Focus on Pharmacology Essentials for Health Professionals Jahangir Moini, MD, MPH Chapter 27 Effects of Drugs on Eye Disorders

Beta-Blockers: Uses reduce elevated intraocular pressure (IOP) Used to treat intraocular hypertension and chronic open-angle glaucoma

Beta-Blockers: Adverse Effects Common: local, mild ocular stinging, dry eyes, tearing, blurred vision, eye irritation Serious: thyrotoxic crisis in patients with hyperthyroidism

Beta-Blockers: Contraindications Contraindicated in angle-closure glaucoma, sinus bradycardia, cardiogenic shock Safety during pregnancy and in children younger than 18 years not established Cautious use in heart failure or diabetes and during lactation

Beta-Blockers: Patient Information Advise patients to report unusual or significant changes in pulse rate. Instruct patients to follow dosing regimen exactly and to not stop drugs abruptly.

Carbonic Anhydrase Inhibitors: Uses Work by decreasing formation of aqueous humor Used to treat glaucoma

Carbonic Anhydrase Inhibitors: Adverse Effects Common: skin rashes, kidney stones, anorexia, electrolyte imbalances Serious: aplastic anemia

Carbonic Anhydrase Inhibitors: Contraindications Contraindicated in patients with chronic noncongestive angle-closure glaucoma; renal or hepatic dysfunction Safety during pregnancy or lactation not established. Cautious use in diabetes, gout, asthma

Carbonic Anhydrase Inhibitors: Patient Information Tell patients to discontinue drug and report eye irritation, infection, or systemic hypersensitivity. Some of these drugs may cause drowsiness.

Bilberry for Eye Health Bilberry has been used to improve night vision and to prevent cataracts, macular degeneration, and glaucoma, and to prevent and treat diabetic retinopathy and myopia. Must be avoided in pregnancy and lactation.

Direct-Acting Miotics: Uses Work by increasing drainage of aqueous humor from anterior eye cavity Used to treat open-angle and angle-closure glaucoma

Direct-Acting Miotics: Adverse Effects Headache Pupil constriction

Direct-Acting Miotics: Contraindications Contraindicated in contact allergy, cataract, retinal detachment, and depression May interact with MAO inhibitors

Direct-Acting Miotics: Patient Information Advise patients to use caution during nighttime driving and in performing hazardous activities in poor light.

Indirect-Acting Miotics: Uses Produce severe miosis (contraction of the pupil)and muscle contractions due to decreased resistance to aqueous outflow Used to treat open-angle glaucoma

Indirect-Acting Miotics: Adverse Effects Common: lacrimation, burning conjunctivitis, conjunctival thickening, nausea, vomiting, diarrhea, difficult breathing, urinary incontinence, salivation, fainting Serious: retinal detachment

Indirect-Acting Miotics: Contraindications Contraindicated in patients with acute inflammatory disorders of eye, during pregnancy and lactation Cautious use in chronic angle-closure glaucoma and myasthenia gravis

Indirect-Acting Miotics: Patient Information Advise patients that aching around the eyebrows or temporary burning and stinging may occur initially but usually disappears with continued use. Advise patients to wear sunglasses.

Eyedrops and Contact Lenses Patients with contact lenses must remove them and leave them out for at least 15 minutes after administering eyedrop preparations.

Cycloplegics Used mostly for eye exams and eye surgery to cause pupil dilation Adverse effects: blurred vision, photophobia, cycloplegia, eye dryness Contraindications: angle-closure glaucoma, ulcerative colitis, tachycardia, acute bleeding, myasthenia gravis (muscle weakness)

Cycloplegics (continued) Patient information: advise patients to drive carefully and wear sunglasses; report allergic reaction.