Drugs Used to Treat Glaucoma and Other Eye Disorders

Chapter 43Chapter 43

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Chapter 43

Lesson 43.1

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ObjectivesObjectives

• Describe the anatomy and physiology of the eye

• Describe the normal flow of aqueous humor in the eye

• Identify the changes in normal flow of aqueous humor caused by open-angle and closed-angle glaucoma

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Anatomy and Physiology of the EyeAnatomy and Physiology of the Eye

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Anatomy and Physiology of the Eye Anatomy and Physiology of the Eye (cont’d)(cont’d)

• The cornea Outermost part of the eyeball Transparent, allows light to enter Lacks blood vessels Diffused air provides oxygen to the cornea Resistance to infections Contains sensory fibers that release pain if

damaged Injury to corneal tissue is replaced by scar

tissue

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Flow of Aqueous HumorFlow of Aqueous Humor

• Produced by the ciliary body, it bathes and feeds the lens

• Flows between the lens and the iris into the anterior chamber of the eye

• Drains through channels located near the cornea and the sclera, and then drains into a meshwork that leads into Schlemm’s canal and into the venous system of the eye

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Major Types of GlaucomaMajor Types of Glaucoma

• Glaucoma characterized by elevated intraocular pressure (IOP); caused by an increased production of aqueous humor or an outflow obstruction

• Primary Closed-angle glaucoma Open-angle glaucoma

• Secondary

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Effect of Light or Ophthalmic Effect of Light or Ophthalmic Agents on the Iris of the EyeAgents on the Iris of the Eye

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Chapter 43

Lesson 43.2

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ObjectivesObjectives

• Explain baseline data that should be gathered when an eye disorder exists

• Develop teaching plans for a person with an eye infection and a person receiving glaucoma medication

• Review the correct procedure for instilling eye drops or eye ointments

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General Considerations for General Considerations for Topical Ophthalmic Drug TherapyTopical Ophthalmic Drug Therapy

• Topical application• Safety and color coding• Check which eye is being medicated• Proper administration

Wash hands Tilt patient’s head back slightly Administer near inner portion of eye Have patient close eye for a minute after

administration

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Drugs Class: Osmotic AgentsDrugs Class: Osmotic Agents

• Actions Reduce volume of intraocular fluid

• Uses Reduce IOP in patients with acute narrow-

angle glaucoma

• Serious adverse effects Thirst, nausea, dehydration, electrolyte

imbalance, headache, circulatory overload

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Drug Class: Drug Class: Carbonic Anhydrase InhibitorsCarbonic Anhydrase Inhibitors

• Actions Inhibit the enzyme carbonic anhydrase,

decreasing the production of aqueous humor

• Uses In conjunction with other medications to

control IOP

• Serious adverse effects Electrolyte imbalance, dehydration,

dermatologic, hematologic, neurologic reactions, confusion, drowsiness

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Drug Class: Cholinergic AgentsDrug Class: Cholinergic Agents

• Actions Produce strong contractions of the iris and

ciliary body

• Uses Lower IOP by widening the angle to allow

outflow of aqueous humor

• Common adverse effects Reduced visual acuity, conjunctival irritation,

erythema, headache, pain, discomfort

• Serious adverse effects Systemic toxicity

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Drug Class: Drug Class: Cholinesterase InhibitorsCholinesterase Inhibitors

• Drug: echothiophate iodide (Phospholine Iodide)• Actions

Prevent metabolism of acetylcholine resulting in increased cholinergic activity which decreases IOP

• Uses Treat open-angle glaucoma

• Common adverse effects Reduced visual acuity, conjunctival irritation,

erythema, headache, lacrimation

• Serious adverse effects Systemic adverse effects

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Drug Class: Adrenergic AgentsDrug Class: Adrenergic Agents

• Actions Cause pupil dilation, increased outflow of

aqueous humor, vasoconstriction, relaxation of ciliary muscle

• Uses Lower IOP in open-angle glaucoma

• Common adverse effects Sensitivity to bright lights, conjunctival irritation,

lacrimation• Serious adverse effects

Systemic adverse effects, diaphoresis, trembling

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Drug Class: Drug Class: Beta-Adrenergic Blocking AgentsBeta-Adrenergic Blocking Agents

• Actions Exact mechanism unknown; thought to reduce

production of aqueous humor

• Uses Reduce IOP with chronic open-angle

glaucoma

• Common adverse effects Conjunctival irritation, lacrimation

• Serious adverse effects Systemic adverse effects

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Drug Class: Prostaglandin AgonistsDrug Class: Prostaglandin Agonists

• Actions Increase the outflow of aqueous humor

• Uses Reduce IOP in patients with chronic open-

angle glaucoma not responding to other agents

• Common and serious adverse effects Conjunctival irritation, lacrimation, burning and

stinging, eye pigment changes

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Drug Class: Anticholinergic AgentsDrug Class: Anticholinergic Agents

• Actions Relax smooth muscle of the ciliary body and iris

to produce mydriasis and cycloplegia

• Uses To examine the interior of the eye, measure

refraction, and rest the eye in inflammatory conditions

• Common adverse effects Sensitivity to bright light, conjunctival irritation,

lacrimation

• Serious adverse effects Systemic adverse effects

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Drug Class: Antifungal AgentsDrug Class: Antifungal Agents

• Drug: natamycin (Natacyn)• Actions

Alter the cell wall of fungus causing death of the fungus

• Uses Effective against Candida, Asperigillus, and

Fusarium infections

• Common adverse effects Sensitivity to bright light, blurred vision,

lacrimation, redness

• Serious adverse effects Eye pain, worsening of symptoms

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Drug Class: Antiviral AgentsDrug Class: Antiviral Agents

• Drugs: ganciclovir (Vitrasert), trifluridine (Viroptic)

• Actions Inhibit viral replication

• Uses Treat herpes simplex keratitis, treat recurrent

infections

• Common adverse effects Visual haze, lacrimation, redness, burning,

sensitivity to bright light

• Serious adverse effects Allergic reactions

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