Mydriasis

• Mydriasis are the drugs that cause dilatation of the pupil.

• Mydriasis is mainly caused by the agents which are
muscarinic (M3) antagonists (indirect) and adrenoreceptor
(α1/α2) agonists (direct).
• Mydriatics agent may be either sympathomimetic or
parasympatholytics.

Commonly used mydriatic agents are:

i. Anticholinergic drugs: atropine sulfate, scopolamine
hydrobromide
ii. Sympathomimetics drugs: epinephrine hydrochloride
iii. Adrenergic drugs: phenylephrine hydrochloride
 Miosis
• Mitotic helps to decrease intraocular pressure and increase
outflow of aqueous humor by exerting a parasympathetic
response that results in the constriction of the pupil.
• miosis is caused by the agents which are muscarinic (M3)
agonists (direct) and adrenoreceptor (α1/α2) antagonists
(indirect).
• Miotic agent are mainly parasympathomimetics.

Use: in the treatment of glaucoma

Commonly used drugs:

• Direct acting cholinergic : pilocarpine
• Prostaglandin analogs: latanoprost
 Glaucoma Treatment
• Glaucoma is a condition that causes intraocular pressure (IOP) to
increase and can lead to permanent blindness.
• Most treatments for glaucoma are designed to lower and/ or control
intraocular pressure which can damage the optic nerve that transmits
visual information to the brain.
• Glaucoma eye drops often are the first choice over glaucoma surgery
and can be very effective at controlling IOP to prevent eye damage.
 Medical Management of Glaucoma
1. Beta-adrenergic Antagonists (Beta Blockers): Timolol, Betaxolol
2. Parasympathomimetics (miotic agent): pilocarpine, carbachol
3. Carbonic Anhydrase Inhibitors (CAI): Dorzolamide,
Acetazolamide
4. Adrenergic Agonists: Brimonide
5. Prostaglandin Analogues: Latanoprost, Bimatoprost
6. Mitotics: Pilocarpine
7. Combined Medications (Timolol + Brimonidine)
8. Hyperosmotic Agents
a) Oral: glycerin and isosorbid;
b) iv: mannitol and urea
 Prostaglandins analogs
• These eyedrops increase the outflow of the fluid in eye
(aqueous humor) and reduce pressure in eye.
• Examples include latanoprost and bimatoprost .
• Possible side effects include mild reddening and stinging
of the eyes and darkening of the iris, changes in the
pigment of the eyelid skin and blurred vision.
 Beta blockers
• These reduce the production of fluid in eye and pressure in eye
(intraocular pressure).
• Examples include timolol and betaxolol (Betoptic).
• Possible side effects include difficulty breathing, slowed heart
rate, lower blood pressure, impotence and fatigue.
• If you have lung or heart problems, medications other than beta
blockers may be recommended because beta blockers may
worsen breathing problems.
 Alpha-adrenergic agonists
• These medications reduce the production of aqueous
humor and increase outflow of the fluid in your eye.
• Examples: brimonidine.
• Possible side effects include irregular heart rate, high
blood pressure, fatigue, red, itchy or swollen eyes, and
dry mouth.
Miotic
• These also increase the outflow of fluid in eye.
• Examples include pilocarpine and carbachol.
• Possible side effects include smaller pupils, blurred or dim vision,
or near sightedness.

• Carbonic anhydrase inhibitors reduce eye pressure by decreasing

the production of intraocular fluid.

• Combined medications can offer an alternative for patients who

need more than one type of medication.

• Hyperosmotic agents. These drugs are usually for people with a

severely high IOP that must be reduced immediately before
permanent, irreversible damage occurs to the optic nerve.
Hyperosmotic agents reduce IOP by lowering fluid volume in the
eye.
 drugs for ear
• the common ear problems are inflammation of the ear,
infection, impacted cerumen and ear pain.

Types of ear medication

 Anti-inflammatory medication
 Anti-infective medication
 Cerumienolytic medications
 Anesthetic medication
 Anti-inflammatory medication
• These are the medication used to reduce inflammation
of the ear by reducing edema and deposition of fibrin in
the external ear.
• Clinical use: to decrease external ear inflammation.
• Commonly used drugs : hydrocortisone acetate,
dexamethasone sodium phosphate
 Anti-infective medication
• These are the drugs to clear gram-negative and gram-
positive infection, and fungal infections of the ear.
• Use: to treat infections of the external auditory canal and
middle ear infection.
• Drugs used:
 chloramphenicol and Neosporin otic drops for bacterial
infection,
 micanazole, clotrimazole and fluconazole otic drops for
fungal infection.
 Cerumienolytic medications

• Cerumen is the soft brownish-yellow wax secreted by

glands in the auditory canal of the external ear.
• Nontechnical name earwax
• These drugs prevent cerumen accumulation and emulsify
hardened, impacted cerumen.
• Use: to prevent cerumen accumulation and remove
impacted cerumen in the external auditory canal.
• Drugs used: triethanolamine polypeptide oleate and
carbamide peroxide
 Anesthetic medication
• These medications block nerve conduction.
• Use: to temporarily relieve ear pain.
• Common drug: benzocaine eardrops.
 Eye medication
• Most Eye Medications are in the form of an eye drop or
an ointment.
• Eye drops are more common, but ointments may last
longer, provide more lubrication, or be easier to
administer in some cases.

TYPES OF EYE MEDICATIONS

• Antibiotics
• anti-inflammatory
• glaucoma medications
• Antivirals
• anti-allergy medications
 ANTIBIOTICS
• Antibiotics are generally used to treat, or sometimes to
prevent a bacterial eye infection.
• Examples of common antibiotics used in the eye are
erythromycin, gentamicin, tobramycin, ciprofloxacin and
ofloxacin.

ANTIVIRALS
• Used primarily in treating herpes virus infections of the
eye, antiviral eye medications may be used in conjunction
with oral medications for elimination of the virus. The
most common type of antiviral is triflurthymidine. Other
include adenine arabinoside and idoxuridine.
 ANTI-INFLAMMATORY
• reduce inflammation, which in the eye is usually manifest by
pain, redness, light sensitivity and sometimes blurred vision.
• can be either corticosteroids or non-steroidal.
• Corticosteroids (steroids) are very effective anti-
inflammatories for a wide variety of eye problems.
Corticosteroids can be safely used in the eye, and do not carry
most of the risks associated with oral steroids like
prednisone. However, patients should always be monitored
by an eye doctor while using them, because they may cause
glaucoma or increase the risk of eye infections in certain
cases. Eg: Prednisolone, Fluorometholone, Dexamethasone
• NSAIDs are useful in reducing inflammation and decreasing
eye pain, though they are usually not as potent as
corticosteroids. Eg: Diclofenac, Ketorolac, Flurbiprofen
 ANTI-ALLERGY MEDICATIONS
• All prescription anti-allergy eyedrops decrease the effects
of histamine, which creates, itching, swelling, redness,
and watering in the eye.
• They may work either by preventing the release of
histamine in the body, or by blocking its effect after it is
released.
• Common anti-allergy medicines include livostin, patanol,
cromolyn, alomide.
• There are also non-prescription antihistamines for the
eye, which are less potent but can be very helpful in
milder case, such as pheniramine.
 Glaucoma Medications
• Glaucoma medications all attempt to reduce the eye's
intraocular pressure, the fluid pressure inside the eye, to
prevent damage to the optic nerve resulting in loss of
vision.
• These medications may lower pressure by decreasing the
amount of fluid produced in the eye, by increasing the
amount of fluid exiting through the eye's natural drain, or
by providing additional pathways for fluid to leave the
eye. Often more than one glaucoma medication will be
used simultaneously, as these effects can combine to
lower pressure even further than possible with one
medicine alone.
Common Glaucoma Medications
• BETABLOCKERS • PROSTAGLANDIN ANALOGUES
Timolol Latanoprost
Metipranolol • CHOLINERGIC AGONISTS
Carteolol Pilocarpine
Betaxolol Carbachol
Levobunolol • ADENERGIC AGONISTS
• ALPHA AGONISTS Epinephrine
Brimonidine Dipivefrin
Iopidine
• CARBONIC ANHYDRASE INHIBITORS
Dorzolamide