Fluorescein Stains What?
Collagen
Mucus
Side Effects of Fluorescein
Permanent staining of contact lenses
Examples of Topical Anaesthetics
Proxymetacaine
Benoxinate
Tetracaine
Uses of Ocular Topical Anaesthetics
Examining painful corneal conditions
Sciotz tonometry
Foreign body removal from cornea/conjunctiva
Negative Effects of Topical Anaesthetics
Toxic to epithelium
Inhibit mitosis and cell migration
Permanent corneal damage
Examples of Anticholinergic Cycloplegics
- Atropine sulphate 0.5% or 1%
- Scopolamine hydrobromide 0.25%
- Cyclopentolate HCl 0.5% or 1%
- Tropicamide 0.5% or 1%
Specific use of Atropine
Hyphaema
Specific use of Cyclopentolate
Anterior Uveitis
Specific use of Tropicamide
Diagnostic
Side-Effects of Anticholinergic Cycloplegics
Nause and vomiting
Pallor
Vasomotor disturbances
Mechanism of Action: Sympathomimetic Mydriatics
Stimulate dilator pupillae
Example: Sympathomimetic Mydriatics
Phenylephrine HCl 2.5%
Examples: Topical Ocular Decongestants
Naphazoline HCL 0.12%
Phenylephrine HCl 0.12%
Tetrahydrozaline HCl 0.05%
Side-Effects: Topical Ocular Decongestants
Rebound vasodilation
Tolerance
Angle closure glaucoma
Examples: Topical Ocular Antibiotics
Sulphacetamide Neomycin Gentamicin Chloramphenicol Ciprofloxacin Tetracycline
Examples: Topical Ocular Antivirals
Acyclovir
Trifluridine
Idoxuridine
Vidarabine
Examples: Topical Ocular Antifungals
Amphotericin B
Natamycin
Examples: Topical NSAIDS
Indomethacin
Na diclofenac
Examples: Topical Ocular Steroids
Prednisolone
Betamethasone
Dexamethasone
Fluormethalone
Agents Used in Glaucoma
- Cholinergic agonists - pilocarpine
- Adrenergic agonists - adrenaline
- Non-selective B-blockers - timolol maleate
- Selective B-blockers - betaxolol
- Carbonic anhydrase inhibitors - acetazolamide
- Prostaglandin Agonists - latanoprost
- Hyperosmotic agents - in acute angle closure
Ocular Side-Effects of Corticosteroids
Glaucoma
Posterior sub-capsular cataracts
Ocular Side-Effects: Chloroquine
Corneal deposits –> photophobia, glare
Maculopathy –> LOV
Ocular Side-Effects: Digitalis
Dull vision
Chromatopsia
Ocular toxicity
Ocular Side-Effects: Phenytoin
Nystagmus (cerebellovestibular side-effects)
Ophthalmoplegia
Ocular Side-Effects: Ethambutol
Optic neuropathy (within 1 month of tx)
Ocular Side-Effects: Chlorpromazine
Reversible punctate corneal epithelial opacities
Irreversible lenticular opacities
Ocular Side-Effects:Thioridazine
Pigmentary retinopathy
Systemic Side-Effects: B-Blockers
Bronchospasm
Aggravate cardiac conduction defects/cardiac failure
Aggravate peripheral vascular disease
Elevate blood glucose
Systemic Side-Effects: Parasympathomimetics
Lacrimation Salivation Perspiration Nausea and vomiting Diarrhoea
Systemic Side-Effects: Sympathomimetics
Hypertension
Cardiac arrhythmias
Pharmacological no-nos for a GP
Instilling eye-drops incorrectly
Dilating pupils with atropine
Local anaesthetic drops TTO
Prescribe topical ocular steroids