ocular pharm

topical rx

prompt, convenient

corneal + conjunctival toxicity

systemic side effects - nasolacrimal absorption

subconjunctival injections

prompt/sustained

for anterior inf, posterior uveitis, cystoid macular edema

local toxicity, tissue injury (corneal perforation), vasculature occlusion

intraocular injection

prompt

for ant segment sx, inf

corneal toxicity, intraocular toxicity

short duration of action

intravitreal injection/device

absorption circumvented > immediate local effect or potential sustained effect

for endophthalmitis, retinitis, AGMD

retinal toxicity

what drug classes facilitate aqueous outflow

prostaglandin analogs + parasympathomimetics/cholinergic agonists

prostaglandin analog rx

1st line tx for glaucoma - incr uveoscleral outflow of aqeuous

bimatoprost, latonoprost, tafluprost, travoprost (soln 1x daily PM, can be combo w/ timolol)

unoprostone (BID daily)

prostaglandin ADR

conjunctival hyperemia, hyperpigmentation periorbital skin, periorbital atrophy, eyelash growht, perm darken iris

rarely: assoc uveitis reactivation, herpetic keratitis

predisposed > macular edema

pilocarpine

parasympathomimetic/cholinergic agonist used for glaucoma (not as common)

- trabecular meshwork action thru ciliary mm contraction > incr aq outflow

pilocarpine ADR

miosis w/ vision dimness

accommodative spasm > disabling to younger pt

retinal detachment (rare)

what rx precipitates glaucoma?

mydriatics - anticholinergic drugs

M3 antagonists or alpha 1 agonists

antidepressants

what rx decreases aqueous production?

beta adrenergic antagonists

alpha 2 adrenergic agonists

apraclonidine

decr aq humor formation WITHOUT effect on outflow

for prevent IOP incr after ant segment laser tx

good for short term - refractory cases

LONG TERM > tachyphylaxis + high incidence allergic rxn

brimonidine

inhibits aq humor prod + incr aq outflow

1st line or adjunct w/ timolol (allergic rxn common)

carbonic anhydrase inhibitors

suppress aqueous production by 40-60%

assoc w MAJOR SYSTEMIC EFFECTS - limits usefulness in long term

acetazolamide

MC in chronic glaucoma when topical tx not enough

acute glaucoma - to control high IOP

oral or IV

dorzolamide/brinzolamide

topical - effective adjunct w/ timolol soln

not as eff as systemics

transient bitter taste + allergic blepharoconjunctivitis

hyperosmotic agents

render blood hypertonic > draws water out of vitreous > shrinks vitreous volume

decreases aqueous production

glycerin (glycerol)

oral 1ml/kg body weight in cold 50% soln w/ lemon juice

MC used agent

use w/ caution in diabetics

alt: oral isosorbide, IV mannitol