Documente Academic
Documente Profesional
Documente Cultură
By:
Dr. Ahmed Selim
Antibiotics Anti-allergic & anti-
Steroids inflammatory
Combined AB & steroids Anti-glaucomatous
Anti-parasitic Contact lens solutions
Anti-viral Drugs for vascular
Anti-fungal insufficiency
Artificial tears Drugs for hemorrhage &
Mydriatics active bleeding
Anesthetics Vitamins
Hyper tonic saline 5 %
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
1-Antibiotics
A-Broad spectrum
Fluoroquinolones
Chloramphenicol
Tetracycline
Sulphonamide-
Cephalosporine
B- Gram +ve
Vancomycin
Fucidic acid
C- Gram –ve
Aminoglycosides
Polymixin B
Routes
Topical
Fortified
Sub-Conjunctival
Intra-Vitreal
Systemic
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
TOPICAL
1-Fluoroquinolones : broad spectrum but relatively weak against
streptococci
-1st generation
- 2nd generation:
a- Ciprofloxacin (Ciprocin ED & EO – Ciloxan ED )
b- Oflxacin (oflox-ofloxin-optiflox) ED
c- Lomeflxacin (orchacin) ED
-3rd generation
a- levofloxacin (levoxin) ED
-4th generation
a- Gatifloxacin (zymar-tymer-gatistar-occubact-pharmagatin-gatipram-
gatilox) ED
b- Moxifloxacin (vigamox-fortymox-fluoroquinomox) ED
Generation G +ve G -ve
st
1 + ++++
nd
2 ++ ++++
rd
3 +++ ++++
th
4 ++++ ++++
N.B : gatifloxacin and moxifloxacin are the newest 4th generation ,but
moxifloxacin is superior to gatifloxacin in ocular penetration .
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
-ex: oxypol EO – terramycin EO
4-sulphonamide : broad spectrum
-ex : ocusul ED – isoptocetamide ED
-contraindicated in G6PD defecincy
Sub-conJunctival
Commercially Volume Volume for Dose
available added injection
Vancomycin 500 mg vial 50 ml 0.25ml 25mg
ceftazidime 500 mg vial 2.5 ml 0.5ml 100mg
cefuroxime 500 mg vial 2 ml 0.5ml 125mg
Amikacin 500 mg vial 2 ml 0.4ml 100mg
Gentamycin 80mg/2ml 0.5ml 20mg
ampoule
Dexamethasone 8mg/2ml 0.5ml 2mg
ampoule
Atropine 1mg/1ml 0.5ml 0.5mg
ampoule
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
Intra-vitreal
1-vancomycin: 1mg/0.1ml
Vancomycin 500mg vial
- Dil in 10 ml
- take 1ml
- Dil in 5ml "add 4 ml"
3- Amikacin : 0.4mg/0.1ml
Amikacin 500 mg vial
-Dil in 10 ml
-take 0.8 ml
-Dil in 10 ml "add 9.2 ml"
4- Triamcinolone : 4mg/0.1 ml
Kenacort A 40 mg/ml
-Without dil
5-Amphotericin B : 0.005mg/0.1ml
Fungizone 50mg vial
-Dil in 10 ml
-take 0.1 ml
-Dil in 10 ml "add 9.9 ml"
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
Systemic A.B
--lipid soluble has better ocular penetration than water soluble
--Most common systemic A.B used in ocular diseases are:
1- Tetracycline:
Ex: tetracycline 250mg tab twice daily
Doxycycline 100mg tab twice daily
- Used for its antibiotic effect in ttt of recurrent blepharitis & lid infections
- Used for its anticollagenase effect in ttt of chemical injury ,recurrent corneal
erosins &corneal thinning or melting as with corneal abcess
2- Ciprofloxacin:
- Ciprofloxacin 750mg tab twice daily
Used when ulcer or abcess is close to limbus to prevent involvement of sclera
(pan ophthalmitis)
3-Azithromycin:
-xithrone 500mg tab "2 tabs once"
Specific for active trachoma
5-Erythromycin :
Erythrin syrup 125 mg
Used in childhood blepharokeratoconjunctivitis (BKC)
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
2-Steroids
Side effects:
1-complicated cataract
2-increase IOP
3-Delay corneal epithelial healing (melting & perforation)
A) Topical steroids
For severe 1-Hydrocortisone E.O (0.5% -1%)
inflammation 2-Prednisolone ED :
-predforte -salcodine
-optipred -echopred
-pharmapred
-orchapred
B) Systemic steroids
1- Oral : prednisolone (Hostacortine-solupred)
1-2 mg/kg/day
2- IV injection methyl prednisolone
Ex : solumedrol vial
1gm/day for 2-3 days
-Betamethasone: Deprofos amp once
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
3-Combined
Dexatrol Polymixin B + G-ve
Maxitrol Neomycin +
Dexa
Optidex T Tobramycin + G-ve
Tobradex Dexa
Co-Avazir
Dexatobrin
Blephamide Sulfa + Broad spectrum
Isoptocetapred Dexa
Terracortil Tetracyclin + Broad spectrum
Hydrocortisone
Orchadexoline Chloramphenicol + Broad spectrum
Dexa +
Tetrahydrozoline
Dexaflox Ofloxacin + Broad spectrum
Dexa
4-Anti Parasitic
For Acanthamoeba
-propamedine isetionate : Brolene ED
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
5-Anti Viral
A)Topical
1-Acycloguanine: (Zovirax –Acyclovir E.O)
- 5 times daily
-relatively nontoxic, can be used for 60 days
-superior to other antiviral in ocular penetration
-95% of dendritic ulcer relief within 2 w
2-Trifluorothymidine (Bephen E.D)
-every 2 h
-more toxic to conjunctiva and corneal epithelium than
acycloguanosine
3- Adenine Arabinoside (Vidarabine EO)
-in cases resistant to acycloguanosine & trifluorothymidine
B)Systemic
Used for
1-recurrent HSV or HZO
-Acyclovir 800 mg 1x5x7
-Zovirax 800 mg 1x5x7
2- for viral uveitis
-Foscarnet
-Valganocyclovir
-cidofovir
-Gancyclovir
C)Skin topical
For HZO shingles: Zovirax skin oint + A.B oint + steroid oint
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
6-Anti Fungal
Fungi : -yeast : candida
-Filamentous : Aspergillus - Fusarium
1-Polyenes:
-Amphotericin B : for candida & Aspergillus
-Natamycin : for Fusarium
2-Imidazoles
-Econazole : yeast & Filamentous & acanthameba
-ketoconazole(Nizoral) : yeast & Filamentous
-Fluconazole (Deflocan) : candida
-Itraconazole : Candida & asperagillus
-Voriconazole : broad spectrum superior to other antifungal in
effect and ocular penetration
3- Flucytosine
7-Hypertonic saline
-Hypertonic saline 5% "Nacl 5%"
Ex : optic saline : used in corneal edema
8-Artificial tears
1-HPMC (hydroxy propyl methyl cellulose)
-tears guard ED
-tears natural ED
-normotears ED (more viscous)
-Artelac ED
8-Polyvinyl Alcohol :
-Liquifilm ED
9-Polyvinyl Pyrrolidone :
-Vidisept N ED
11-BSS:
-Balanced salt solution
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
9-Mydriatics &cycloplegics
Used for:
fundus examination
Pre cataract extraction surgery
Accomodation paralysis
corneal ulcer to relief ciliary spasm
Uveitis to prevent synechia formation
Hyphema to maintain constant pupil
Pupillary block
N.B: Mydriatics have cycloplegic effect except phenylephrine
Ex :
-Atropine : Isopto atropine "14 d"
-Cyclopentolate : cycloplejeco – Plegica " 24 h"
-Tropicamide : mydrapid –mydriacyl "6 h"
-phenylephrine : "3 h"
cyclophrine :
Cyclopentolate
Phenylephrine
10-Anaesthetics
-Benoxinate : Benox E.D
N.B: Epitheliotoxic
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
11-Anti allergic+ Anti inflammatory
1-Anti histaminic : standard
2-Mast cell stabilizers standard
3-Decongestant : adjunctive to anti-H to relief symptoms
4-NSAIDs : adjunctive to anti-H to relief symptoms
5- Steroids :in resistant cases
6-Combination
3-Decongestant :
-Naphazoline : Visine ED
-Tetrahydrozoline : Berberil N ED – Eye clear ED
-phenylephrine : phenylephrine ED – Prefrin ED
N.B : Prolonged use leads to rebound V.D ,dryness & decrease
corneal healing
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
4-NSAIDs :
Uses :
Ocular surface inflammation
prevent intra operative miosis
prophylaxis against post operative cystoid macular
oedema " Irvine Gass syndrome"
Ex :
-Diclofenac : voltaren ED –epiphenac ED – Romalex ED-Declophen ED
-Ketorlac : Acular ED– Ketorlac ED
-Flubiprofen : Ocufen ED – sigmaprofen ED
-Nepafenac : Nevanac ED
5- Combinations :
1-Anti H + mast cell stabilizers
-Ketotifen : Orchazid ED ,Mastosytex ED &Zaditen ED
-Olopatadine : Patanol ED, olohistine ED & conjyclear ED
-Azylastine : Azylast ED
2-Anti H + decongestant :
- Naphazoline + pheneramine : Naphcon A ED
- Naphazoline +chlorpheneramine: Nostamin ED & Prisoline ED
- Naphazoline + diphenylhydramine :Occumethyl ED
3-Steroid +Mast cell stabilizers:
Ex : Fluca ED (Fluorometholone+Na chromoglycate)
4-Steroid +Decongestant:
-Isoptosterofrin ED (prednisolone+ phenylephrine)
5- Decongestant +tear substitute :
Ocutal tec ED (phenylephrine +HPMC)
6- Anti H +Decongestant+tear substitute :
Trillerg ED(tetrahydrozoline+Antazoline+HPMC)
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
Drugs containing Zinc
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
12-Anti Glaucomatous
A)B.B :
decrease IOP by 20-30 % except Betaxolol (15-20 %)
C.I in cardiac and asthmatic ptn
1-Timolol : 1x2 E.D Timolol ED
1x1 Timogel
-it is non selective B1 & B2 blocker
2-Betaxolol :1x2
-Betoptic ED –Apixol ED
-cardioselective B1 blocker
-effect in lowering IOP is less than Timolol ,but
superior in preserving visual field
-neuroprotective : increase blood supply to optic nerve
3-Metipranolol : 1x2
-Betaophthiol ED
-preservative free : used in allergic ptn
-non selective B1 & B2 blocker
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
4- Levoburolol : 1x1
-Betagan
B)P.Gs
1- Latanoprost : decrease IOP by 25-32 % " 1x1"
Ex : xalatan –Ioprost
2-Travoprost : decrease IOP by 25-32 % "1x1"
Ex : Travatan
3-Bimatoprost : decrease IOP by 27-32% "1x1"
Ex : Lumigan (strongest mono agent)
4-Unoprostone : decrease IOP by 13-18 % "1x2"
Ex :Rescula
C) Sympathomimetics :
1- Adrinaline –Dipivifrin "propine": decrease IOP by 15-20%
2-Brimonidine : decrease IOP by 20-30% "1x2"
Ex : Alphagan – pharmapress –Brimonidine
-Neuroprotective
3-Apraclonidine : decrease IOP by 20-30%
-lower IOP after Laser procedures
F)Combinations:
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
13-contact lens solutions
1-Renu (B & lomb)
2-complete (Allergan)
3-Opti free (Alcon)
4-Perfect care (Orchidia)
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih
15-Drugs for Hge & active bleeding
1-Dicynone : Ethamsylate (tab & amp)
2-Cyklokapron : Tranexamic acid (tab & amp)
****Multi vitamins
1-I care: contain Lutein for ARMD
2-Ocuguard & Eye vit : for all cases of retinopathies &
ARMD
3- octatron :multivitamins + antioxidant " selenium"
By: Dr. Ahmed Selim Mansoura Ophthalmic Hospital Written By: Dr. Maroa Nabih