UPDATE ON DRUGS AND THE EYE 1.LOCAL EFFECTS OF TOPICAL EYE MEDICATION

UPDATE ON DRUGS AND THE EYE 1.LOCAL EFFECTS OF TOPICAL EYE MEDICATION 2.SYSTEMIC EFFECTS OF TOPICAL MEDICATION

UPDATE ON DRUGS AND THE EYE 1.LOCAL EFFECTS OF TOPICAL EYE MEDICATION 2.SYSTEMIC EFFECTS OF TOPICAL MEDICATION 3.OCULAR EFFECTS OF SYSTEMIC MEDICATION

OCULAR SURFACE TOXICITY ALL PRESERVATIVES CAN BE DAMAGING

OCULAR SURFACE TOXICITY ALL PRESERVATIVES CAN BE DAMAGING BAK IS FOUND IN MOST EYE DROPS AND IS A COMMON CAUSE OF EPITHELIAL TOXICITY ESPECIALLY WHERE MULTIPLE DAILY DROPS ARE REQUIRED ( E.G. GLAUCOMA )

OCULAR SURFACE TOXICITY ALL PRESERVATIVES CAN BE DAMAGING BAK IS FOUND IN MOST EYE DROPS AND IS A COMMON CAUSE OF EPITHELIAL TOXICITY ESPECIALLY WHERE MULTIPLE DAILY DROPS ARE REQUIRED ( E.G. GLAUCOMA ) SOME TOPICAL AGENTS CAN CAUSE PUNCTATE KERATITIS E.G. TOBRAMYCIN, GENTAMICIN, ACULAR, ACYCLOVIR. EVEN DILATING DROPS CAN CAUSE THIS E.G. PRE-OP PHENYLEPHRINE

OCULAR SURFACE TOXICITY ALL PRESERVATIVES CAN BE DAMAGING BAK IS FOUND IN MOST EYE DROPS AND IS A COMMON CAUSE OF EPITHELIAL TOXICITY ESPECIALLY WHERE MULTIPLE DAILY DROPS ARE REQUIRED ( E.G. GLAUCOMA ) SOME TOPICAL AGENTS CAN CAUSE PUNCTATE KERATITIS E.G. TOBRAMYCIN, GENTAMICIN, ACULAR, ACYCLOVIR. EVEN DILATING DROPS CAN CAUSE THIS E.G. PRE-OP PHENYLEPHRINE BEWARE “HIDDEN” PRESERVATIVE E.G. POVIDONE IN REFRESH BLISTER PACKS

LOCAL EFFECTS OF TOPICAL MEDICATION 1.TOXIC EPITHELIOPATHY

LOCAL EFFECTS OF TOPICAL MEDICATION 1.TOXIC EPITHELIOPATHY 2.ALLERGIC CONJUNCTIVITIS

LOCAL EFFECTS OF TOPICAL MEDICATION 1.TOXIC EPITHELIOPATHY 2.ALLERGIC CONJUNCTIVITIS 3.SPECIFIC SIDE EFFECTS

ALLERGIC CONJUNCTIVITIS ALLERGY TO CHLORAMPHENICOL DROPS AND OINTMENT IS COMMON BUT IT CAN BE SEEN WITH OTHER ANTIBIOTICS SUCH AS SOFRAMYCIN

ALLERGIC CONJUNCTIVITIS ALLERGY TO CHLORAMPHENICOL DROPS AND OINTMENT IS COMMON BUT IT CAN BE SEEN WITH OTHER ANTIBIOTICS SUCH AS SOFRAMYCIN I HAVE ALSO SEEN ALLERGY TO AZOPT ON OCCASIONS

ALLERGIC CONJUNCTIVITIS ALLERGY TO CHLORAMPHENICOL DROPS AND OINTMENT IS COMMON BUT IT CAN BE SEEN WITH OTHER ANTIBIOTICS SUCH AS SOFRAMYCIN I HAVE ALSO SEEN ALLERGY TO AZOPT ON OCCASIONS ALPHAGAN ALLERGY IS VERY COMMON AND OFTEN APPEARS AROUND 6 MONTHS PURITE AS THE PRESERVATIVE ( ALPHAGAN P ) MAY REDUCE THE INCIDENCE AS MAY COMBINING A TOPICAL β BLOCKER ( E.G. COMBIGAN )

SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINS CAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN

SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINS CAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINE CAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE

SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINS CAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINE CAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROID FOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION

SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINS CAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINE CAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROID FOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION 30% OF THE POPULATION ARE STEROID RESPONDERS

SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINS CAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINE CAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROID FOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION 30% OF THE POPULATION ARE STEROID RESPONDERS WEAKER STEROIDS SUCH AS FML HAVE LESS OCULAR PENETRATION AND ARE LESS LIKELY TO CAUSE THESE PROBLEMS

SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINS CAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINE CAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROID FOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION 30% OF THE POPULATION ARE STEROID RESPONDERS WEAKER STEROIDS SUCH AS FML HAVE LESS OCULAR PENETRATION AND ARE LESS LIKELY TO CAUSE THESE PROBLEMS ALPHAGAN CAUSES CONJUNCTIVAL BLANCHING AND PUPIL CONSTRICTION

SPECIFIC SIDE EFFECTS OF TOPICAL AGENTS PROSTAGLANDINS CAUSE CONJUNCTIVAL HYPERAEMIA, INCREASED IRIS PIGMENTATION, LASH GROWTH AND INCREASED LOWER LID SKIN PIGMENTATION INCIDENCE XALATAN < TRAVATAN < LUMIGAN PILOCARPINE CAUSES CHRONIC PUPILLARY MIOSIS WITH LONG TERM USE TOPICAL STEROID FOR LONGER THAN 3 WEEKS CAN CAUSE SECONDARY OCULAR HYPERTENSION 30% OF THE POPULATION ARE STEROID RESPONDERS WEAKER STEROIDS SUCH AS FML HAVE LESS OCULAR PENETRATION AND ARE LESS LIKELY TO CAUSE THESE PROBLEMS ALPHAGAN CAUSES CONJUNCTIVAL BLANCHING AND PUPIL CONSTRICTION IOPIDINE CAUSES CONJUNCTIVAL BLANCHING AND ENLARGED PUPIL

AVASTIN/LUCENTIS ARE ASSOCIATED WITH POSSIBLE INCREASED RISK OF CARDIOVASCULAR ADVERSE EFFECTS MAINLY STROKE AND MYOCARDIAL INFARCTION SPECIFIC SIDE EFFECTS OF INTRAVITREAL DRUGS

SYSTEMIC EFFECTS OF TOPICAL MEDICATION β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA

SYSTEMIC EFFECTS OF TOPICAL MEDICATION β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA α BLOCKERS MAY LOWER B P

SYSTEMIC EFFECTS OF TOPICAL MEDICATION β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA α BLOCKERS MAY LOWER B P CHLORAMPHENICOL – VERY RARE ASSOCIATION WITH APLASTIC ANAEMIA

SYSTEMIC EFFECTS OF TOPICAL MEDICATION β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA α BLOCKERS MAY LOWER B P CHLORAMPHENICOL – VERY RARE ASSOCIATION WITH APLASTIC ANAEMIA PHENYLEPHRINE 10% MAY CAUSE TACHYCARDIA ± SYSTEMIC HYPERTENSION ( ESPECIALLY IN ELDERLY )

SYSTEMIC EFFECTS OF TOPICAL MEDICATION β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA α BLOCKERS MAY LOWER B P CHLORAMPHENICOL – VERY RARE ASSOCIATION WITH APLASTIC ANAEMIA PHENYLEPHRINE 10% MAY CAUSE TACHYCARDIA ± SYSTEMIC HYPERTENSION ( ESPECIALLY IN ELDERLY ) CYCOGYL DROPS CAN BE ASSOCIATED WITH DROWSINESS AND RARELY WITH AGITATION

SYSTEMIC EFFECTS OF TOPICAL MEDICATION β BLOCKERS CAN CAUSE ASTHMA AND BRADY CARDIA α BLOCKERS MAY LOWER B P CHLORAMPHENICOL – VERY RARE ASSOCIATION WITH APLASTIC ANAEMIA PHENYLEPHRINE 10% MAY CAUSE TACHYCARDIA ± SYSTEMIC HYPERTENSION ( ESPECIALLY IN ELDERLY ) CYCOGYL DROPS CAN BE ASSOCIATED WITH DROWSINESS AND RARELY WITH AGITATION ATROPINE DROPS MAY ALSO CAUSE SYSTEMIC SIDE EFFECTS ESPECIALLY IN YOUNG CHILDREN

LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS PLAQUENIL: –AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY

LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS PLAQUENIL: –AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY PREDNISONE: – CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT

LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS PLAQUENIL: –AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY PREDNISONE: – CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT FLOMAXTRA: –DIFFICULT CATARACT SURGERY –LOSS OF IRIS TONE –POOR PUPIL DILATATION –PROGRESSIVE MIOSIS DURING OP

LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS PLAQUENIL: –AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY PREDNISONE: – CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT FLOMAXTRA: –DIFFICULT CATARACT SURGERY –LOSS OF IRIS TONE –POOR PUPIL DILATATION –PROGRESSIVE MIOSIS DURING OP ANTICHOLINERGICS E.G. TRYPTANOL ANTI SPASMODICS: –CAN PRECIPITATE AACG IN PREDISPOSED INDIVIDUALS –CONFUSES DOCTORS AS THE TYPE OF GLAUCOMA IS NOT SPECIFIED IN PRODUCT INFORMATION

LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS PLAQUENIL: –AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY PREDNISONE: – CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT FLOMAXTRA: –DIFFICULT CATARACT SURGERY –LOSS OF IRIS TONE –POOR PUPIL DILATATION –PROGRESSIVE MIOSIS DURING OP ANTICHOLINERGICS E.G. TRYPTANOL ANTI SPASMODICS: –CAN PRECIPITATE AACG IN PREDISPOSED INDIVIDUALS –CONFUSES DOCTORS AS THE TYPE OF GLAUCOMA IS NOT SPECIFIED IN PRODUCT INFORMATION DIAMOX: –RARE ASSOCIATION WITH ACUTE GLAUCOMA –LOW SERUM K⁺ / BLOOD DISORDERS

LOCAL OCULAR EFFECTS OF SYSTEMIC DRUGS PLAQUENIL: –AVIDLY BOUND TO RPE AND CAN CAUSE MACULAR TOXICITY PREDNISONE: – CAN BE ASSOCIATED WITH PSCC AND NUCLEAR SCLEROTIC CATARACT FLOMAXTRA: –DIFFICULT CATARACT SURGERY –LOSS OF IRIS TONE –POOR PUPIL DILATATION –PROGRESSIVE MIOSIS DURING OP ANTICHOLINERGICS E.G. TRYPTANOL ANTI SPASMODICS: –CAN PRECIPITATE AACG IN PREDISPOSED INDIVIDUALS –CONFUSES DOCTORS AS THE TYPE OF GLAUCOMA IS NOT SPECIFIED IN PRODUCT INFORMATION DIAMOX: –RARE ASSOCIATION WITH ACUTE GLAUCOMA –LOW SERUM K⁺ / BLOOD DISORDERS GLIVEC: –CME AND LID OEDEMA

PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING:

PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING: 1.DOSE > 6.5mg/Kg OF IDEAL BODY WEIGHT

PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING: 1.DOSE > 6.5mg/Kg OF IDEAL BODY WEIGHT 2.DURATION OF TREATMENT > 10 YEARS

PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING: 1.DOSE > 6.5mg/Kg OF IDEAL BODY WEIGHT 2.DURATION OF TREATMENT > 10 YEARS 3.LIVER OR KIDNEY DISEASE ( REDUCED DRUG EXCRETION )

PLAQUENIL TOXICITY THIS DRUG IS FAIRLY SAFE HIGHER RISK SEEN IN THE FOLLOWING: 1.DOSE > 6.5mg/Kg OF IDEAL BODY WEIGHT 2.DURATION OF TREATMENT > 10 YEARS 3.LIVER OR KIDNEY DISEASE ( REDUCED DRUG EXCRETION ) 4.? COINCIDENT MACULAR DISEASE E.G. DRUSEN

MONITORING PLAQUENIL 1.DISTANCE AND NEAR V A

MONITORING PLAQUENIL 1.DISTANCE AND NEAR V A 2.COLOUR VISION ( B/Y PLATES )

MONITORING PLAQUENIL 1.DISTANCE AND NEAR V A 2.COLOUR VISION ( B/Y PLATES ) 3.AMSLER

MONITORING PLAQUENIL 1.DISTANCE AND NEAR V A 2.COLOUR VISION ( B/Y PLATES ) 3.AMSLER 4.? BLUE ON YELLOW FIELDS

MONITORING PLAQUENIL 1.DISTANCE AND NEAR V A 2.COLOUR VISION ( B/Y PLATES ) 3.AMSLER 4.? BLUE ON YELLOW FIELDS 5.ERG/EOG IF > 5 YEARS CONTINUOUS TREATMENT

Which of the following ocular side effects is not associated with Flomaxtra? B. Iris flaccidity during cataract surgery D. Ocular hypertension C. Progressive miosis during cataract surgery A. Poor pupil dilatation

Which of the following eye drop preservatives is most likely to cause corneal epithelial toxicity? B. Polyquaternium D. Povidone C. Benzalkonium Chloride A. Purite

Which of the following is not a side effect of topical or systemic B Blockers? B. Asthma D. High BP C. BP lowering A. Brady cardia ( slow pulse )

Which of the following is not a known side effect of topical prostaglandins? B. Lash growth D. Pupillary constriction C. Lid pigmentation A. Conjunctival hyperaemia