1.

Miotics:

Actions-parasympathomimetic that stimulates both muscarinic and nicotinic receptors. In topical ocular
and intraocular administration its principal effects are miosis and increased aqueous humour outflow.

Indications-Primarily used in the treatment of glaucoma, but is also used during ophthalmic
surgery.used to counter the effect of mydriatrics and cycloplegics.

Common side effects-nausea, vomiting, tenesmus, abdominal spasm, salivation, lacrimation, sweating,
pulmonary edema, and bronchial spasm

Adverse Effects-muscle weakness, spasms, or convulsions changes in heartbeat, such as palpitations or

rapid heartbeat hearing loss

1. Mydriatics:

Actions-Tropicamide binds to and blocks the receptors in the muscles of the eye (muscarinic receptor
M4). Tropicamide acts by blocking the responses of the iris sphincter muscle to the iris and ciliary
muscles to cholinergic stimulation, producing dilation of the pupil and paralysis of the ciliary
muscle. Phenylephrine is an alpha-1 adrenergic agonist that mediates vasoconstriction and
mydriasis depending on the route and location of administration. Systemic exposure to phenylephrine
also leads to agonism of alpha-1 adrenergic receptors, raising systolic and diastolic pressure as well as
peripheral vascular resistance.Increased blood pressure stimulates the vagus nerve, causing reflex
bradycardia.

Indications-For mydriasis and cycloplegia for diagnostic procedures.Phenylphrine is also used to

diagnose Horner’s syndrome where there is miosis in the affected eye; on instilling 1% phenylephrine in
both of the eyes, the pupil in the affected eye -- dilates more than the normal

Side Effects-Chest Pain, DizzinessPhenylephrine injections are indicated to treat hypotension caused by
shock or anesthesia,an ophthalmic formulation is indicated to dilate pupils and induce vasoconstriction,
an intranasal formulation is used to treat congestion, and a topical formulation is used to treat
hemorrhoids. Off-label uses include situations that require local blood flow restriction such as the
treatment of priapism.

Adverse Effects- Increased intraocular pressure. Psychotic reactions, behavioral disturbances, and
cardiorespiratory collapse in pediatric patients and some adults with this class of drugs have been
reported. Transient stinging, dryness of the mouth, blurred vision, photophobia with or without corneal
staining, tachycardia, headache, parasympathetic stimulation, or allergic reaction may occur.

C.Cycloplegics:

Actions-Natural alkaloid, Acts directly on muscarinic receptors of structures innervated by

postganglionic fibers parasympathetic, Is a competitive inhibitor of the muscarinic action of
acetylcholine, Strongest cycloplegic, causes abolition of light reflex, cycloplegia lasts for 7-10 days, Ciliary
muscle recovers earlier than the pupillary sphincter, Has mild anaesthetic action on the cornea ,Atropine
in the eye is absorbed through the cornea
Indications:Used as an ointment in children < 5yrs of age dose is three times a day for 3 days,
retinoscopy is done at 4th day, PMT done at 3wks, Cycloplegia and Mydriasis, Pupillary dilatation in
inflammatory conditions like anterior uveitis, For prevention of synechia, Relief of ciliary spasm.

Side Effects:Blurred vision, Stinging of eyes, Loss of near focus & Glare,Photophobia,The blurring of near
vision, Allergic reactions locally around eyes—redness, crusting, wrinkling, conjunctival
congestion,Dryness of mouth,Tachycardia,Skin rash,Abdominal distension in
children,Hypotension,Respiratory depression

Adverse Effect: Most adverse effects are manifestations of pharmacologic effects at muscarinic-

cholinergic receptors and usually are reversible when therapy is discontinued.

1. Alpha Adregergic Antagonist

Actions-All of these agents decrease peripheral vascular resistance and lower blood pressure by causing
relaxation of both arterial and venous smooth muscle. These drugs,
unlike phenoxybenzamine and phentolamine, cause minimal changes in cardiac output, renal blood flow,
and glomerular filtration rate. Yohimbean is a selective competitive α2-blocker. It is found as a
component of the bark of the yohimbe tree and has been used as a sexual stimulant and in the
treatment of erectile dysfunction. 

Indications-Adrenergic drugs stimulate the nerves in your body’s sympathetic nervous system (SNS). This
system helps regulate your body’s reaction to stress or emergency. During times of stress, the SNS
releases chemical messengers from the adrenal gland. These chemical messengers act on your body to
increase heart rate, sweating, and breathing rate and to decrease digestion. This is sometimes called the
“fight or flight” response. are drugs that stop noradrenaline from being able to affect the walls of our
blood vessels and internal organs
Side Effects- weakness, weight gain, dizziness, fatigue, headache and a pounding heartbeat.
Adverse Effects- postural hypotension, nasal stuffiness, nausea, and vomiting. It may inhibit ejaculation.
It may also induce reflex tachycardia..These agents may cause “floppy iris syndrome,” a condition in
which the iris billows in response to intraoperative eye surgery.
D .Beta- Adrenergic antagonist-

Action- Activation of β adrenergic receptors leads to relaxation of smooth muscle in the lung, and
dilation and opening of the airways. β adrenergic receptors are coupled to a stimulatory G protein of
adenylyl cyclase.

Indication-Indications of administration for β agonists include:

Bradycardia ,(slow heart rate)Asthma, Chronic obstructive pulmonary disease (COPD), Heart failure ,

Allergic reaction, Hyperkalemia , Beta blocker poisoning,Premature labor this is an off-label use and
could be detrimental

Side Effects-  anxiety, hypertension, increased heart rate, and insomnia

Adverse Effects:Findings indicate that β2 stimulants, especially in parenteral administration such as

inhalation or injection, can induce adverse effects: 1. Tachycardia secondary to peripheral vasodilation
and cardiac stimulation; tachycardia can be accompanied by palpitations 2. Tremor, excessive sweating,
anxiety, insomnia, and agitation 3. More severe effects include paradoxical bronchospasm, hypokalemia,
and in rare cases a myocardial infarction.

E.Beta Adrenergic Antagonist-

Action-  β blockade leads to decreased glycogenolysis and decreased glucagon secretion. Therefore,
if propranolol is given to a diabetic patient receiving insulin , careful monitoring of blood glucose is
essential, because pronounced hypoglycemia may occur after insulin injection. β-blockers also attenuate
the normal physiologic response to hypoglycemia.

Indication-Increase cardiac chronotropic and inotropic effect

Side Effect- Burning, Stinging, Eye Irritation, Headache, Dizziness & signs of common cold

Adverse Effect- receptor agonists can cause tremor, tachycardia, palpitations, and anxiety. 

1. Carbonic Anhydrase Inhibitor

Action-Carbonic anhydrase enzyme is present in many sites of nephron but predominantly it is present
in the luminal membrane of PCT. It plays an important part in bicarbonate reabsorption from proximal
convoluted tubule. Acetazolamide inhibits this reabsorption of Na2HCO3 and cause alkaline diuresis
with the loss of sodium and bicarbonate. It inhibits bicarbonate ions in the PCT rather than Chloride
ions, which are more important. Thus, acetazolamide has little influence on sodium reabsorption so it is
considered as weak diuretic  agent.
Indication- used for Intraocular pressure,Glaucoma (Topical use of Dorzolamide),Benign intracranial
hypertension, Mountain sickness,Cyteinuria (in children)
Side Effect & Adverse Effect- Metabolic acidosis, Paresthesia, Fatigue, Dyspepsia, Renal stone formation
(prolong use), GI disturbance

1. Prostaglandin Analogue

Action: prostanoid selective FP receptor agonist  that is believed to reduce the intraocular pressure  by

increasing the outflow of aqueous humor  Studies in animals and man suggest that the main mechanism
of action is increased uveoscleral outflow. Elevated IOP represents a major risk factor  for glaucomatous
field loss. The higher the level of IOP, the greater the likelihood of optic nerve  damage and visual
field  loss.

Indication reducing the accumulation of aqueous humor , or eyeball fluid, in order to lower the pressure.

Side Effects: The following adverse reactions were reported in postmarketing experience and are
discussed in greater detail in other sections of the label:

Iris pigmentation changes, Eyelid  skin darkening, Eyelash changes (increased length, thickness,

pigmentation, and number of lashes), Intraocular . inflammation (iritis /uveitis ), Macular edema,
including cystoid macular edema.

1. Non-Steroidal Inflammatory Drugs:

Actions:Prostaglandins are a family of chemicals that are produced by the cells of the body and have
several important functions. They promote inflammation that is necessary for healing, but also results
in pain , and fever; support the blood clotting function of platelets; and protect the lining of the stomach
from the damaging effects of acid.

Indications:Aspirin is a NSAID that is used in small doses to lower the risks of having a heart attack or
a stroke ) caused by a blood clot. It may also be given as a single dose at the time of a heart attack to
improve outcomes. This is because it irreversibly inhibits the COX-1 enzyme.

3.Side Effects:Irritation or pain,heartburn , Gas, diarrhea or constipation, bleeding and ulcers,

Nausea,vomiting.

1. Opthalmic Drugs:

Action: .

Indication: This medication is used to treat eye infections. This product contains neomycin, bacitracin,
and polymyxin, antibiotics that work by stopping the growth of bacteria.steroid medicine used to treat
eye inflammation caused by allergies, shingles (herpes zoster), severe acne, iritis, uveitis, eye injury,
radiation, chemical burns, or certain other conditions.. Dexamethasone ophthalmic may also be used for
purposes not listed in this medication guide.

Side Effects: Stinging/burning of the eyes for 1 to 2 minutes or temporary blurred vision may occur when
this medication is applied. If any of these effects persist or worsen, notify your doctor or pharmacist
promptly

Adverse Effects:

3. Identify the special nursing priorities in the administration of these drugs.

4. Miotics

People/ Clients should not take Miotics if they have the ff:,

mental problems, detachment of the retina of the eye, inflammation of the iris - the colored part of the
eyeball,, closed angle glaucoma, high blood pressure, low blood pressure, asthma attack, bronchospasm,
severe liver disease, gallstones, inflammation of the gallbladder, biliary and gallbladder problem, kidney
stoneschronic obstructive pulmonary disease

Ask client to verbalize:

Tell your doctor if you have ever had:

a detached retina;

iritis ; uveitis .

Do not give pilocarpine ophthalmic to a child without medical advice. Tell your doctor if you are
pregnant or breastfeeding

1. Mydriatics

Contraindications:Narrow-angle Glaucoma
Hypertension, 10% conc. not to be given in infants, Hypersensitivity, Dose 2.5 and 10% conc. one – two
drops

1. Maximum dilatation- 30-40 minutes

2. The effect lasts for 4-6 hrs.

3. In infants 2.5 % conc. Is used along with other cycloplegics

Tell client to:

Do not take by mouth. Mydriacyl is for use only in the eyes. Do not use this medicine while wearing
contact lenses. Mydriacyl may contain a preservative that can discolor soft contact lenses. It may be best
to wait until eyes are no longer dilated before putting in contact lenses.

Wash hands before and after using the eye drops. Because a child might rub his or her eyes after the
drops are given, wash the child's hands after use

1. Cyclopegics:

Contraindications:- narrow anterior chamber,Narrow-angle glaucoma,Hypersensitivity,Use with caution

in elderly with prostate hypertrophy,Side effects of atropine.

1. Alpha Adrenergic Antagonist-

If you’re thinking about an adrenergic drug, you should also consider side effects and your own medical
history. Side effects of adrenergic drugs vary and depend on the specific drug you’re taking. Not all
people will experience all possible side effects of each adrenergic drug. Likewise, not every adrenergic
drug is right for every person. Health conditions other than what you need to treat with an adrenergic
drug can play a role in deciding which drug is right for you. You can discuss all of these factors with your
doctor to find a good choice.

Phenoxybenzamine should be used with caution in patients with cerebrovascular or cardiovascular

disease. Yohimbin is used in the treatment of these disorders is not recommended, due to lack of
demonstrated efficacy

Condtraindications:  It is contraindicated in cardiovascular disease, psychiatric conditions, and renal

dysfunction because it may worsen these conditions.

1. Beta Adrenergic Antagonist-If you think there has been an overdose, call your poison control
center or get medical care right away. Be ready to tell or show what was taken, how much, and
when it happened.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes
deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of
the following signs or symptoms that may be related to a very bad side effect:

Signs of an allergic reaction, like rash; hives ; itching; red, swollen, blistered, or peeling skin  with or
without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking;
unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side
of the face, or blurred eyesight.

Change in eyesight, eye pain, or very bad eye irritation.

Very bad dizziness or passing out.Very bad headache . Slow heartbeat. A heartbeat that does not feel
normal. Chest pain. Trouble breathing. Muscle weakness.,Heart failure has rarely happened in people
taking this medicine (timolol eye drops). Sometimes, this has been deadly. Call your doctor right away if
you have shortness of breath, a big weight gain, or swelling in the arms or legs.

1. Carbonic Anhydrase Inhibitor-Nursing Considerations, Implications: PRE & POST NURSING CARE

 Ask patient if he .is allergic to the sulphonamide agents.

 Obtain complete health history & inform the HP e.g. kidney &liver disease, metabolic problems,
pulmonary disease, adrenal gland failure.

 Investigate blood electrolytes specially sodium, calcium and potassium levels

 Ask the patient if he is diabetic and medication used and check the current blood sugar levels.

G, Prostaglandin Analogue

-XALATAN has been reported to cause changes to pigmented tissues. The most frequently reported
changes have been increased  of the i, periorbital tissue, and eyelashes. Pigmentation is expected to
increase as long as latanoprost is administered.Risk of changes in eyelashes and permanent darkening of
iris, eyelashes, or skin around the eyes associated with therapy.Potential for disparity between eyes if
only one eye is treated.Importance of learning and adhering to proper administration techniques to
avoid contamination of the solution with common bacteria that can cause ocular infections.Serious
damage to the eye and subsequent loss of vision may result from using contaminated ophthalmic
solutions.Importance of informing clinicians if an intercurrent ocular condition (e.g., trauma, infection)
develops or ocular surgery is planned. Importance of immediately reporting ocular reactions, particularly
conjunctivitis and eyelid reactions.Importance of delaying insertion of contact lenses for at least 15
minutes after travoprost instillation, since benzalkonium chloride preservative may be absorbed by soft
lenses.Importance of administering different topical ophthalmic preparations at least 5 minutes
apart.Importance of informing clinician of existing or contemplated concomitant therapy, including
prescription and OTC drugs.Importance of women informing clinicians if they are or intend to become
pregnant or plan to breast-feed.

H.Non-Steroidal AntiInflammatory Drugs: Children and teens who have viral infections shouldn’t take
aspirin or drugs containing aspirin, because there’s a risk of the potentially fatal .If you have a health
condition that affects your heart, liver, or kidneys. discuss alternatives to NSAIDs with a doctor. If you’re
pregnant, discuss the possible effects of NSAIDs on the fetus after 30 weeks. Be aware that alcohol may
exacerbate the side effects of NSAIDs, especially stomach bleeding

I .Opthalmic Drugs:

This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk
to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your
medical history, especially of: other eye problems . After you apply this drug, your vision  may become
temporarily blurred. Do not drive, use machinery, or do any activity that requires clear vision ( until you
are sure you can perform such activities safely.During pregnancy , this medication should be used only
when clearly needed. Discuss the risks and benefits with your doctor.It is not known if this drug passes
into breast  milk. Consult your doctor before breast-feeding.

2.  MYOPIA “nearsightedness” – near vision is normal but distant vision is defective. = Transient Myopia
may occur also with the administration of a variety of medications such as sulfonamides,
acetazolamides, salicylates and steroids. TREATMENT: = Use of biconcave lens or eyeglasses or use of
contact lens.

HYPEROPIA “farsightedness” – have an excellent distance vision but blurry or poor near vision. =
Demands for close work and reading usually bring on manifestations of headache and eye strain.
TREATMENT: = Use of biconvex lens.

PRESBYOPIA – loss of accommodation due to aging process. Usually occurs in people in their 30’s and
40’s.

ASTIGMATISM “distorted vision” – there is an irregular curvature of the cornea preventing a sharp image
focus by diffusing the light rays on the retina. TREATMENT: = Use of astigmatic lens or cylindrical lenses.

PHAKIA – absence of the natural lens of the eye usually resulting from the removal of cataracts.
Assessment Findings: 1. Hyperopia or Hypermetropia 2. Loss of accommodation 3 Lens Replacement
options: 1. Aphakic Glasses 2. Contact Lenses 3. IOL Implants

STYE- Warm compresses 2. Topical sulfonamides or antibiotic eye drops or systemic antibiotics 3. I&D

CHALAZION – a chronic inflammation of the meibomian gland, a granulomatous sterile cyst of unknown
etiology which presents as a local inflammation of either the upper or lower lid with external symptoms
similar to hordeolum.

TREATMENT: 1. Warm compresses for 15 mins 4x a day. 2. Topical and systemic eye antibiotics 3.
Surgical Excision.

Bacterial Conjunctivitis  treated with antibiotics which may last for few days to 7 days except for
gonococcal and staphylococcal conjunctivitis. = 1 % silver nitrate or ophthalmic erythromycin  as
prophylaxis for gonococcal conjunctivitis.

Viral Conjunctivitis – is not responsive to any treatment. Vidarabine ointment are prescribed; cold
compresses may be applied. Caused by Adinovirus  highly contagious.

Allergic Conjunctivitis – usually given corticosteroids in ophthalmic preparations. Use of vasoconstriction

(topical epinephrine solution); ice packs and cool ventilation. Toxic Conjunctivitis – caused by chemical
irritants, the eye must be irrigated immediately and profusely with saline or sterile water.

2. Avoid mydriatics – these drugs dilate pupil and the iris is brought closer to the angle of outflow
aqueous humor= FURTHER OBSTRUCTION AND INCREASED IOP.  AVOID Atropine, benadryl, cogentin
FOR GLAUCOMA

3.  avoid Increase of IOP

Carbonic anhydrase inhibitor- restricts action of enzyme necessary to produce aqueous humor Beta
blockers-nonselective- TIMOLOL; BETAXOLOL decrease production and facilitate the outflow of aqueous
humor Hyperosmotic agents- decrease IOP by promoting diuresis Acetazolamide- diamox- reduces the
formation of aqueous humor

Avoid activities that may increase IOP: maintain bed rest ( quiet, darkened room)

Exertion Stooping  Heavy lifting, Sneezing,  coughing. Wearing constrictive clothing TOOTHBRUSHING
Avoid atropine, Benadryl,  cogentin.  Administer antiemetics Compliance to medication is emphasized
Meds: pilocarpine Acetazolamide ( diamox)

3.  Avoid watching movies in a dark light like in cinemas to avoid IOP