K. P.

RISHNA BABU
 CONTENT
DRUG COMMON DRUGS USED IN
OPHTHALMOLOGY

MODES OF ADMINISTRATION MYDRIATRICS AND CYCLOPLEGICS AGENTS

TOPICAL INSTILLATION
ANTI-VIRAL DRUGS
PERIOCULAR INJECTION
ANTI-FUNGAL DRUGS
INTRAOCULAR INJECTION

SYSTEMIC ADMINISTRATION ANTI-INFLAMMATORY AGENTS

LUBRICATING AGENTS AND ARTIFICIAL TEAR

OTHER DRUGS AFFECTING EYE
INTRAOCULAR AND IRRIGATING SOLUTIONS
 DRUG
In pharmacology, a pharmaceutical drug,also
called a medication or medicine, is a chemical
substance used to treat, cure, prevent, or
diagnose, a disease or to promote well-being.
 MODES OF
ADMINISTRATION
 DRUG DELIVERY IN EYES

Topical Periocular Intraocular Systemic

Drop Subconj. Intracameral Oral

Ointment Subtenon Intravitreal Intravenous

Intramuscular
Gel Peribulbar

Soft contact lens Retrobulbar

Ocuserts
 STANDARD COLOURS FOR DRUG
LABELING & BOTTLE CAP
• Yellow,, Blue : B blocker
• Red : Mydriatics and cycloplegics
• Green : Miotics
• Orange : Carbonic anhydrase inhibitors
• Brown or tan : Anti-infective agents
• Gray : NSAIDS
• Pink : Steroids
COMMON DRUGS USED
IN OPHTHALMOLOGY
 MYDRIATRICS AND CYCLOPLEGICS
AGENTS
• MYDRIATICS
– Only mydriasis
– Care should be taken in older patients
• Phenylephrine
• CYCLOPLEGICS
– Along with mydriasis paralysis of accommodation
• Atropine sulfate
• Homatropine hydrobromide
• Cyclopentolate hydrochloride
• Tropicamide
 PHENYLEPHRINE
• Direct acting drug
• Pupil dilation for diagnostic purpose
• Indication
– COAG
– Subacute or chronic ACG after iredectomy
– Refused surgery cases
• Contraindication
– Narrow angle glaucoma.
– Hypertensives.
– Type 1 diabetes mellitus.
– Aneurysms.
– Cardiac diseases
– Patients on reserpine
– Infants
• Adverse effects
– Mild stinging
– HTN, headache, browache
• Dosage
– 1 or 2 drops for each refraction
 ATROPINE
• Atropine sulfate is anticholinergic – 0.5%, 1%,3%
• Strongest drug in cycloplegics
• Inhibitor of muscarinic action of acetylcholine
• Indication
– Mydriasis & cycloplegia
– Pupil dilation in inflammatory condition of iris
– Amblyopia therapy
• Contraindication
– 1˚ glaucoma
– Hypersensitive
• Adverse effects
– Allergic responses
– Blurred vision
– Photophobia
– Dryness of skin & mouth
– Skin rash
• Dosage
– 1 or 2 drops 0.5% to each eye, twice daily for 1 to 3 days prior to examination
 HOMATROPINE
• First anticholinergic
• Directly blocks muscarinic action of acetylcholine
• Its effect last for longer time
• Indication
– Cycloplegic refraction
– Treatment of inflammatory uveal tract condition
• Contraindication
– Tendency with occludable angles
– Patient who have allergic to atropine
• Adverse reaction
– Follicular conjunctivitis
– Vascular congestion
– Edema exudate
• Dosage
– 1 or two drops repeated in 5 to 10 minute if necessary
 CYCLOPENTOLATE
• Cyclopentolate hydrochloride 1% is an anticholinergic
• Indication
– Cycloplegics of children under the age 12 to 20 yrs
• Contraindication
– Narrow angle glaucoma
– Hypersensitive
– Children with emosional problems
• Adverse effects
– Increased IOP, blurring of vision, photophobia
– Psychotic reaction
– Dryness of mouth, headache or allergic reactions
• Dosage
– One drop followed by second drop in 5 minutes of arc
 TROPICAMIDE
• Most common anticholinergic medriatric drug
• Stronger – 1%, paralysis accomodation
0.5% produce mydriasis with slight cycloplegia
• Indication
– Diagnostic process
– Pre and post operative stages
– Infants – combination with phenylephrine
• Contraindication
– Narrow angle glaucoma
– Hypersensitive
• Adverse effect
– Stinging sensation
– Confusion or hyperactivity
• Dosage
– 2 drops of 1% in each eye 2 to 3 times at 5 min intervals
Onset & Recovery
STRENGTH OF MYDRIASIS
DRUG AGE SOLUTION % MAXIMAL RECOVERY

Atropine <5 years 1% 30 - 40min 7 - 10 days

Homatropine 5 – 8 years 2% 30 - 40min 1 - 3 days
Cyclopentolate 8 – 20 years 0.5 - 1% 30 - 60min 24 hours
Tropicamide - 0.5 - 1% 20 - 40min 6 hours

STRENGTH OF PARALYSIS OF
DRUG AGE SOLUTION % ACCOMODATION
MAXIMAL RECOVERY
Atropine <5 years 1% 1 - 3 hours 6 - 12 days
Homatropine 5 – 8 years 2% 30 - 40min 1 - 3 days
Cyclopentolate 8 – 20 years 0.5 - 1% 30 - 60min 24 hours
Tropicamide - 0.5 - 1% 30 min 6 hours
 ANTI - VIRAL DRUGS
• Locally given to the eye
• HSV, HZV, CMV retinitis
• Common drugs
– Acyclovir
– Vidarabine
– Ganciclovir
 ACYCLOVIR
• Can enter the sequence of DNA formation only in cells infected by virus
• Used as topical therapy of viral keratitis
• Systemically used in Herpes zoster ophthalmicus & acute retinal necrosis
• Contraindicated in person with hypersensitivity
• Adverse reaction
– Local – SPK
– Systemic – nausea, vomiting, headache, anorexia, dizziness and fatigue
intravenous can potentiate nephrotoxicity
• Dosage
– Topical – 3%, 5 times/day
– Systemc – 800mg, 5 times daily for 7 – 10 days
– Intravitreal – 10 – 40μg/0.1ml
 VIDARABINE
• For the topical treatment of keratitis caused by HSV
• Indication
– Acute keratoconjunctivitis
– Recurrent epithelial
– Supeficial keratitis caused by HV which is not respond to Idoxuridine
• Contraindication
– Hypersensitivity patient
• Adverse reaction
– Lacrimation
– Fb sensation conjunctival inflammation
– Burning
– Irritation
– SPK
– Pain
– Photophobia
– Punctal occlusion
– Sensitive
• Dosage : ½ an inch of ointment (3%) into lower conj. sac 5 times daily at
3hr intervals
 GANCICLOVIR
• Indication
• CMV retinitis
• 10 – 25 times more effective than Acyclovir
• Progressive outer retinal necrosis
• Contraindication
• Pregnant women
• Hypersensitivity patient
• Adverse effects
• Myelosuppression
• Nephrotoxicity
• Elevation of liver enzymes
• Dosage
• Oral – 10mg/kg body wt/dose 4-5 times/day
• Intravenous – 5mg/kg over 1 hr every 12hr for 14 – 21 days
• Intrvitreal – 2000 - 400μg/0.1ml
 ANTI – FUNGAL DRUGS
• Common drugs
– Natamycin
– Amphotericin B
 NATAMYSIN
• Derived from Streptomyces natalensis
• Topical administration produces effective conc. of natamycin in corneal
stroma but not in the intra ocular fluid
• Indication
– Fungal blepheritis
– Conjunctivitis
– Keratitis
• Contraindication
– Hypersensitivity
• Adverse reaction
– Conjunctival chemosis
– Hyperemia
– Allergic
• Dosage
– 1 drop hourly or 2 hourly intervals for 14 – 21 days
 AMPHOTERICIN B
• Derived from a strain of Streptomyces nodusus
• Bind to sterol in fungal cell membrane
• Cause both toxicity &anti-biotic effect
• Indication
– Sterilization of corneal ulcers
– Mycotic keratitis
– Intraocular histoplasmosis
– Candida keratitis
• Contraindication
– Patient with nephropathy
– Hypersensitive
• Adverse effects
– Local irritation
– Nausea
– Vomitting
– Diarrhoea
– Renal damage – if dosage exceeds 3mg
• Dosage
– Topical – 0.15%
– Subconjunctival – 0.5mg to 1mg
– Systemic – intravenous : 0.1mg/cc
intravitreal : 5-10μg/0.1ml
ANTI-INFLAMMATORY AGENTS
• Non – steroidal
– Topical :- Flurbiprofen sodium
– Systemic :- Keterolac tromethamine
• Steroidal
– Topical :- Fluoromethelone
– Systemic :- Prednisolone
 FLURBIPROFEN SODIUM
• Inhibit the cyclo-oxygenase enzyme
• Indication
– Inhibition of intraoperative miosis
– Postlaser & postoperative ant. segment inflammation
• Contraindication
– Dendritic keratitis
– Hypersensitive
– Patient with bleeding tendency
• Adverse effect
– Transient burning
– Stinging
• Dosage
– Total 4 drops instilling 1drop in every 30 min, 2hrs befor surgery
 KETEROLAC TROMETHAMINE
• Available in 0.5% sol.
• Inhibit prostaglandin biosynthase
• Indication
– Ocular itchingdue to seasonal allergic conjunctivitis
– Post excimer surgery
– Pain management
– Chronic conjunctivitis
– Cycstoid macular edema
• Contraindication
– SCL wearer
• Adverse effects
– Transient stinging & burning sensation
– Ocular irritation
– Allergic reaction
– Superficial keratitis
• Dosage
– 1 drop 4 times/day
 FLUOROMETHELONE
• Metabolized in cornea
• Indication
– Primarily used in mild ant. segment
inflammation
– Post-LASIK surgery
• Dosage
– available in 5ml vials in 0.1% & 0.25%
 PREDNISOLONE
• Synthetic corticosteroid
• Inhibits edema, fibrin deposition, capillary dilatation & deposition
of collagen and scar formation
• Contraindication
– Acute untreated purulent ocular infection
– Dendritic keratitis
– Viral disease of cornea & conjunctiva
– Fungal diseases of eye
• Adverse effects
– Increased IOP with optic nerve damage
– Visual field defect
– PSC formation
• Dosage
– 1-2drops for 2-4 times daily
 LUBRICATING AGENT AND
ARTIFICIAL TEAR
• Indication
– Ocular irritations in various diseases
– Dry eyes
• Commonly available commercial tear substitutes
– REFRESH TEARS
– TEARS PLUS
– ARTIFICIAL TEARS
• Warning
– Discontinue using if any irritation produces
• Direction for use
– 1 or 2 drops as frequently as required
INTROCULAR AND IRRIGATING
SOLUTIONS
• Contain concentration of inorganic &
organic constituents
• Mainly used in surgery procedure
• Keep the glob inflated
Indications:
• Cataract surgery
• Vitrectomy & posterior
segment surgeries
• Anterior segment
reconstruction
 OTHER DRUGS AFFECTING EYE
DRUG USE SIDE EFFECT
Amiodarone A cardiac arrhythmia drug Corneal vortex keratopathy
Optic neuropathy

Digitalis A cardiac failure drug Chromatopsia

Chloroquines Malaria, Rheumatoid Arthritis, Corneal verticillata

SLE Retinopathy

Thioridazine A psychiatric drug Pigmentary retinopathy

Ethambutol An anti-TB drug Optic neuropathy

Chorpromazine A psychiatric drug Corneal punctate epithelial opacities

Lens surface opacities
Chromatopsia

Vortex keratopathy
Pigmentary retinopathy

Corneal punctate
epithelial opacities
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