Also causes corneal vortex keratopathy (corneal
verticillata) which is whorl-shaped pigmented
deposits in the corneal epithelium
Digitalis
• A cardiac failure drug
• Causes chromatopsia (objects appear yellow)
with overdose
Chloroquines
• E.g. chloroquine, hydroxychloroquine
• Used in malaria, rheumatoid arthritis, SLE
• Cause vortex keratopathy (corneal
verticillata) which is usually asymptomatic but
can present with glare and photophobia
• Also cause retinopathy (bull’s eye
maculopathy)
Chorpromazine
• A psychiatric drug
• Causes corneal punctate epithelial opacities,
lens surface opacities
• Rarely symptomatic
• Reversible with drug discontinuation
Thioridazine
• A psychiatric drug
• Causes a pigmentary retinopathy after high
dosage
Ethambutol :
• An anti-TB drug
• Causes a dose-related optic neuropathy
• Usually reversible but occasionally permanent
visual damage might occur
• Thank u
Ocular  pharmacology
Ocular  pharmacology
Ocular  pharmacology
Ocular  pharmacology
Ocular  pharmacology
Ocular  pharmacology
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Ocular pharmacology

  • 2. Pharmacodynamics • It is the biological and therapeutic effect of the drug (mechanism of action) • Most drugs act by binding to regulatory macromolecules, usually neurotransmitters or hormone receptors or enzymes • If the drug is working at the receptor level, it can be either agonist antagonist
  • 3. • If the drug is working at the enzyme level, it can be activator inhibitor
  • 4. Pharmacokinetics • It is the: ADEM Absorption, Distribution, Metabolism, and Excretion of the drug • A drug can be delivered to ocular tissue as: • Locally: Eye drop Ointment Periocular injection Intraocular injection • Systemically: Orally Intravenous(I.V.)
  • 5. Drug Delivery in Eyes TOPICAL PERIOCULAR INTRAOCULAR SYSTEMIC DROPS SUBCONJUNCTIVAL INTRACAMERAL ORAL OINTMENT SUNTENON INTRAVITREAL INTRAVENOUS GEL PERIBULBAR/RETR OBULBAR INTRAMUSCULAR
  • 6. Factors influencing local drug penetration into ocular tissue Drug concentration and solubility : • The higher the concentration the better the penetration e.g pilocarpine 1-4% but limited by reflex tearing Viscosity: Addition of methylcellulose and polyvinyl alcohol increases drug penetration by increasing the contact time with the cornea and altering corneal epithelium Lipid solubility : Because of the lipid rich environment of the epithelial cell membranes, the higher lipid solubility the more the penetration Amphipathic- epithelium/endothelium----lipophilic stroma---hydrophilic
  • 7. Factors influencing local drug penetration into ocular tissue Surfactants : The preservatives used in ocular preparations alter cell membrane in the cornea and increase drug permeability e.g. benzylkonium and thiomersal pH : The normal tear pH is 7.4 and if the drug pH is much different, this will cause reflex tearing Drug tonicity : When an alkaloid drug is put in relatively alkaloid medium, the proportion of the uncharged form will increase, thus more penetration Molecular weight and size:
  • 8. TOPICAL Drop - simplest and more convenient mainly for day time use • 1 drop=50 microlitre • Conjuctival sac capacity=7-13 micro liter so, even 1 drop is more than enough Method -hold the skin below the lower eye lid - pull it forward slightly -INSTALL 1 drop measures to increase drop absorption : -wait 5-10 minutes between drops -compress lacrimal sac -keep lids closed for 5 minutes after instillation
  • 9.
  • 10. Ointments  Increase the contact time of ocular medication to ocular surface thus better effect  It has the disadvantage of vision blurring The drug has to be high lipid soluble with some water solubility to have the maximum effect as ointment
  • 11.
  • 12. Peri-ocular injections • They reach behind iris-lens diaphragm better than topical application E.g. subconjunctival, subtenon, peribulbar, or retrobulbar • This route bypass the conjunctival and corneal epithelium which is good for drugs with low lipid solubility (e.g. penicillins) • Also steroid and local anesthetics can be applied this way
  • 13. Periocular • Subconjunctival - To achieve higher concentration -Drugs which can’t penetrate cornea due to large size -Penetrate via sclera • Subtenon — ant. Subtenon– disease ant to the Lens Post Subtenon– disease posterior to the lens Retrobulbar - Optic neuritis Papillitis Posterior uveitis Anesthesia • Peribulbar -- anesthesia
  • 14.
  • 15. Intraocular injection Intracameral or intravitreal E.g. • Intracameral acetylcholine (miochol) during cataract surgery • Intravitreal antibiotics in cases of endophthalmitis • Intravitreal steroid in macular edema • Intravitreal Anti-VEGF for DR
  • 16.
  • 17. Sustained-release devices • These are devices that deliver an adequate supply of medication at a steady-state level E.g. -Ocusert delivering pilocarpine -Timoptic XE delivering timolol -Ganciclovir sustained-release intraocular device -Collagen shields
  • 18.
  • 19. Common ocular drugs • Antibacterials (antibiotics) • Antivirals • Antifungal • Mydriatics and cycloplegics • Antiglaucoma Corticosteroids • Anti-inflammatory agents NSAIDS • Ocular Lubricants • Ocular diagnostic drugs • Local anesthetics • Ocular Toxicology
  • 20. Antibacterials( antibiotics) • Penicillins • Cephalosporins • Sulfonamides • Tetracyclines • Chloramphenicol • Aminoglycosides • Fluoroquinolone • Vancomycin • macrolides
  • 21. Antibiotics • Used topically in prophylaxis (pre and postoperatively) and treatment of ocular bacterial infections. • Used orally for the treatment of preseptal cellulitis e.g. amoxycillin with clavulonate, cefaclor • Used intravenously for the treatment of orbital cellulitis e.g. gentamicin, cephalosporin, vancomycin, flagyl • Can be injected intravitrally for the treatment of endophthalmitis
  • 22.
  • 23. Specific antibiotic for almost each organisms • Sulfonamiodes –
  • 24. USES: Chlamydial infections like TRACHOMA INCLUSION CONJUNCTIVITIS TOXOPLAMOSIS
  • 26. • first generation- gm + cocci eg cephazolone • second generation —Gm – ve and antistaphylococcal— cefuroxime • Third generation – Gm –ve bacilli – ceftriaxones
  • 27. • Side effects- allergic reaction Neutropenia thrombocytopenia
  • 28. Amino glycosides • Mechanism of Action: Bacterial protein synthesis inhibitors • mainly against gm negative bacilli • Gentamycin- 0.3% eye drop • Tobramycin- Pseudomonas 1% eye drop • Neomycin- 0.3-0.5% eye drop
  • 29. Tetracycline • Inhibit protein synthesis • active against both gm+ and gm -, some fungi and Chlamydia Chloromphenicol • Inhibit protein synthesis • Broad spectrum ,bacteriostatic, gm+/gm-, Chlamydia • 0.5% Eye drop, ointment
  • 30. Antibiotics • Trachoma can be treated by topical and systemic tetracycline or erythromycin, or systemic azithromycin. • Bacterial keratitis (bacterial corneal ulcers) can be treated by topical fortified penicillins, cephalosporins, aminoglycosides, vancomycin, or fluoroquinolones. • Bacterial conjunctivitis is usually self limited but topical erythromycin, aminoglycosides, fluoroquinolones, or chloramphenicol can be used
  • 31. Antivirals Acyclovir 3% oinment 5 times-10-14 days 800mg oral 5 times 10-14 days intravenous for Herpes zoster retinitis Others INDICATIONS Idoxuridine HZ keratitis Vidarabine Viral uveitis Cytarabine Triflurothymidine Gancyclovir
  • 34. ANTIFUNGAL INDICATIONS • Fungal corneal ulcer • Fungal retinitis/ Endophthalmitis • Commonly used drugs are Polyenes -damage cell membrane of susceptible fungi -e.g. amphotericin B, natamycin, nystatin -side effect: nephrotoxicity Imidazoles increase fungal cell membrane permeability • e.g. miconazole, ketoconazole,fluconazile Flucytocine act by inhibiting DNA synthesis
  • 36. MYDRIATICS AND CYCLOPLEGIC • MYDRIATICS- Dilate the pupil, by constriction of radial muscles(sympathetic supply) e.g.Phenylepherine • Cycloplegic – causes ciliary muscle paralysis(parasympathetic) CLASSIFICATION • Short acting- Tropicamide (4-6 hours) • Intermediate- homatropine ( 24 hours) • Long acting- atropine (2 weeks) Indications • corneal ulcer • uveitis • cycloplegic refraction
  • 37. Antiglaucoma drugs Beta blockers- Selective – betaxolol Non selective- timolol Mechanism of Action: reduces aqueous humour production Reduces IOP Side effect: systemic ocular Bradycardia Irritation Sweating Frontal Headache Anxiety Iris cyst Follicular Conjunctivitis
  • 38. Carbonic anhydrase inhibitors Systemic Topical • acetazoamide Dorzolamide Brinzolamide Mechanism of action-- reduce aqueous humour formation Side effect Paresthesiae Frequent urination GI disturbances Hypokalamia
  • 39. • Hyperosmotic agent- iv mannitol when IOP is very high 60-70 In adults the dose is 0.2 g/kg body weight. In pediatric patients the dose is 0.2 g/kg body weight or 6 g/m² body surface area. The infusion is given as a 15% to 25% solution over a period of 3 to 5 minutes to produce a urine flow of at least 30 to 50 mL/hour. • Prostaglandins • Latanoprost (0.005% eye drop) • increased aqueous out flow • Reduced IOP • Side effect– conjunctival redness, iris and periocular pigmentation hypertrichosis, darkening of iris
  • 41. • ANTI – INFLAMMATORY Corticosteroids Non- steroidal anti-inflammatory drugs(NSAIDS)
  • 43. Corticosteroids CLASSIFICATION • Short acting hydrocortisone, cortisone, prednisolone • Intermediate acting :Trimcinolone, Fluprednisolone • Long acting Dexamethasone ,betamethasone
  • 44.
  • 45. Indications • Topical • allergic conjunctivitis, • scleritis, • uveitis, • Allergic keratitis • after intraocular and extra ocular surgeries • Systemic (pathology behind the LENS) • Posterior uveitis • Optic neuritis • corneal graft rejection NEVER GIVE STEROID IF YOU ARE SUSPECTING ACTIVE INFECTION
  • 49. Contraindications Ocular • Fungal Infections • Glaucoma • Corneal Epithelial defect • Herpetic Epithelial Keratitis Systemic • Osteoporosis • Diabetes Mellitus • Congestive Heart Failure(CHF) • Renal Filure • Peptic Ulcer
  • 50. Side effects • Ocular Glaucoma Cataract Activation of infection Delayed wound healing
  • 51.
  • 52.
  • 53. Pre-requisite • BP • Blood sugar • Mantoux • TC,DC,ESR • CXR
  • 54. NSAIDS Topical use • flurbiprofen • indomethacine • Ketorolac Indications • episcleritis and scleritis • uveitis • CME • PRE operatively to maintain dilation of the pupil Preservative used is Benzalkonium Chloride(BAK)
  • 55.
  • 56.
  • 57. Ocular Lubricants Indication • ocular irritations in various diseases • Dry eyes Commonly available commercial tear substitutes REFRESH TEARS • TEAR PLUS • MOISOL • OCCUWET • Genteal gel eye drops Preservative used is Stabilized Oxycholrocomplex
  • 58. Ocular diagnostic drugs Fluorescein dye Available as drops or strips Dose: 2% Sodium Salt Uses : stain corneal abrasions, applanation tonometry, detecting wound leak, NLD obstruction, fluorescein angiography Caution: stains soft contact lens Fluorescein drops can be contaminated by Pseudomonas sp.
  • 59.
  • 60. Ocular diagnostic drugs Rose bengal stain Stains devitalized epithelium Dose : 1% Uses: severe dry eye, herpetic keratitis
  • 61. Local anesthetics Local anesthetics • topical E.g. Proparacaine—0.5% tetracaine Uses : applanation tonometry, goniscopy, removal of corneal foreign bodies, removal of sutures, examination of patients who cannot open eyes because of pain Adverse effects : toxic to corneal epithelium, allergic reaction rarely
  • 62. Local anesthetics • Orbital infiltration -peribulbar or retrobulbar -cause anesthesia and akinesia for intraocular surgery -e.g. Lidocaine—2%, bupivacaine:0.5%
  • 65. Complications of topical administration Mechanical injury from the bottle e.g. corneal abrasion Pigmentation: epinephrine Ocular damage : e.g. topical anesthetics, benzylkonium Hypersensitivity : e.g. atropine, neomycin, gentamicin Systemic effect : topical phenylephrine can increase BP
  • 66. Amiodarone • A cardiac arrhythmia drug • Causes optic neuropathy (mild decreased vision, visual field defects, bilateral optic disc swelling) • Also causes corneal vortex keratopathy (corneal verticillata) which is whorl-shaped pigmented deposits in the corneal epithelium
  • 67.
  • 68. Digitalis • A cardiac failure drug • Causes chromatopsia (objects appear yellow) with overdose
  • 69.
  • 70. Chloroquines • E.g. chloroquine, hydroxychloroquine • Used in malaria, rheumatoid arthritis, SLE • Cause vortex keratopathy (corneal verticillata) which is usually asymptomatic but can present with glare and photophobia • Also cause retinopathy (bull’s eye maculopathy)
  • 71.
  • 72. Chorpromazine • A psychiatric drug • Causes corneal punctate epithelial opacities, lens surface opacities • Rarely symptomatic • Reversible with drug discontinuation
  • 73. Thioridazine • A psychiatric drug • Causes a pigmentary retinopathy after high dosage
  • 74. Ethambutol : • An anti-TB drug • Causes a dose-related optic neuropathy • Usually reversible but occasionally permanent visual damage might occur
  • 75.