Ophthalmic Pharmacology

Definition:

►Study of the medicinal use and actions of drugs

in the area of ophthalmology

In Ophthalmology – medications are used to

►Diagnose some conditions of the eye
►Treat eye diseases / conditions
Responsibility of nurses –
Medication:
VERIFY DOCTOR’S ORDER AND DO 3 CHECKS AND 7
RIGHTS.

Prepare and administer medication as prescribed

by the Ophthalmologist

Prepare routine medication required when

assisting in certain procedure

DOCUMENTATION IN patient’s folder

To carry out these responsibilities –
the nurse must:
Have basic knowledge of;
Drug actions – types and usage
Patient’s reaction to the drugs
Side effects and allergic reactions of drugs

Know how and when to administer the medication:

Route of administration
Time of administration
Dose of drug required

Recognize
the symptoms of allergic reactions and its
management; and how to call for help
Route of Administration of Medication:
 Topical
► Drug applied directly to the surface of the eye or surrounding
skin
► Liquid drop in the form of
– solution
– suspension
– ointment or gel
– special wafer called ‘insert’

 Injectable
► Drug injected with a needle into or around the eye or into
another part of the body

 Oral
► Drug taken by mouth
Topical Route
 Solution and Suspension also known as Guttae /
Gutt / g.
► Drug completely dissolved in liquid form
► Frequently used
► Easy to apply
► Do not interfere with vision except those with action that
alter vision
► Disadvantage – requires frequent application
Topical Route
 Ointment or Gel also known as Occulentum / Occ. / o.
► Drug dissolved or suspended in an oily or greasy media
► Remain in contact with the eye longer than the solution form
► Less likely to be washed away with tears
► Disadvantage
– can be difficult to apply
– may blur vision due to its greasiness; usually applied at
bedtime
Topical Route
 Inserts
► Wafer form which are placed in the corner of the eye
► Release drug into the eye slowly
► May be used to release medication over a period of up to 1
week before replacement is required – infrequent application
► Disadvantage
– expensive
– difficult to insert, tolerate or remove
– can be dislodged or dropped off without patient’s
awareness
Injectable / Injection
 Drug in solution form

 Introduced into body by injecting with needle

 Can only be administered by a registered nurse

or medical doctor

 Used as
► Treatment
► Testing or diagnostic procedure
Injectable / Injection
 4 types of injections:
► Into the eye – local
 Intravitreal – into the vitreous
 around the eye – periocular
– retrobulbar
– subconjunctival

 Into the vein / intravenous

 Into the muscles / intramuscular

 Under the skin / subcutaneous

Oral:
 Drug taken orally

 Types:
► Tablets
► Capsules
► Liquids

 Similar to systemic injections – the active agent will be

absorbed into the body system before reaching the eye

 Certain condition – glaucoma, the patient cannot tolerate

topical medication; or the condition is not adequately
controlled by topical medication, oral drugs is important
► Drug taken by mouth
Drug groups:
1. use for diagnostic
2. use for treatment
1. Mydriatics and cycloplegics
2. Diagnostics / dyes
3. Anaesthetics
4. Anti-glaucoma
5. Antimicrobials
6. Anti-inflammatory
7. Lubricants
 Mydriatics:
 Dilate pupils – mydriasis, by stimulating iris dilator
muscles

 Aid in examination of fundus of eye

 May also be used to improve vision of patients with

cataract or other media opacities

 Side-effects:
► Stingon application
► Headache
► Increased blood pressure
► Photophobia

 May cause angle-closure glaucoma in patient with

narrow anterior chamber angle
Cycloplegics:
 Temporarily paralyse the ciliary muscles – cycloplegia
causing dilation of pupil; and limit or prevent
accommodation

 Principle use:
► Perform refraction
► Conduct fundus examination
► Treatment of: – uveitis
– intraocular inflammation post-surgery
Cycloplegics:
 Side-effects:
► Sting on application
► Blurred vision / difficulty to see near object
► Photophobia
► Dry mouth
► Fever
► Rapid pulse
► Hallucinations
► Disorientation
► Bizarre behavior
► Angle-closure glaucoma in patient with narrow anterior
chamber angle

 Short-acting types are used to reduce risk of side-

effects
Dyes:
 Temporarily stain cells or systems within the eye to
outline or highlight defects in structure / function

 Principle use:
► Evaluate ocular surface
► Applanation tonometry and contact lens fitting
► May be given in injection form to evaluate retinal
conditions
Anesthetics:
 Temporarily numbs / deaden the nerve which result in
loss of feeling in the surrounding tissue; and
sometimes paralysis of affected muscles

 May be in topical solution or injectibles locally

 Only affect the involved eye

 Acts within minutes; and effect last from 10 – 20

minutes for topical application; and hours for
injectibles
Anesthetics:
 Principle use:
► Prevent discomfort during diagnostic and therapeutic procedures
► Relieve pain
► As local anesthesia in minor surgery

 Side-effects:
► Allergic reaction in sensitive patient
► Prolonged use: – toxic to cornea
– systemic toxicity
► Can inhibit cornea healing

 Caution – ensure patient do not rub eye to prevent injury

Therapeutic Medication
 Used to treat eye condition
 Have specific action for each individual condition
 Prescribed by Ophthalmologist for patient to administer
the medication themselves

 Types:
► Miotics
► Other Glaucoma medications
► antimicrobials
► Anti-allergic
► Anti-inflammatory agents
► Decongestants
► Lubricants
Miotics
 Action:
► Contraction of iris sphincter muscles producing miosis –
improve vision in patient with uncorrected or poorly
corrected refractive error
► Contraction
of ciliary body muscle – increased
accommodation and opening of trabecular drainage

 Uses:
► Tropical treatment of glaucoma by lowering intraocular
pressure and improve drainage of aqueous through
trabecular meshwork
► Treat accommodative strasbimus
► During cataract surgery to contract the pupil
Miotics
 Major side effects: – Brow ache
– Myopia
– Tearing
– Cataract
– Retinal detachment

 Available in topical application of: – Solution

– Gels
– Inserts

 Principal miotic agents: – Pilocarpine

– Carbachol
– Physostigmine
Other Glaucoma medication
 Action to reduce intraocular pressure:
► Open outflow pathways of aqueous humor
► Decreased production of aqueous humor
► Both action

 Side effects:
► Allergic reaction
► Blurred vision
► Increased / decreased blood pressure
► Emotional / psychological effects
Other Glaucoma medication
 Categories of Glaucoma medications:
► Beta blockers.
► Anti-prostaglandins
► Adrenergic blocking agents
► Adrenergic stimulating agents
► Carbonic anhydrase inhibitors
► Hyperosmotic – oral and injectibles
Anti-microbials
 Comprise of:
► Antibiotics – bacterial infection
► Antivirals – viral infection
► Antifungals – fungal infection

 Side effects:
► Hypersensitivity
► Digestive discomfort
► Toxicity to other system

 Available in:
► Topical application of: – solution
– ointment
► Oral form
► Injection form
Antibiotics
 Kill or inhibit growth of bacteria

 Use to treat:
► Superficial infection: – blepharitis
– bacterial conjunctivitis
– corneal ulcers
► Severe infection: – bacterial corneal ulcers
– endophthalmitis

 May be used alone or in combination

Antivirals
 Inhibit ability of virus to reproduce itself

 Use to treat serious virus-caused ophthalmic

condition:
► Herpes simplex
► Herpes zoster
Antifungal
 Kills fungi

 Use to treat external and internal ocular fungal

infections
► Fungal blepharitis
► Fungal keratitis
► Conjunctivitis
Anti-allergic and Anti-inflammatory agents
 The main drug is Corticosteroids / Steroids

 Hormones derived from body’s adrenal glands or

made synthetically

 Action – decrease swelling, redness, scarring

 Available in:
► Topicalapplication for condition in eyelids; anterior
segment
► Systemic application for condition of posterior segment;
acute and serve allergic reaction locally and systemic
Anti-allergic and Anti-inflammatory agents
 Side effects:
► Glaucoma
► Cataract
► Lowers body resistance to infection – Bacterial / Viral /
Fungal infection
► Delayed wound healing
► Swelling of face and eyelids

 Check patient’s medical record for disease like

► Hypertension
► Peptic ulcer
► Diabetes
► Tuberculosis
Decongestants
 Constrict superficial blood vessels in conjunctiva

 Action:
► Reduce eye redness caused by smoke or smog
► Soothe eyes fatigued from driving; reading; or close work

 May contain antihistamine that help relieve

inflammation and redness in cases of Hay fever or
other allergies

 Side effects:
► Allergy
► Angle-closure glaucoma
► Rebound – blood vessels become more congested
Lubricants
 Help patient to maintain appropriate tear film
balance to keep eye moist

 Action:
► Protect eyes from dryness

 Side effects:
► Allergy
► Irritations from preservative