1. Agents Used in the Treatment of Conditions of the Eye
Chapter 40
Agents Used in the Treatment of Conditions of the Eye

2. The Eyes Organ of vision Retina Uvea Sclera and cornea
Light reacts off the retina

3. The Eyes Images are transmitted by the optic nerve
Interpreted by the brain
Anterior and posterior chambers
Aqueous humor

4. Ophthalmic Agents Facilitate eye examinations Treat Infection
Inflammation
Glaucoma

5. Sympathomimetic Mydriatics
Produce
Pupil dilation
Increase aqueous humor outflow
Decrease formation of aqueous humor

6. Anticholinergic Mydriatics
Block sphincter iris muscle
Produce pupil dilation
Allow for measurement of refractive errors
Cause vision and focus problems

7. Ophthalmic Anti-infectives
Antibiotics
Antifungals
Antivirals
Antiseptics

8. Ophthalmic Anti-Infectives
Eye is susceptible to bacterial, viral, and fungal infections
Some require mild therapy
Some require aggressive treatment
Diagnosis is important
Antibiotics
Antifungals
Antivirals

9. Antibiotics Monitor for hypersensitivity
Systemic therapy should be given in addition to topical agents
Topical agents administered as eye drops

10. Antibiotics
Antibiotic eye drops contain agents not usually given systemically
Agents are usually a combination of drugs

11. Antifungal Agents
Natamycin treats blepharitis, conjunctivitis, and keratitis
Applied to conjunctival sac frequently

12. Antiviral Agents Can cause severe discomfort
May lead to scarring and vision loss if not treated
Drugs usually block reproduction of viral agent

13. Antiviral Agents Alters normal DNA synthesis
Most common is herpes simplex and varicella zoster viruses
Adverse effects could include burning, irritation, hypersensitivity, pain, photophobia, or toxicity

14. Nursing Considerations
Always monitor effectiveness of therapy
Monitor for signs of toxicity
Use proper instillation techniques and teach to patients
Wash hands
Avoid contamination of tip of applicator

15. Other Eye Agents
Local anesthetics
Corticosteroids
Glaucoma agents

16. Local Anesthetics Anesthetize the eye Reduce the blinking reflex
To remove
Chemicals
Foreign objects

17. Corticosteroids Useful for eye allergies
Useful as an additive agent in eye infections
Reduce
Inflammation
Pain

18. Nonsteroidal Anti-inflammatory Agents
Four are available for ophthalmic use
Inhibits pupil constriction
Reduce edema and inflammation
Relief of pain
May cause hypersensitivity
Some may not be used in patients who wear contact lens

19. Glaucoma Increased intraocular pressure (IOP) Aqueous humor buildup
Pressure pushes the vitreous humor against the retina
Constant pressure destroys the retina, which leads to blindness

20. Glaucoma
Narrow-angle glaucoma is caused by the iris occluding the anterior chamber structures
Dilation of the pupil could cause acute attack
Treatment is surgery
Creates a new opening
Open-angle more common

21. Glaucoma No change in the chamber angle Local degenerative changes
Symptoms appear after severe damage to optic nerve
Goal is to decrease production and increase outflow

22. Antiglaucoma Drugs Reduce the formation of aqueous humor
Carbonic anhydrase inhibitors
Osmotic diuretics
Beta-adrenergic blocking agents

23. Carbonic Anhydrase Inhibitors
Inhibits the enzyme carbonic anhydrase
Reduces production of aqueous humor
Decreases intraocular pressure
Treatment of open-angle glaucoma and pre-operative management of acute narrow-angle glaucoma

24. Carbonic Anhydrase Inhibitors
Used with topical therapy
Diuretics
Increases excretion of sodium, potassium, bicarbonate, and water

25. Osmotic Diuretics Rapidly reduces production of aqueous humor
Treats acute attacks of narrow-angle glaucoma and preparation of surgery
Not for chronic use

26. Osmotic Diuretics Extreme caution in patients with renal impairment
May cause headaches, nausea, and vomiting
Given orally or parenterally

27. Beta-Adrenergic Blocking Agents
Applied topically
Lowers ocular pressure by reducing formation of aqueous humor
Little effect on pupil size or visual acuity

28. Beta-Adrenergic Blocking Agents
Used alone or in combination with other drugs
Can be absorbed systemically
Can interfere with treatment of patients with airway disease and congestive heart failure

29. Antiglaucoma Drugs Increase aqueous humor outflow Direct-acting miotic
Cholinesterase inhibitors: para-sympathomimetics
Prostaglandin-inhibiting agents
Sympathomimetics agents

30. Direct-Acting Miotics
Mimic action of acetylcholine
Constricts pupil
Contracts ciliary muscle
Facilitates outflow of aqueous humor

31. Direct-Acting Miotics
Drops, gel, or Ocusert Therapeutic System
Adverse effects include reduction in visual acuity, flushing, sweating, gastric distress, diarrhea, and headache

32. Miotics That Inhibit Cholinesterase Activity
Prevents enzymatic destruction of acetylcholine within the eye
Inhibits the enzyme cholinesterase
Greater acetylcholine activity

33. Miotics That Inhibit Cholinesterase Activity
Production of miosis
Contraction of the ciliary muscle
More toxic and longer lasting than direct-acting miotics
Reserved for use in patients that do not respond to other therapy

34. Miotics That Inhibit Cholinesterase Activity
Adverse effects are both local and systemic
Systemic effects
- salivation, urinary incontinence,
sweating, diarrhea, and muscle weakness

35. Miotics That Inhibit Cholinesterase Activity
Local effects
- stinging, burning, lacrimation, lens
opacities, and ocular inflammation
Monitor for toxicity
Antidote is atropine sulfate or pralidoxime chloride

36. Agents That Effect Formation and Outflow of Aqueous Humor
Prostaglandin-inhibiting agents
- stimulates outflow by inhibiting
prostaglandin synthesis; increases
vascular permeability
- used prior to eye surgery, open-angle
glaucoma, and ocular hypertension
- remove contact lenses
- latanoprost can cause eye color changes

37. Agents That Effect Formation and Outflow of Aqueous Humor
Sympathomimetic agents
- stimulate adrenergic receptors in the eye
- reduces aqueous humor production
- with extended use, may rebound and
increase production

38. Agents That Effect Formation and Outflow of Aqueous Humor
Used in combination with a miotic
- use with caution in elderly and patients
with hypertension, diabetes,
hyperthyroidism, or heart disease
- exaggerated effects may occur if taking
MAOI’s or other antidepressants
- used only in open-angle glaucoma

39. Nursing Considerations
Assess the patients eyes
Teach proper administration of eye medications
Use eye patches as appropriate
Ensure medication is used properly
Assess for safety
Teach patient to continue treatment as long as prescribed
Throw away contaminated medications