THERAPEUTIC MEDICATIONS
Medications used to treat certain eye conditions have very specific actions for each individual
disorder. Such therapeutic medications are generally prescribed by the doctor for patients to
administer themselves. Occasionally, ophthalmic medical assistants may be asked by the
physician to either administer such medications to patients or teach patients how to administer
the medication to themselves. This class of medications includes miotics and other glaucoma
treatments, antimicrobials, antiallergic and anti-inflammatory agents, decongestants, and
lubricants.
Medications used to treat certain eye conditions have very specific actions for each individual
disorder. Such therapeutic medications are generally prescribed by the doctor for patients to
administer themselves. Occasionally, ophthalmic medical assistants may be asked by the
physician to either administer such medications to patients or teach patients how to administer
the medication to themselves. This class of medications includes miotics and other glaucoma
treatments, antimicrobials, antiallergic and anti-inflammatory agents, decongestants, and
lubricants.
1.MIOTICS:
Miotics cause the iris sphincter muscle to contract, producing miosis (pupillary constriction),
which leads to a reduction in the light entering the eye. One effect of a small pupil is to increase the
patient's depth of field, which may improve vision in a patient with an uncorrected or poorly corrected
refractive error. Miotic agents also cause contraction of the ciliary body muscle, which results in
increased accommodation and opening of the trabecular drainage system.
Miotics serve chiefly as topical treatment of glaucoma by lowering intraocular pressure and improving
the drainage of the aqueous humour through the trabecular meshwork. In addition, certain miotic drugs
may occasionally be used to treat accommodative strabismus. Often they are used inside the eye during
cataract surgery to contract the pupil.
Miotics are available for topical application in the form of solutions, gels, and inserts. The major
side effects of this class of pharmaceuticals include browache, myopia, tearing, cataract, and retinal
detachment. With the most potent agents, sweating, salivation, abdominal cramps, and diarrhea can
occur. The principal miotic agents used in ophthalmology today are
Miotics cause the iris sphincter muscle to contract, producing miosis (pupillary constriction),
which leads to a reduction in the light entering the eye. One effect of a small pupil is to increase the
patient's depth of field, which may improve vision in a patient with an uncorrected or poorly corrected
refractive error. Miotic agents also cause contraction of the ciliary body muscle, which results in
increased accommodation and opening of the trabecular drainage system.
Miotics serve chiefly as topical treatment of glaucoma by lowering intraocular pressure and improving
the drainage of the aqueous humour through the trabecular meshwork. In addition, certain miotic drugs
may occasionally be used to treat accommodative strabismus. Often they are used inside the eye during
cataract surgery to contract the pupil.
Miotics are available for topical application in the form of solutions, gels, and inserts. The major
side effects of this class of pharmaceuticals include browache, myopia, tearing, cataract, and retinal
detachment. With the most potent agents, sweating, salivation, abdominal cramps, and diarrhea can
occur. The principal miotic agents used in ophthalmology today are
1. pilocarpine
2. carbachol
3. physostigmine
4. echothiophate
These drugs are available in a variety of concentrations and under many brand names.
Other Glaucoma Medications:
In addition to miotics, a great many medications exist to treat glaucoma, all of which aim to
reduce intraocular pressure, although by diverse mechanisms of action. Some glaucoma agents open
the outflow path ways of the aqueous humour, others decrease the production of the aqueous humour,
and still others work through a combination of both effects. Side effects of glaucoma medications vary
with the type and action of the specific drug. These effects can range from an allergic reactions to
blurred vision, increased or decreased blood pressure, and emotional or psychological effects.
The major glaucoma medications can be subdivided into categories based on the part of the
nervous system or other body system they affect:
In addition to miotics, a great many medications exist to treat glaucoma, all of which aim to
reduce intraocular pressure, although by diverse mechanisms of action. Some glaucoma agents open
the outflow path ways of the aqueous humour, others decrease the production of the aqueous humour,
and still others work through a combination of both effects. Side effects of glaucoma medications vary
with the type and action of the specific drug. These effects can range from an allergic reactions to
blurred vision, increased or decreased blood pressure, and emotional or psychological effects.
The major glaucoma medications can be subdivided into categories based on the part of the
nervous system or other body system they affect:
1. Adrenergic blocking agents
a. timolol (Timoptic)
b. betaxolol (Betoptic)
c. bunalol (Betagen)
2. Adrenergic stimulating agents
a. epinephrine (Eppy, Epinal, Epiphrin, Epitrate, Propine)
3. Carbonic anhydrase inhibitors (usually administered orally)
a. acetazolamide (Diamox)
b. methoxolamide (Neptazane)
4. Hyperosmotics: oral formulations
a. glycerine (Glycol)
b. ethyl alcohol
c. isosorbide (Isomotic)
5. Hyperosmotics: injectable formulations
a. mannitol
2. ANTIMICROBIALS:
Antimicrobials comprises a large variety of agents, including antibiotics to treat bacterial
infections, antivirals for viral infections, and antifungals for fungal infections. The ophthalmologist has
a great many choices among each type of antimicrobial medication for treatment of a specific eye
condition. The side effects of many antimicrobial products are numerous and complex and often
influence the doctor's selection of a specific drug. Adverse reactions to antimicrobials include
hypersensitivity to the particular drug, digestive system upset, and toxicity to other body systems.
First and foremost, however, the doctor chooses an antimicrobial drug based on its ability to
counter the specific microbial organism. The ophthalmic medical assistant should become familiar with
this broad category of drugs over time by asking questions and reading the package insert that
accompanies every drug.
Antimicrobials comprises a large variety of agents, including antibiotics to treat bacterial
infections, antivirals for viral infections, and antifungals for fungal infections. The ophthalmologist has
a great many choices among each type of antimicrobial medication for treatment of a specific eye
condition. The side effects of many antimicrobial products are numerous and complex and often
influence the doctor's selection of a specific drug. Adverse reactions to antimicrobials include
hypersensitivity to the particular drug, digestive system upset, and toxicity to other body systems.
First and foremost, however, the doctor chooses an antimicrobial drug based on its ability to
counter the specific microbial organism. The ophthalmic medical assistant should become familiar with
this broad category of drugs over time by asking questions and reading the package insert that
accompanies every drug.
3. ANTIBIOTICS:
Antibiotics kill or inhibit the growth of bacteria. For ophthalmic use, these drugs exist as topical drops or
ointments to treat superficial infections such as blepharitis, bacterial conjunctivitis, and corneal ulcers.
Antibiotic solutions can be injected around the eye for severe infections caused by bacterial corneal
ulcers or by endophthalmitis. When taken orally or injected systematically, antibiotics serve to treat more
serious ophthalmic conditions such as severe endophthalmitis, orbital infections (including orbital
cellulitis), and, occasionally, acute dacryocystitis.
Antibiotics in common use in ophthalmology exist in a myriad of formulations and under
scores of brand names. An individual antibiotic can be used alone or with one or more other
antibiotics. The following are the most common antibiotics an ophthalmic medical assistant
would encounter in daily practice:
Antibiotics kill or inhibit the growth of bacteria. For ophthalmic use, these drugs exist as topical drops or
ointments to treat superficial infections such as blepharitis, bacterial conjunctivitis, and corneal ulcers.
Antibiotic solutions can be injected around the eye for severe infections caused by bacterial corneal
ulcers or by endophthalmitis. When taken orally or injected systematically, antibiotics serve to treat more
serious ophthalmic conditions such as severe endophthalmitis, orbital infections (including orbital
cellulitis), and, occasionally, acute dacryocystitis.
Antibiotics in common use in ophthalmology exist in a myriad of formulations and under
scores of brand names. An individual antibiotic can be used alone or with one or more other
antibiotics. The following are the most common antibiotics an ophthalmic medical assistant
would encounter in daily practice:
1. bacitracin
2. neomycin
3. tobramycin
4. gentamycin
5. sulfonamides
6. chloramphenicol
4. ANTIVIRALS:
These agents inhibit the ability of the virus to reproduce itself. Antiviral drugs are used to
treat the more serious virus-caused ophthalmic conditions such as the herpes simplex
and herpes zoster infections. Some of the antiviral drugs in use in ophthalmology include:
1. idoxuridine (Herplex)
2. vidarabine (Vira-A)
3. trifluorothymidine (Viroptic)
4. acyclovir (Zovirax)
5. ANTIFUNGALS:
These drugs kill fungi and are therefore used to treat a variety of external ocular fungal infections,
such as fungal blepharitis, keratitis, and conjunctivitis, and some internal fungal conditions as well.
Antifungals commonly used in ophthalmologic practice include:
These drugs kill fungi and are therefore used to treat a variety of external ocular fungal infections,
such as fungal blepharitis, keratitis, and conjunctivitis, and some internal fungal conditions as well.
Antifungals commonly used in ophthalmologic practice include:
1. nystatin
2. amphotericin (extremely toxic)
3. pimaricin
6. ANTIALLERGIC AND ANTI-INFLAMMATORY AGENTS:
Corticosteroids are the chief drugs used to treat allergic reactions and inflammations.
Corticosteroids, also simply steroids, are hormones derived from the body's adrenal gland or
made synthetically. Most corticosteroids are modifications of the hormone cortisone. In the
treatment of the eye disorders, these hormonal agents act by reducing inflammation and can
dramatically decrease swelling, redness, and scarring. Most corticosteroids are applied topically
in drop or ointment form to treat conditions involving the eyelid or the anterior segment of the eye.
Systemic steroid drugs taken orally are used as therapy for disorders of the posterior segment as
well as for acute or severe allergic reactions around the eye or anywhere in the body.
Corticosteroids must be used and administered carefully because of their potentially harmful
side effects. The ophthalmic medical assistant should check the patient's medical record for
diseases such as hypertension, peptic ulcers, diabetes, and tuberculosis, all of which could worsen
through the use of systemic corticosteroids. Side effects of steroid use from topical application can
occur, although most of these happen only after weeks to months of treatment. These side effects
include glaucoma, bacterial or viral infection, overgrowth of fungi, slower healing, and cataract.
Steroids are sometimes injected around the eye to treat severe inflammation. Side effects are
similar to those from topical use. If taken orally for a long period of time, corticosteroids can retard wound
healing, cause swelling of the face and eyelids, promote cataract and glaucoma, and lower a patient's
resistance to infection.
Corticosteroids are the chief drugs used to treat allergic reactions and inflammations.
Corticosteroids, also simply steroids, are hormones derived from the body's adrenal gland or
made synthetically. Most corticosteroids are modifications of the hormone cortisone. In the
treatment of the eye disorders, these hormonal agents act by reducing inflammation and can
dramatically decrease swelling, redness, and scarring. Most corticosteroids are applied topically
in drop or ointment form to treat conditions involving the eyelid or the anterior segment of the eye.
Systemic steroid drugs taken orally are used as therapy for disorders of the posterior segment as
well as for acute or severe allergic reactions around the eye or anywhere in the body.
Corticosteroids must be used and administered carefully because of their potentially harmful
side effects. The ophthalmic medical assistant should check the patient's medical record for
diseases such as hypertension, peptic ulcers, diabetes, and tuberculosis, all of which could worsen
through the use of systemic corticosteroids. Side effects of steroid use from topical application can
occur, although most of these happen only after weeks to months of treatment. These side effects
include glaucoma, bacterial or viral infection, overgrowth of fungi, slower healing, and cataract.
Steroids are sometimes injected around the eye to treat severe inflammation. Side effects are
similar to those from topical use. If taken orally for a long period of time, corticosteroids can retard wound
healing, cause swelling of the face and eyelids, promote cataract and glaucoma, and lower a patient's
resistance to infection.
Topical steroids commonly used in ophthalmology include:
1. hydrocortisone acetate suspension 0.5%
2. hydrocortisone acetate ointment 1.5%
3. cortisone acetate suspension 0.5% and 1.5%
4. dexamethasone phosphate 0.1% and ointment 0.5%
5. prednisolone acetate 0.12% and 1.0% and phosphate 0.5%
6. betamethasone solution 0.5%
7. fluoromethodone 0.1% and 1.0%
Commonly used systemic corticosteroids and their tablet doses include
1. hydrocortisone 20 mg
2. cortisone acetate 25 mg
3. prednisone 5 mg
4. prednisolone 5 mg
5. triamcinolone 4 mg
6. dexamethasone 0.75 mg
7. betamethasone 0.5 mg
7.DECONGESTANTS:
A decongestant acts by constricting the superficial blood vessels in the conjunctiva. Ophthalmologists
may prescribe decongestants as a cosmetic aid to reduce the eye redness caused by smoke or
smog or to soothe eyes fatigued from driving, reading, or close work. Although this effect is soothing
and cosmetic, it does nothing to alleviate the cause of the redness. Side effects related to decongestants
include allergy, angle-closure glaucoma(rarely), and rebound, which means the superficial blood vessels
become even more congested than before the drug was taken.
A decongestant acts by constricting the superficial blood vessels in the conjunctiva. Ophthalmologists
may prescribe decongestants as a cosmetic aid to reduce the eye redness caused by smoke or
smog or to soothe eyes fatigued from driving, reading, or close work. Although this effect is soothing
and cosmetic, it does nothing to alleviate the cause of the redness. Side effects related to decongestants
include allergy, angle-closure glaucoma(rarely), and rebound, which means the superficial blood vessels
become even more congested than before the drug was taken.
Most decongestants used to treat ophthalmologic conditions are available without a doctor's
prescription(also known as over-the-counter products), including such brand names as
prescription(also known as over-the-counter products), including such brand names as
1. Visine
2. Murine
3. Clear Eyes
Some brand-name prescription decongestants are
1. Vasocon
2. Naphcon
8.LUBRICANTS:
Lubricants help the patient to maintain an appropriate tear film balance or to keep the external
eye moist. When used in the ointment form, lubricants protect the eye from dryness.The
ophthalmologist prescribes these medications to treat or relieve dry eye conditions, such as
keratoconjunctivitis sicca and other tear-deficiency conditions. Side effects of lubricants are allergy to
or irritation from the preservative in these agents.
Lubricants help the patient to maintain an appropriate tear film balance or to keep the external
eye moist. When used in the ointment form, lubricants protect the eye from dryness.The
ophthalmologist prescribes these medications to treat or relieve dry eye conditions, such as
keratoconjunctivitis sicca and other tear-deficiency conditions. Side effects of lubricants are allergy to
or irritation from the preservative in these agents.
The lubricants used often to treat ophthalmic conditions include numerous artificial tear solutions,
most of them over-the-counter. Some common brand names of these products are
most of them over-the-counter. Some common brand names of these products are
1. Clerz
2. AquaTears
3. Tear Plus
4. Refresh
5. Hypotears
6. Tears Naturale
7. Celluvisc
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