1

Drugs for Common

Eye Problems
Cecilia A. Jimeno, M.D.
Ateneo School ond Medicine & Public Health
08/23/15

Anatomy & Physiology

08/23/15

Topical Ophthalmic Drugs:

Considerations
They must be absorbed into the anterior
chamber
They may be administered at different
frequencies depending on whether they are in
ointment or solution form
Ointments: have a longer duration of action
(2-4 hrs) than drops
They must be relatively easy to administer for
client compliance
08/23/15

INTRODUCTION: Tips on using

Ophthalmological Preparations
Ophthalmological preparations are sterile
but once opened they have the potential to
be contaminated
Hence, dropper tips should NOT touch any
surface
Maximum volume accommodated by the
lids is 30l; usual drop size of a standard
eye drop bottle is 20 l which will stimulate
tearing for 5 minutes
08/23/15

TIPS
Only one drop should be placed in the eye at a
time since by sheer volume it will just spill over
Allow a 5 minute interval between 2 consecutive
eye drops
Some pts cannot tolerate ointments because of
blurring of vision and the deposition on the
eyelids (unacceptable cosmetic appearance and
discomfort)

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TIPS
Hence, prescribe drops during the day and
ointments at night
Moreover, if necessary, drops should
precede ointments because the latter
impedes the absorption of the former

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KINETICS: ADME
Topical drugs exert their effect by absorption
via the cornea and conjunctival vessels
Excess drug is cleared via the lacrimal
apparatus through the nasal mucosa and the
nasopharynx ----- access to systemic
circulation [and hence, systemic side effects]
Hence, instruct patients on manual
nasolacrimal occlusion and eyelid closure for 1
to 2 min to decrease systemic absorption
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Outline (based on PNDF)

1. Anti-infective agents
2. Anti-inflammatory agents
- Steroids

- NSAIDs

3. Diagnostic agents
4. Drugs used in glaucoma

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Cholinergics

Beta-arenoceptor blocking drugs (Beta blockers)

Adrenergic agonsts

Prostglandin analogues

Carbonic anhydrase inhibitors

Hyperosmotic agents

Outline
6. Local anesthetics (not included)
7. Mydriatics and Cycloplegics (Anticholinergics)

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10

Anti-Infective Agents: general

Avoid indiscriminate use of broad spectrum
antibiotics, or
The use of antibiotics for excessively long
periods of time
Caution on use of combined antibiotics &
steroid preparations
RATIONAL PRESCRIBING:
To prevent emergence of resistant organisms
To avoid ADRs (toxic eye reactions)
To avoid unnecessary expense

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11

Anti-Infective Agents (general

principles)
For maximal effect on ocular and periocular
tissues, the properly dosaged and diluted IV
antibiotic preparations may also be injected
through the ff routes: subconjunctival,
intracameral, intravitreal and retrobulbar
areas

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12

Chloramphenicol
Broad spectrum, bacteriostatic against most
Gm (+), Gm (-) and anaerobic organisms
Resistance is increasing esp for hospital
strains of staphylococci (50%)
High lipid solubility: good therapeutic evels
in the aqueous humor
No route of admin can achieve good levels in
the vitreous

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13

Chloramphenicol
INDICATIONS: superficial infections of the eye caused
by susceptible bacteria (used only when less toxic
drugs are contraindicated or ineffective)
Local drug toxicity is rare
Consider systemic absorption ff topical ophtalmic
application: gray baby syndrome, urticaria, allergic
reactions (rash), bone marrow suppression (e.g.
aplastic anemia)
Pregnancy Risk: C
Eye ointments (BID-TID) or drops (hourly or q 6hrs)

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14

Erythromycin
Macrolide: gram positive cocci (staph,
strep) and bacilli ; some gm (-) cocci
(Neisseria) & bacilli (H. Influenzae,
Moraxella, Chlamydiae, Treponema)
Recommended for prevention of neonatal
ophthalmia
Pregnancy Risk Category: B

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Erythromycin (cont)
Indications
Superficial infections of the eye caused by
susceptible orgs
Adjunct to oral anti-infective therapy of
Chlamydia infections (trachoma, inclusion
conjunctivitis)
Prophylaxis of ophthalmia neonatorum from both
gonococci and Chlamydia

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16

Erythromycin (cont)
Dose: as eye ointment
Bacterial infections: OD to BID
Chlamydial ophtalmic infections: BID daily for
2 mos or BD for the first 5 days of each month
for 6 mos
Prophylaxis of ophthalmia neonatorum: 1 cm
ribbon of 0.5% ointment into each conjunctival
sac immediately after birth: new tube for each
neonate (single use)

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17

Oxytetracycline
Bacteriostatic against gm (-) [Pseudomaonas aeruginosa,
Entorobacteriacae] and gm (+) bacteria and against
Rickettsia, Chlamydia, Mycoplasma, spirochetes, fungi &
viruses
Penetrate ocular tissues better than other anti-infectives
because of their high lipid solubility
Same indications as Erythromycin
Systemic absorption possible : serious dental & skeletal
effects
Pregnancy risk category: D
Eye ointment

08/23/15

Gentamicin
Bactericidal for gm (-) aerobic organisms through
bacterial ribosomal inhibition
Limited bioavailability: After topical application ,
much of the drug is bound to the iris and choroidal
pigment
For superficial infections of the eye caused by
susceptible orgs: Pseudomonas aeruginosa, E. Coli,
Enterobacter, Klebsiell, Proteus, Serratia
Pregnancy risk: C
Ointment 2-3x/d, drops q1-4 hr

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Tobramycin
Also an aminoglycoside against gm (-) orgs
Unlike gentamicin, has poor activity against
Enterococcus and Mycobacterium
When inflammation is severe, there is a
combined tobramycin + dexamethasone
preparation (eye drops and ointment)

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Framycetin
Aminoglycoside closely related to the
neomycin group; bactericidal & active against
both gm (+) and gm(-) bacteria found in
superficial eye infections (staph, Pseudomonas,
coliforms, and Pneumococci)
Treatment of local eye infections
(Conjunctivitis, blepharitis) due to susceptible
organisms; corneal abrasions, ulers and burns
Eye drops, 1 drop 3-4x/d
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21

Aciclovir
Purine analog, 1st or 2nd gen antiviral specific for
local treatment of Herpes simplex
keratoconjunctivitis and varicella zoster viral
infection
Highly effective effective viral DNA polymerase
inhibitor in affected cells
For local treatment of HSV 1 and 2, varicella
zoster infections affecting eye
Apply eye ointment to cover all lesions 5x/d for
14 days to start as soon as with signs & sx
08/23/15

Ganciclovir
Purine analog much like acyclovir but differs by an
additional hydroxymethyl group on the side chain
with wider spectrum of activity
HSV 1 and 2, Herpes varicella-zoster, EBV
Inhibits viral DNA synthesis by competitive inhibition
of viral DNA polymerase and is incorporated into
viral DNA as DNA chain terminator
Has potential to cause cancer, birth defects,
azospermia (unlikely for topical but possible)
Pregnancy Risk category: C

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22

23

Trifluridine
Thymidine analog which inhibits DNA
polymerase and incorporates itself into DNA
Very effective against HSV 1 and 2,and
vaccinia. Inhibits CMV and adenovirus in vitro
Precaution: may impair wound healing (postop and thinned corneas)
Pregnancy risk category: C
08/23/15

Fusidate sodium (fusidic acid)

Antibiotic derived from Fusidium coccineum
Inhibits protein synthesis in bacteria, active against
a wide range of gm (+) orgs esp staphy & Strep and
some gm (-) orgs (pneumococus, Neisseria,
Hemophilus, Moraxella, Corynebacterium)
No known cross-resistance with other antibiotics
Stable to bacterial beta-lactamases
Penetrates well into the aqueous humor
Drops suspension: 1 drop q 12 h

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24

25

Ofloxacin
One of the 4 quinolones, bactericidal to a large
number of gm (+) and gm (-) orgs through
inhibition of DNA gyrase
For Staph aureus, H. influenzae, Pseudomonas
aeruginosa, E. Coli, Klebsiella &
enterobacteriacae, anerobes, legionella,
Neisseria gonorrhea, Chlamydia trachomatis
Pregnancy risk category: C
Eye ointment, Eye drops solution
08/23/15

Povidone-iodine (topical)
Used as an epitheolytic agent causing
destruction of corneal epithelium;
Does not remove viruses or enter live cells
Cocaine inactivates this agent; should not
be used for corneal anesthesia
Indicated for superficial dendritic forms of
herpes simplex keratitits when aciclovir and
ganciclovir are not available
Used for peri-operative preparations of the
conjunctiva and periocular skin
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26

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Anti-inflammatory Agents
STEROIDAL
NSAID

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28

STEROIDAL
WARNING: Intake or application of
corticosteroids to the eye may induce an attack
of or aggravate open angle glaucoma
Inhibit inflammatory response of whatever
cause: mechanical, chemical or immunologic
agents
Inhibit redness, edema, exudation, capillary
dilatation, fibroblastic proliferation and fibrin
deposition, and cellular infiltration & migration
of leukocytes and phagocytes, collagen
deposition and cicatrization
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29

Steroids
Stablize lysosomal membranes with
prevention of release of kinins, inhibition of
prostaglandin synthesis, and with chronic
use decrease Ab production
Following instillation into the conjunctival
sac, corticosteroids are absorbed into the
aqueous humor and systemic absorption
may occur
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STEROIDS: Indications
Corneal & conjunctival inflammation such
as allergic keratoconjunctivitis, episcleritis,
immune viral interstitial keratitis
To decrease inflammation and rejection in
corneal transplant
For uveitis, iritis and cyclitis, scleritis
Corneal, conjunctival, and scleral injuries
from chemical, radiation and thermal burns
Treatment of post-op inflammation
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31

Steroids: contraindications
Microbial, viral, fungal and tuberculous
infections of the eye, unless these infections are
controlled by appropriate chemotherapy, and use
is under close supervision of a specialist
Precaution: some preparations contain sulfite,
which may cause allergic reactions
Chronic use may cause corneal perforation
Example: prednisolone, dexamethasone drops
suspension
08/23/15

Combination of Antibiotics &

Steroids
Sulfacetamide + Prednisolone: eye drops
suspension 10% sulfacetamide + 0.25%
prednisolone (as acetate), 5 mL bottle
Tobramycin + dexamethasone:
Eye Drops Suspension: 0.3% tobramycin + 0.1%
dexamethasone, 5 mL bottle
Eye Ointment: 0.3% tobramycin + 0.1%
dexamethasone, 3.5 g tube

08/23/15

32

33

NSAIDs
Used for local treatment of ocular
inflammation without the disadvantages of
steroids
E.g. diclofenac eye drops suspension
Reduces leukocyte accumulation and exudation
into the chamber fluid
Has good penetration into the ant chamber
Re-epithelialization of the corneal epithelium
is not inhibited by local diclofenac treatment
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34

NSAIDs: Indications
1. Inhibition of intra-operative miosis during
cataract surgery
2. Treatment of macular edema
3. Chronic conjunctivitis, ketaoconjunctivitis,
keratitis, episcleritis
4. Painful post-traumatic conditions of the cornea
and conjunctiva
5. Pre-op and in short- and long-term post-operative
inflammatory process, to reduce ciliary and
conjunctival injection
6. Corneal margin ulcers
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35

NSAIDs: precautions
Use with caution on pts with known bleeding
tendencies, or on medications that prolong
bleeding
Pregnancy risk category: B
Generally well tolerated with only mild
transient burning
Examples: Nepafenac Eye Suspension: 1
mg/mL, 5 mL bottle
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36

DIAGNOSTIC AGENT: Fluorescein

Yellow water-soluble dibasic that produces an
intense green fluorescence in alkaline medium
An indicator dye for the diagnosis of corneal
epithelial defects or abrasions, & detection of
foreign bodies; for testing the patency of the
nasolacrimal drainage, fitting of contact lenses,
etc
IV preparation is used to study the aqueous
secretion of the ciliary body; for fluorescein
angiography, and vitreous fluorophotometry
08/23/15

37

DRUGS USED IN
GLAUCOMA

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38

Anatomy & Physiology

08/23/15

Flow of aqueuos humor

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39

40

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41

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42

Pathophysiology of glaucoma
Increased intraocular pressure causes optic
nerve damage, visual field deterioration and
eventually blindness
Degree of damage depends on the level of
the IOP and the chronicity of the conditio
Major therapeutic objective: reduce IOP
urgently to arrest the damage to the optic
nerve
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43

Therapeutic options
Options for lowering IOP include
the use of topical or systemic medications,
laser trabeculoplasty,
surgery to improve outflow facility, and
cyclodestructive laser to reduce aqueous
production.

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44

Treatment of Glaucoma
Primary open-angle glaucoma is primarily
treated medically, while angle closure
glaucoma and congenital glaucoma are
treated surgically, although short term drug
therapy should be initiated to decrease
intra-ocular pressure prior to surgery
IOP may be decreased by increasing the
rate of outflow (drainage) of aqueous humor
from the anterior chamber OR decreasing
rate of production
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45

Glaucoma Medications Used for

Chronic Treatment

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46

CHOLINERGIC AGONISTS (miotics)

Parasympathomimetics which duplicate the
effects of acetylcholine
Exerts effects on muscarinic receptors of the
ciliary body stimulating the contraction of the
longitudinal muscle fibers inserting to the
scleral spur which then widens the valve-like
pores of the trabecular meshwork facilitating
outflow of aqueous humor
Possibly also a direct effect on the cholinergic
receptors of the meshwork itself
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47

CHOLINERGIC AGONISTS (miotics)

Pupilary constriction is NOT an impt factor for
pressure reduction in open-angle glaucoma but
is relevant in angle closure glaucoma
Constriction of pupil pulls the peripheral iris
away from the trabecular meshwork
Other effects: vasodilatation of blood vessels
of the conjunctiva, iris and ciliary body & inc
permeability of blood-aqueous barrier leading
to vascular congestion & ocular inflammation
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48

08/23/15

CHOLINERGIC AGONISTS (miotics)

Contraindications: cause a breakdown of the
blood-aqueous barrier- they are
contraindicated in pts with acute ant chamber
inflammation, pupillary block glaucoma,
neovascular glaucoma
Caution in elderly (miosis leads to decrease in
ambient light reception/dark adaptation).
Retinal detachment may rarely occur because
of the drug-induced pull on the peripheral
retina as the iris-lens diaphragm is pulled
forward
08/23/15

49

Parasympathomimetics
(cholinergic agents)
Generic name
Trade name
pilocarpine
1%, 2%, 4%
Isopto Carpine

Mechanism of
action
Increases facility
of outflow
of aqueous
through
pilocarpine gel 4% conventional
Pilopine HS
trabecular
outflow pathway
carbachol
1.5%, 3%
Isopto Carbachol

Efficacy* and
dosing
Pilocarpine
lowers IOP in
1 hour and lasts
67 hours
Pilocarpine: QID
Pilopine HS: HS
Carbachol: TID
Reduces IOP by
1525%

Considerations
Contraindications: Uveitis-related
and neovascular glaucoma,
aqueous misdirection syndrome
Side effects: Miosis, myopia with
accommodative spasm, brow
ache, retinal detachment,
intestinal cramps, bronchospasm
Precautions: Axial myopia, history
of rhegmatogenous retinal
detachment, or peripheral retinal
disease predisposing to retinal
detachment
May be used with caution in
pregnancy

*Values reported are relative change (%) from baseline (peak to trough effect).

08/23/15

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.

CHOLINERGIC AGONISTS (miotics)

Systemic side effects from parasympathetic
stimulation: rare, tachycardia, bronchospasm,
nausea, vomiting, diarrhea, abd pain, int
cramps, tightness in the urinary bladder

08/23/15

Beta-adrenoceptor Blocking
drugs

08/23/15

Review of Beta-adrenergic receptors

Beta-1 receptors: cardiac tissue inotropism,
tachycardia, inc cardiac conduction time
Beta-2 receptors: lungs bronchodilation
In the eye, primary receptors appear to be Beta2 (mainly in the ciliary process); blockade results
in reduction of aqueous humor thus reducing the
IOP in eyes with or without glaucoma
FIRST CHOICE agents for treatment for openangle, angle-closure, inflammatory glaucoma
08/23/15

Beta-blockers
Combination therapy: additive effects are seen
with miotics, epinephrine, and especially
carbonic anhydrase inhibitors
Caution: there may be consensual drop in IOP in
the contralateral untreated eye, due to both
systemic absorption and direct diffusion through
shared blood circulation

08/23/15

Beta adrenergic antagonists

Generic name
Trade name
Selective beta-1
antagonist
betaxolol 0.25%
Betoptic S
Non-selective beta
antagonists
timolol 0.25%, 0.5%
Timoptic

Mechanism of
action
Decreases
aqueous
production

Efficacy* and
dosing
BID
Reduces IOP
by 2023%
BID
Daily for
Timoptic XE
Reduces IOP
by 2030%

timolol gel-forming
solution 0.25%,
0.5%
Timoptic XE
levobunolol 0.25%,
0.5%
Betagan

BID
Reduces IOP
by 2030%

*Values reported are relative change (%) from

baseline (peak to trough effect).

Timolol may be used during lactation. Punctal

occlusion is recommended following drop instillation
to 08/23/15
reduce systemic absorption, as timolol in
particular may appear in breast milk.

Considerations
Better tolerated than non-selective agents,
but not as effective
Relative side effects and contraindications
same as non-selective agents
Additive to most IOP-lowering agents
Side effects: Exacerbates obstructive
pulmonary diseases such as asthma, slows
heart rate and lowers BP. May mask
symptoms of hypoglycemia in patients with
diabetes on insulin or insulin secretagogues
Best-tolerated class from ocular standpoint,
some dry eye symptoms
Absolute contraindications: Patients with
asthma, COPD, sinus bradycardia, or
greater than first-degree heart block.
Precaution: Not recommended in patients
with life-threatening depression
May be used with caution in pregnancy.
Fetal heart monitoring for bradycardia and
arrhythmia may be indicated periodically

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.

Alpha-2 Adrenergic
Agonists

08/23/15

Alpha-2 Adrenergic Agonists

MOA: decrease IOP by increasing aqueous
outflow facility and possibly by decreasing the
rate of aqueous humor formation
For open angle glaucoma; may be used with
miotics, B-blockers, and carbonic anhydrase inh
Do NOT use for narrow occludable angle
glaucoma as mydriasis may cause angle closure
May cause discoloration of contact lens

08/23/15

Alpha-2 adrenergic agonists

Generic name
Trade name
apraclonidine
0.5%, 1.0%
Iopidine

Mechanism of
action
Decreases aqueous
production (prevents
severe elevation of
IOP following laser
procedures)

Efficacy* and
dosing
Maximum effect
in 45 hours
Duration of
effect:
812 hours
Reduces IOP by
2030%

brimonidine 0.2%
Alphagan

Decreases aqueous
production and
increases
brimonidine 0.15% uveoscleral outflow
Alphagan-P
(using Purite as
preservative)

TID if monotherapy, BID if

adjunctive
therapy

Considerations
High rate of allergy limits use
of apraclonidine for chronic
treatment
For chronic use of brimonidine:
Contraindications: Children,
patients taking monoamine
oxidase inhibitors
Side effects: Dry mouth, lid
retraction, allergy (more
common with apraclonidine),
conjunctival injection,
somnolence, fatigue,
headaches, hypotension
May be used with caution in
pregnancy

Duration of
effect: 812
hours
Reduces IOP by
*Values reported are relative change (%) from baseline
(peak to trough effect).
2030%
08/23/15

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.

Prostaglandin Anaogues
Endogenously produced naturally occurring
chemical mediators
Reduces IOP by enhancing uveoscleral aqueous
flow without significantly affecting other
parameters of aqueous humor dynamics
Efficacy persists even with chronic use

08/23/15

Prostaglandin derivatives
Generic name
Trade name
bimatoprost 0.03%
Lumigan

Mechanism
of action
Increases
uveoscleral
outflow

latanoprost 0.005% Bimatoprost

may also
Xalatan
increase
travoprost 0.004% trabecular
Travatan
outflow

Efficacy* and
dosing
Dosing once daily
IOP lowering starts
24 hours after
administration
Maximum IOPlowering often takes
35 weeks from start
of treatment
Reduces IOP:
latanoprost 2831%
travoprost 2931%
bimatoprost 2833%

Considerations
Side effects: Iris colour changes,
conjunctival hyperemia, burning,
stinging, foreign-body sensation,
eyelash change (length, thickness,
color; reversible after cessation),
cystoid macular edema in aphakia
and pseudophakia, possible
reactivation of herpes keratitis,
possible anterior uveitis
Should be avoided in pregnancy, as
prostaglandin F2-alpha can cause
uterine contraction and influence
fetal circulation

*Values reported are relative change (%) from baseline (peak to trough effect).

08/23/15

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.

Carbonic Anhydrase
Inhibitors

08/23/15

Carbonic Anhydrase Inhibitors

Carbonic anhydrase is an enzyme which
influences the production of bicarbonate in the
ciliary body allowing diffusion of sodium ions into
the posterior chamber making the aqueous
humor hypertonic ---- attracts water by
osmosis
CAIs inhibit carbonic anhydrae in the ciliary
processes thereby reducing aqueous secretion
Indicated for open and angle-closure glaucoma,
esp for control of acute angle-closure glaucoma
08/23/15

Carbonic anhydrase
inhibitors systemic
Generic name
Trade name
acetazolamide
methazolamide

Mechanism of
action
Decreases
aqueous
formation

Efficacy* and
dosing
Acetazolamide:
125250 mg PO
QID
Methazolamide:
2550 mg PO
TID
Reduces IOP by
2535%

Considerations
Indicated when topical medication
is not effective
May lead to hypokalemia
Contraindications: When sodium
and potassium blood levels are
depressed, as in kidney or liver
disease; in sickle cell anemia
Side effects: Parasthesia,
gastrointestinal symptoms,
depression, decreased libido,
kidney stones, blood dyscrasias,
metabolic acidosis, electrolyte
Imbalance
Precautions: Allergy to
sulfonamides, pregnancy
(teratogenic effects reported), and
nursing mothers

*Values reported are relative change (%) from baseline (peak to trough effect).

08/23/15

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.

Carbonic Anhydrase Inhibitors

ACETAZOLAMIDE: oral, well absorbed from the
gut; decrease in IOP is achieved 60 min after
oral intake, peaks in 4 hr and lasts 6-12 hrs
250 mg tablet
Side effects: electrolyte imbalance, metabolic
acidosis, anorexia, diarrhea, wt loss,
drowsiness, sedation, confusion

08/23/15

Carbonic anhydrase
inhibitors topical
Generic name
Trade name
brinzolamide 1%
Azopt
dorzolamide 2%
Trusopt

Mechanism of
action
Decreases
aqueous
Formation

Efficacy* and
dosing
Azopt: BID
Reduces IOP by
1522%

Considerations

Side effects: Ocular burning and

discomfort
Precautions: May increase
corneal edema with low
Trusopt:
endothelial cell count and (or)
Monotherapy: TID
corneal endothelial dysfunction
Adjunctive to
(e.g., Fuchs dystrophy).
topical beta
Combined oral and topical
blockers: BID
carbonic anhydrase inhibitors not
Reduces IOP by
recommended in this patient
1522%
population
Not well studied in pregnancy,
and should probably be avoided
due to concerns with oral agents
and teratogenicity

*Values reported are relative change (%) from baseline (peak to trough effect).

Dorzolamide may be used during lactation. Punctal occlusion is recommended following drop
instillation to reduce systemic absorption, as timolol in particular may appear in breast milk.

08/23/15

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.

Hyperosmotic Agents
Lower IOP by inducing rapid increase in blood
osmolality creating an osmotic gradient between
plasma & the ocular fluid leading to diffusion of
water from the eye to the iris, choroidal and retinal
vessels, and out to the peri-ocular vessels
resulting in ocular hypotonia
Used pre-operatively and in acute glaucoma
GLYCEROL (oral glycerin): most widely used oral
hyperosmotic agent for treating acute glaucoma
MANNITOL: intravenous
08/23/15

Documentation of
medical management
Recommendation
Monitoring of patients should include
documentation of the IOP (method and time
measured), patient confirmation of and frequency
of medications used, as well as the time of their
last medication administration [Consensus].

08/23/15

Canadian Ophthalmological Society evidence-based clinical

practice guidelines for the management of glaucoma in the
adult eye. Can J Ophthalmol 2009;44(Suppl 1):S1S93.

Other drugs: Mydriatics &

cycloplegics

08/23/15

Mydriatics & Cycloplegics

(Anti-cholinergics)
Warning: may cause an increase in IOP
Pupillary dilatation (mydriasis) and ciliary muscle
paresis or paralysis (cycloplegics) are the result
of anti-cholinergic drug use via blockage of the
parasympathetic innervation
Atropine, Tropicamaide, Cyclopentolate

08/23/15

70

THANK YOU
VERY MUCH!

08/23/15