DRUGS IN OPTHALMOLOGY

ANTIVIRAL AGENTS
• ldoxuridine (IDU, 5- iodo -2 deoxyuridinc)
• pyrimidine.
•
Mechanism of nctio11:t inhibits viral metabolism by
substituting for thymidine in DN A synthesis and thus
prevents replication of virus.
•
Topicall y, it is used as 0. 1% eye drop s.
Preparations. It is availab le as 0. 1% eye drop s and
0.5% eye ointment.
•
Indications :acute epithelial
herpetic keratitis.
•
adverse effects : follicular conjunctivitis, Iacrimal
pun ctal stenosis and irrita ti o n with photophobia .
•
Contraindications: inhibit corneal
stromal healing, hence its use is not advisable durin g
first few weeks after keratoplasry.
 Adenine arabinoside
• Purine nucleoside.
• It ha s antiviral activity against herpes
simplex, cytomegalo, vaccinia and zoster viruses.

• Mechanism ofaction: It is metabolized to LriphosphaLe

form wh ich inhibits DNA polymerase and thus the
growth of viral DNA is arrested .

• Preparations : It is available as 3% ophthalmic

ointment.

• Dose: It is used 5 times a day till epithelialization

occurs and then reduced to once or twice daily for
4-5 days to prevent recurrences.

• Side-effects are superficial punctate keratitis and

irritation on prolonged application
 Acyclovir (Acycloguanosine).
• Effective in most forms of herpes simplex and herpes zoster
infection s.
•
Mechanism of action: It inhibits viral D N A

Preparation. It is available as 3% ophthalmic ointment

and also as tablet and inject ion
•
contraindication and doses: stromal herpes
simplex keratitis. After penetrating
keratoplasty in patients suffering from herpes simplex
keratiTis. ( ii ) Recalcitrant stromal or uveal disease
caused by HSV. (iii) To reduce ocular complications
of keratitis and uveitis in herpes zoster ophthalmicus.
•
Side -effects: light punctate
epithelial keratopathy which ceases once the drug
is stopped
 ANTIFUNGAL AGENTS
• 1. Nystatin. It is fungistatic and is well tolerated in
the eye as 3.5% ointment. It has a medium level
of activity in ocular infections cause d by Candida
or Aspergillus isolates. Because or it s narrow
spectrum and poor intraocular penetration its use
is restricted
• 2 . Amphotericin B (Fungizone).:act as fungistatic or
fungicidal.Topically, it is effective in superficial
infections of the eye in the concentration of
0.075 to 0. 3% drops.Effective aginst
Candida, Histoplasma , Cryptococcus
and so me strains of Aspergillus
3. Natamycin : broad-spectrum
antifungal drug having activity against Candida,
Aspergilus , Fusarium and Cephalosporium.
drug of choice for Fusarium solani keratitis. It adheres well
to the surface of The ulcer, making the contact time
of the anti fungal agent with the eye greater. :not
recommended for injection.

4. Ketoconazle. !t is effective after oral administration

and possesses activity against common fungi.
given as single oral dose of200-400 mg daily up to at
least one week.
It is an adjunctive systemic anti fungal agent in fungal
keratitis complicated by endophthalmitis
• Silver compounds
Combination of silver with sulphonamides and
with other anti-microbial compounds significantly
increases the activity against bacterial and fungal
infections. frequently used is silver
sulphadiazine which is reported to be highly effective
against Aspergillus and Fusarium species

• Flucytosine: very effective against Candida

species and yeasts. It is used as 1.5% aqueous drops
hourly. It can also be given orally or intravenously in
doses of 200 mg/kg/ d
 MYDRIATRICS AND CYCLOPLEGICS

PHENYLEPHRINE
• Direct acting drug

Indication
• COAG
• Subacute or chronic ACG after iredectomy

Contraindication
• Narrow angle glaucoma. — Hypertensives.
• Type 1 diabetes mellitus.
• Aneurysms.
• Cardiac diseases
• Infants

Adverse effects
• — Mild stinging
• — HTN, headache
• ATROPINE
• Atropine sulfate is anticholinergic — 0.5%, 1%,3%
• Strongest drug in cycloplegics
• Inhibitor of muscarinic action of acetylcholine

Indication
• Mydriasis & cycloplegia
• pupil dilation in inflammatory condition Of iris
• —Amblyopia therapy

Contraindication
• glaucoma — Hypersensitive

Adverse effects
• Allergic responses
• Blurred vision
• Photophobia
• Dryness of skin & mouth
• Skin rash
• HOMATROPINE
• First anticholinergic
• Directly blocks muscarinic action of acetylcholine
• Its effect last for longer time

Indication
• Cycloplegic refraction
• Treatment of inflammatory uveal tractcondition

• Contraindication
• Tendency with occludable angles
• Patient who have allergic to atropine

• Adverse reaction
• Follicular conjunctivitis
• Vascular congestion
• Edema exudate
• TROPICAMIDE
• Most common anticholinergic medriatric drug Stronger — 1%, paralysis accomodation
• 0.5% produce mydriasis with slight cycloplegia

Indication
• Diagnostic process
• Pre and post operative stages
• Infants — combination with phenylephrine

Contraindication
• Narrow angle glaucoma
• Hypersensitive

• Adverse effect
• Stinging sensation
• Confusion or hyperactivity
• CYCLOPENTOLATE
• Anticholinergic

Indication
• Cycloplegics of children under the age 12 to 20 yrs

Contraindication
• Narrow angle glaucoma
• Hypersensitive
• Children with emosional problems

Adverse effects
• Increased blurring of vision, photophobia
• Psychotic reaction
• Dryness of mouth, headache or allergic reactions
  
ANTI-INFLAMMATORY AGENTS

• PREDNISOLONE
• Synthetic corticosteroid
• Inhibits edema, fibrin deposition, capillary dilatation & deposition of collagen and
scar formation Contraindication

• Acute untreated purulent ocular infection

• — Dendritic keratitis
• — Viral disease Of cornea & conjunctiva
• — Fungal diseases of eye

Adverse effects
• Increased lop with optic nerve damage
• Visual field defect
• PSC formation
 LUBRICATING AGENT AND
ARTIFICIAL TEAR

Indications
• Dry eye and ocular irritations
Eg: MethylcelluJose
Hydroxypropyl methylcellulose
Polyvinyl alcohol
INTROCULAR AND IRRIGATING SOLUTIONS
• Contain concentration of inorganic & organic constituents
• Mainly used in surgery procedure

Indications:
• Cataract surgery
• Vitrectomy & posterior segment surgeries
• Anterior segment reconstruction
ANTIBACTERIAL AGENTS
Sulphonamides
• Used in Chlamydial infection like

trachoma, toxoplasmosis

Cephalosporins
Aminoglycosides
Tetracyclines
Chloramphenicol