steroids have anti inflammatory effects as well as side effects to eye. NSAIDS have an advantage of less side effects.

1. 1. ocular Anti inflammatory therapy
2. Mydriatics and cycloplegics
3. Local aneasthetics
OCULAR PHARMACOLOGY

2. CHAPTER NO.1:
ANTI –INFLAMMATORY THERAPY
• Anti –inflammatory therapy is directed against:
• various chemical and cellular mediators of inflammation e.g. mast
cells, lymphocytes, leukocytes, complement histamine, kinin,
photolytic enzyme and various arachidonic acid derivative
• Classification
• Corticosteroids
• NSAIDS
• Immuno-suppressive agents

5. CORTICOSTEROIDS
USE-INDICATIONS

6. CORTICOSTEROIDS
• Mechanism of action
• Suppress hyperemia ,cellular infiltration, vascularization and Fibroblastic proliferation
• By potentiation of Epinephrine vasoconstriction, retardation of Macrophage movement ,
prevention of kinnin release, inhibition of lymphocyte and neutrophil functions, inhibition of
prostaglandin synthesis,
• In prolonged use antibody production etc….
• General principals (for use of corticosteroids)
• Type and location of inflammation.
• Close follow-up to assess the effects of therapy on disease and adverse effects to the patient.
• Treatment should not be extended from 3-4 weeks
• Individulized dosage
• Minimum dose, minimum possible time
• Gradual removal of drug
• Patient compliance etc…

7. CORTICOSTEROIDS
• Corticosteroids: Side Effects of eye drops
Burning sensation.
Headache.
Itching.
Blurred vision.
Light sensitivity.
Temporary pain, stinging, or irritation.
Runny nose.
Dry eyes.

8. CORTICOSTEROIDS: OCULAR SIDE EFFECTS
DECREASED VISION, EYE INFECTION & PAIN , GRADUAL BLURRING AND LOSS OF VISION

10. CONTRAINDICATIONS AND DOSAGE:
• Fungal diseases of ocular structures
• Untreated purulent ocular infections
• Viral infections of cornea and cunjunctiva
• Hypersensitivity
• Simplex keratitis
• Ocular tuberculosis
• After removal of superficial corneal foreign body
DOSAGE:
• 1-2 drops in conjunctival sac every hour during day and 2 hours during night in acute
inflammatory conditions.
• Mild-moderate inflammation 1 drop in 4-6 hours
• Ointments :apply thin coating in lower comjunctival sac 3-4 times a day in sever
inflammation. In mild to moderate cases 1 time application at night time is sufficient to
control the symptoms.
• Ointment +eye pad= more contact time of drug to ocular surface= more effectiveness

11. PREDNISOLONE (INTERMEDIATE ACTING
CORTICOSTEROIDS)
• Available as:
• Acetate suspension -0.5% and 2.5%
• Acetate solution- 0.2%
• Acetate ointment- 1.5%
• Is a synthetic corticosteroid
• Inhibits edema , capillary dilatation and deposition of collagen , deposition of fibrin and scar formation.
• Contraindications:
• Acute untreated purulent infections of eye
• Viral diseases of cornea and conjunctiva
• Fungal infections of eye
• Dendritic keratitis
• Adverse effects:
• Raised IOP with optic disk damage
• Visual field defects
• PSC formation
• Dosage:
• 1-2 drops in conjunctival sac 3-4 times a day.

12. FLUOROMETHELONE
• Available as 0.1% and 0.25% suspension with Liquifilm (polyvinyl alcohol).
• Indications :
• After PRK and LASIK surgery
• Mild anterior segment inflammation ( pan-uveitis , scleritis and episcleritis)
• Phaco emulcification (post surgical inflammation)
• Traumatic inflammation of eye
• Dosage and administration:
• 1 Drop 2-4 times daily in intial 24-48 hours drops can be increased 2 drops
every hour depending upon severity of condition.
• Don’t discontinue therapy prematurely and abrupty.

13. TOPICAL STEROIDS + ANTIBIOTIC
COMBINATIONS
• Dexamethasone (0.1%) + neomycin ( 0.5%) solution form
• Dexamethasone (0.1%) + tobramycin ( 0.3%) suspension
• Dexamethasone (0.1%) + chloramphenicol ( 0.5 – 1%) solution
• Dexamethasone (0.1%0 + Ofloxacin (0.3)
• Dexamethasone (0.1%) + ciprofloxacin (0.3)
• Betamethasone (0.1%) + neomycin ( 0.5%) solution
• Betamethasone (1%) + chloramphenicol (0.5%) soln. and ointment
• Betamethasone (0.1%) + gentamicin (0.3%) soln.

14. NSAID’S
• These are non-steroidal anti inflammatory drugs/ agents.
• Have effects:
• Antipyretic
• Anti inflammatory
• Antiplatelet

16. NASID’S

17. • Uveitis
• Scleritis and episcleritis
• Allergic and giant papillary conjunctivitis
• Maintenance of intraoperative mydriasis
• Reduction of post operative Inflammation
• Prevention and treatment of Phakic and
Pseudophakic CYSTOID MACULAR
EDEMA
• Reduction of discomfort after intraocular
surgery
• Well absorbed after oral administration
• 90 to 99 % protein bound
• Topical penetrate eye better
• Topical application can result in
Systemic toxicity if Nasolacrimal
occlusion and eye lid closure is not
applied
• Primarily undergoes hepatic
metabolism
• Excreted in the urine
NSAID’S
pharmacokinetics Ocular infections for NSAID’S

18. NSAID’S
Adverse effects ( general and systemic toxicity)
• Topical burning, stinging , hyperemia of the conjunctiva
• Systemic: GIT, Hematological, Liver, dermatological and Metabolic changes

19. NSAID’S