Ocular pharmacology ii, dr.kurinchi, 22.06.17

1. OCULAR
PHARMACOLOGY II
Antiglaucoma
Mydriatic & cycloplegic
Ocular toxicity of systemic & ocular medications
-DR. T.
Kurinjhi
Asst.Prof.
Ophthalmolog

2. Antiglaucom
aAIM - lowering of IOP to levels that permit normal
functioning of optic nerve

3. PARASYMPATHOMIMETICS
Pilocarpine (2% - 4%) 6-8 hrly, ocuserts
MOA: contraction of longtitudinal fibres of ciliary muscle :
pull on scleral spur & widen TBM spaces.
pull peripheral iris away from angle structures
Miosis, brow ache, accomodative spasm

4. SYMPATHOMIMETICS
Non selective - epinephrine(1%), dipivefrine(0.1%)
MOA: increase rate of aqueous outflow
Stinging, reactive hyperemia, adrenochrome deposits, CME
Selective – α1& α2 : apraclonidine (0.25%-1%)
α2 : brimonidine (0.15%-0.2%)
MOA: Decrease aqueous production, increase uveoscleral
outflow, increase optic nerve head perfusion
Ocular allergy, conjunctival blanching

5. ADRENERGIC ANTAGONISTS
(ß blockers)
Non selective – timolol (0.25%-0.5%), levobunolol (0.25%-
0.5%)
MOA: reduce rate of aqueous production.
Tachyphylaxis, dry eye, bradycardia, bronchial spasm
Selective – (ß1) betaxolol (0.25%-0.5%)
MOA: reduce rate of aqueous production
increase perfusion of optic nerve head
Stinging sensation, local anesthesia

6. PROSTAGLANDIN ANALOGUES
Latanoprost (0.005%) OD, unoprostone(0.12%),
bimatoprost(0.03%), travoprost (0.004%).
MOA: increase uveoscleral outflow
Conjunctival hyperemia, SPK, iris pigmentation

7. CARBONIC ANHYDRASE
INHIBITOR
Acetazolamide (oral-1gm/day), dorzolamide (topical
2%) brinzolamide (topical 1%)
MOA: reduces aqueous production
Altered taste, paresthesia, loss of appetite, depression,
metabolic acidosis.

8. HYPEROSMOTIC AGENTS
Mannitol (5%-25%,1%-2% intravenous), glycerol
(1-1.5 gm/Kg BD/TDS oral)
MOA: lower IOP by reducing vitreous volume
Not suitable for diabetics, uncontrolled hypertensives,
pul.odema, cardiac/renal failure.

9. Mydriatic &
cycloplegic
SYMPATHOMIMETICS
Dilate pupil
Phenylephrine (5%-10%)
ANTICHOLINERGICS /
PARASYMPATHOLYTICS
Dilate pupil, impair accomodation
Atropine (1%), homatropine (2%), cyclopentolate(1%),
tropicamide (0.5%)

10. Fundus examination
To measure objective refractive error of the eye
Headaches, latent hypermetropia
Suspected malingering or hysteria
Pharmacologic occlusion therapy in amblyopia

11. • Narrow anterior chamber angle – ACG
• Toxicity : fever, skin rash, rapid and irregular pulse, dry
mouth and nose, and delirium
• Systemic toxicity - death, from an idiosyncratic response.

12. Ocular toxicity of
systemic & ocular
medications

13. Corticosteroids
Long-term use produces:
• posterior subcapsular cataracts, (especially in asthmatics, renal-
transplant recipients and with rheumatic arthritis)
• increased IOP (steroid-induced glaucoma)
• exacerbation of bacterial and viral infections
• scleral melting
NSAIDs
• corneal complications: melting
perforation

14. Amiodarone
Cardiac arrhythmia drug
Whorl shaped pigment deposits in corneal epithelium –
cornea verticillata
Deposits are dosage related and reversible

15. Chloroquine
Chloroquine and hydroxychloroquine
malaria, rheumatoid arthritis, lupus, autoimmune diseases
corneal deposits (cornea verticillata) - reversible
macular lesion (bull’s eye maculopathy) - not reversible

16. Diphenylhydant
oin
Antiepileptic
Dose-related cerebellar-vestibular effects (e.g.,nystagmus, diplopia)
Complex forms of nystagmus and ophthalmoplegia
All reversible effects

17. Ethambutol
Tuberculosis
Dosage related optic neuropathy
• 15mg/kg/day: optic neuropathy in 1%
• 25mg/kg/day: optic neuropathy in 5%
• 50mg/kg/day: optic neuropathy in 15%
Onset in 1 month
Recovery on discontinuing of drug ; rarely permanent

18. Thioridazine
Anti-psychotic
Pigmentary retinopathy after high dosage (usually at least 1000
mg/day)
Current recommendation is a maximum dose of 800 mg/day

19. Thank You

20. Anti-inflamatory
Corticosteroids
NSAIDS
Mast-cell stabilizers,
Antihistamines,
Antifibrotics

21. Corticosteroids – systemic,
topical - drops, ointment,
subconjunctival injections,
subtenon’s injection,
intravitreal injections / implants.
uveitis
post ocular surgical procedures
ocular inflammation in trauma
optic neuritis
systemic immune diseases with severe ocular
inflammations
Prednisolone; dexamethasone; fluromethalone; loteprednol

22. NSAIDS – systemic,
topical -drops, ointment
anterior segment inflamation,
prophylaxis of CME
Reduces intraoperative miosis
postoperative inflammation
 allergic conjunctivitis
Indomethacin, Flurbiprofen, Ketorolac, Diclofenac,
Nepafenac and Bromfenac