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Transcript
Jiří Slíva, M.D.
Administration of the drug to the eye I:
Topical application - eye drops
eye lotions
eye ointments
local injection
eye drops - instilled into the pocket formed by
gently pulling down the lower eyelid
and keeping the eye closed for as long
as possible after application,
preferably 1-2 minutes
eye ointment - small amount is applied similarly,
melts rapidly, blinking helps to spread it
Two different eye-drop preparations - patients should leave
an interval of 5 minutes between the two
Administration of the drug to the eye II:
eye lotions - act mechanically to flush out irritants or foreign
bodies as first-aid
- systemic effects - absorption from conjunctival vessels
absorption from nasal mucosa via tear ducts
subconjunctival injections - mydriatics, anti-infective drugs, steroids
implants - gradually releasing of a drug over a prolonged period
- preparations should be sterile
- eye drops for domiciliary use shouldn´t be used more than
four weeks after opening
1. Anti-infective eye preparation I:
- eye infections of different kind
 antibacterials
 antifungals
 antivirals
antibacterials
• 1 drop at least every 2 hours then reduce frequency, continue
for 48 hours after healing
- drops or ointments; event. injections or systemic application
chloramphenicol, quinolones (ciprofloxacin, ofloxacin), broad
bacterial-spectrum antibacterials (gentamicin, neomycin) - Ps.
aeruginosa
- trachoma - azithromycin, tetracycline
- staphylococcal infections -fusidic acid
- acanthamoeba keratitis - propamidine isetionate
1. Anti-infective eye preparation II:
antifungals
- fungal infections of the cornea are rare - agricultural injuries
(hot and humid climates)
antivirals
- herpes simplex - aciclovir, ganciclovir (herpetic keratitis)
- cytomegalovirus - fomivirsen, ganciclovir
2. Corticosteroids:
- drops, ointments, subconjunctival injections or systemically
topical use: - change of symptoms by still unconfirmed diagnosis
- steroid glaucoma
- steroid cataract
- thinning of the cornea and sclera
systemic use: - the risk of steroid cataract is very high (75%) when
is used more than 15 mg prednisolone in a day for several
years
- betamethasone, dexamethasone, fluorometholone, hydrocortisone,
prednisolone, rimexolone
3. Other anti-inflammatory drugs:
Antihistamines
-antazoline, azelastine, ketotifen, levocabastine
Sodium cromoglycate and nedocromil sodium
Lodoxamid
- stabilisation of mast cells, inhibition of Ca++ influx
Emedastine - high afinity to H1-receptors
4. Mydriatics and cycloplegics:
- antimuscarinics x sympatomimetics
Antimuscarinics
atropine, cyclopentolate, homatropine, tropicamide
Sympatomimetics
phenylephrine
5. Treatment of glaucoma I:
- disorders characterised by visual field loss, cupping of the opti
disc and optic nerve damage; generally often associated with raised
intra-ocular pressure
- open-angle x closed-angle glaucoma
Miotics
carbachol, pilocarpine
CI: acute iritis, anterior uveitis, some forms of secondary glaucoma
Sympatomimetics
adrenaline, dipivefrine, guanethidine
- act due to decreasing rate of production of aqueous humour and
by increasing the outflow through the ocular meshwork
normal vision
viewed by a person with glaucoma
5. Treatment of glaucoma II:
Beta-blockers
- reduce intra-ocular pressure by reducing the rate of production
of aqueous humour
- oral (side effects) or intra-ocular application
- betaxolol, carteolol, levobunolol, metipranolol, timolol
Carbonic anhydrase inhibitors
- acetazolamide, dorzolamide, brinzolamide
5. Treatment of glaucoma III:
Osmotic diuretics
Short-term acting drugs - intravenous hypertonic mannitol
- glycerol by mouth
Prostaglandin analogue
- latanoprost, travoprost, bimatoprost - increase uveoscleral
outflow
Laser surgery
also called laser trabeculoplasty
6. Local anesthetics:
oxybuprocaine, lidocaine, tetracaine, proxymetacaine
7. Miscellaneous ophthalmic preparations:
Tear deficiency:
• Hypromellose, povidone - in combination with carbomers (cling
to the eye surface - reduce frequency of application )or
polyvinylalcohol (increase the persistence of the tear film)
• Sodium chloride 0.9%
Corneal epithelial erosion:
Paraffin - temporary visual disturbance, best suited before sleep
8. Ocular diagnostic preparations:
• fluorescein, rose bengal - for locating damaged areas of the
cornea due to injury or disease (slit lamp)
9. Subfoveal choroidal neovascularisation
inhibitors:
• verteporfin - for use in the photodynamic treatment
of subfoveal choroidal neovascularisation associated
with macular degeneration or with pathological myopia.
- i.v. infusion, activation by non-thermal red light => cytotoxic
derivates